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Depression: How To Overcome It

How Can Medication Help?

Wednesday, March 21, 2012 - 15:36

Contributing Author: Guy Slowik FRCS

Not everyone with depression needs medication. Your doctor will conduct a thorough assessment to determine, based on your level of depression, whether medication is needed and which type would work best .

Different types of antidepressants are available, and they are designed to restore proper chemical balance in the brain. Most individuals benefit most from a combination of medication and psychotherapy.

Today's antidepressants are not addictive and are highly successful. In one study, up to 90% of people with major depression improved after taking the right antidepressant drug in the right amount.

One of the most important things to realize when taking antidepressant medications is that it is not like taking a painkiller for a headache. If you take a painkiller, the pain goes away shortly. Antidepressants, however, must build up gradually in the bloodstream to reach an optimal, stabilized level. It can take three to six weeks for any antidepressant to offer relief. In the early stages, sometimes antidepressants can make one feel worse before feeling better, because most of these medications have side effects.

If a person is already depressed, it can be difficult to cope with side effects such as drowsiness, dizziness, nausea, dry mouth, constipation, and sexual side effects. While none are dangerous, they can be bothersome and may be intolerable to some people.

Need To Know:

While the list of possible side effects from antidepressants can be lengthy, the important thing to remember is that they are possible side effects, and an individual will rarely (if ever) experience more than a few. Each person must weigh the inconvenience of side effects with the inconvenience of depression, which, without treatment, can hinder one's entire life.

No two individuals will respond the same way to an antidepressant, and so the person and doctor must embark on a course of trial-and-error to find the right dosage.

  • A dose that is too low may not offer relief.
  • A dose that is too high may make side effects too pronounced.

When the right dose and/or combination is found, side effects can fade and a person's mood and depressive symptoms can lift like a curtain rising on the world. This is the time when the person may benefit most from working with a good psychotherapist (while staying on the medication).

Taking an antidepressant alone, without psychotherapy, may quell depressive symptoms biologically - but may not address the psychological part of it. Learning (through psychotherapy or counseling) how one's behavior or thought patterns contribute to depression can be very important in preventing a relapse.

Need To Know:

A lack of compliance - when an individual fails to take the medication as prescribed - is the biggest reason for failure. So it is crucial, if you are treated with medication, to take the medication every day as prescribed, and to be patient.

  • After a short time, most side effects usually disappear or lessen to an acceptable level.
  • If they do not, the doctor can prescribe a different medication or a combination of medications.
  • It is common for a person to remain on an antidepressant for six to nine months or even longer, to prevent a relapse of depression.

Long-term medication, sometimes referred to as maintenance medication, may be needed for chronic depressions such as dysthymia and to prevent relapses in recurrent major depression.

While antidepressants are not addictive or habit-forming, unpleasant withdrawal symptoms can occur if they are halted abruptly. Discontinuing a medication should be done in gradually decreasing dosages and in consultation with the prescribing physician.

There are several different types of antidepressant medications:

Selective Serotonin Re-Uptake Inhibitors (SSRIs)

Selective serotonin re-uptake inhibitors (SSRIs) are usually the first types of medications prescribed for depression. They work by increasing theserotoninlevels in the brain. Serotonin is one of the chemical messengers in the brain responsible for moods and emotions.

These medications include:

  • Citalopram (Cylexa)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Some people believe SSRIs have been to depression what antibiotics once were to bacterial infections - "miracle drugs. " Most individuals respond very well to SSRIs. Because they target serotonin activity selectively, they have fewer side effects than the other more broad-acting medications, tricyclics and MAOIs.

  • One of the biggest problems with SSRIs is that they may cause sexual dysfunction - loss of interest in sex and/or difficulty achieving orgasm - in up to 20% of people.
  • Milder side effects that some people experience may include insomnia (common), nausea, diarrhea or loose stools, headache, nervousness, anxiety, mild shaking, and drowsiness (uncommon).

Tricyclics

Tricyclics, which have been used since the 1950s, had been the standard treatment for depression before SSRIs were introduced. Tricyclics include:

  • Imipramine (Tofranil, Janimine)
  • Amitriptyline (Elavil, Endep)
  • Desipramine (Norpramin)
  • Nortriptyline (Pamelor, Aventyl)
  • Protriptyline (Vivactil)
  • Trimipramine (Surmontil)
  • Doxepin (Sinequan)
  • Amoxapine (Asendin)
  • Clomipramine (Anafranil)

Tricyclics are available in generic form, which is less expensive than brand-name drugs.

Tricyclics are effective for depression, but their biggest drawbacks are their side effects. Most users experience some side effects, which may include drowsiness, constipation, dry mouth, blurred vision, weight gain, difficulty in urinating, sexual dysfunction, insomnia, disturbances in heart rhythm, anxiety, shaking, and orthostatic hypotension (a sudden drop in blood pressure when standing, which causes dizziness). People with certain heart conditions should not use tricyclics.

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) are usually tried when other antidepressants have been ineffective. Some MAOIs are available in a patch form as an alternative to pills. They include:

  • Tranylcypromine (Parnate)
  • Phenelzine (Nardil)

MAOIs have been around for decades and also are available in generic form. They elevate mood by blocking the actions of a chemical in the brain (monoamine oxidase), which normally breaks down the neurotransmitters that stimulate the brain.

Possible side effects include constipation, dry mouth, drowsiness or insomnia, nervousness, anxiety, jerking of the muscles, dizziness on standing, weight gain, sexual dysfunction, and problems urinating. Because they can cause birth defects, pregnant women should not take MAOIs. MAOIs also can interact badly with other drugs and with certain foods.

Need To Know:

If you are taking MAOIs

People taking MAOIs must avoid foods that are high in a substance called tyramine, because the interaction can cause severe high blood pressure (hypertension) and headaches.

  • Foods and liquids to avoid include aged cheeses (ricotta, yogurt, cottage cheese, cream and processed cheeses are safe); fermented or aged foods (corned beef, salami, fermented sausage, pepperoni, summer sausage, pickled herring); spoiled fruit, banana peel (fresh bananas are safe); aged liver (chicken, beef or pork); liverwurst, broad bean pods, meat or yeast extracts, sauerkraut, red wine, sherry, vermouth, cognac, beer and ale.
  • In rare instances, other foods also may cause high blood pressure when taken with MAOIs. These include chocolate, anchovies, caviar, coffee, colas, figs, mushrooms, beets, rhubarb, curry powder, junket, Worcestershire, soy sauce, licorice, and snails. These latter foods may be eaten in small amounts.

People on MAOIs must also avoid:

  • Decongestants
  • Cold, allergy and sinus medications (including pseudoephedrine and phenylpropanolamine)
  • Asthma inhalants (pure steroid inhalants are safe)
  • Amphetamines
  • Preparations containing methylphenidate, ephedrine, cyclopentamine, metaraminol, and phenylephrine.

Other medications that pose moderate risks include antihistamines, narcotics (codeine is safe), local anesthetics with epinephrine, levodopa, and dopamine.

Clearly, anyone taking MAOIs needs to read food and medication labels very carefully. Always consult with your physician before starting new medicaion or taking over-the-counter medication as well as herbal medications such as St. John's Wort.

Heterocyclics

Like SSRIs, heterocyclic drugs target specific chemical messengers in the brain that regulate mood. They include:

  • Amoxipine (Asendin)
  • Maprotiline (Ludiomil)
  • Trazodone (Desyrel)

Common side effects of Asendin include dry mouth, blurred vision, constipation, and drowsiness. Ludiomil may cause these effects, plus drowsiness, dizziness, and nervousness. Desyrel has been associated with all of the above, as well as fatigue, nausea, vomiting, insomnia, and headache.

Newer Drugs

Some of the newer drugs developed to treat depression include:

  • Bupropion-SR or XL (Wellbutrin and Zyban, used for smoking cessation)
  • Venlafaxine-XR (Effexor)
  • Nefazodone (Serzone)
  • Mirtazapine (Remeron)

These types of medications work selectively on certain neurotransmitters. Their side effects vary; for example:

  • Side effects of Wellbutrin may include insomnia, nervousness, or dizziness,
  • People with a history of seizures should not take bupropion .
  • Effexor may cause sedation or insomnia, sexual dysfunction, or loss of appetite.
  • Nefazodone may cause sedation.
  • Mirtazapine may cause sedation or weight gain.

Mood-Stabilizing Drugs

The most commonly used mood-stabilizing drug is lithium carbonate, available under the brand names Lithonate, Eskalith, Lithobid , andLithotabs . Lithium carbonate is the most commonly prescribed medication for bipolar disorder, and it may be used in conjunction with another antidepressant.

  • Too high a dose can cause lithium poisoning. Therefore blood levels must be monitored regularly by the physician.
  • Side effects that may occur on low doses include stomach upset, frequent urination, hand tremor, mild thirst, and nausea.
  • Too-high doses may cause diarrhea, drowsiness, lack of coordination, muscular weakness, and vomiting.
  • Lithium levels can be affected by dehydration, fluctuating salt levels in the body, or diuretic medications used to treat high blood pressure.

Depression: How To Overcome It