Depression

Drug treatments for depression

Individuals who don't receive treatment for depression often remain depressed much longer than people who do. Even more important are the personal and financial costs associated with untreated depression as it interferes with work, family, relationships, and nearly all aspects of a person's life. In addition, the risk of suicide remains high in people whose depression isn't treated.

Effective treatment of depression involves medication and/or psychotherapy. Its success depends on:

• The depressed person's optimism
• The number and types of stressors present
• The severity and frequency of depressive symptoms
• How long the person has been depressed
• The results of previous treatments
• The support of family, friends, and colleagues

It may take time to find the best possible treatment. This is because effective treatment solutions involve establishing a therapeutic and trusting relationship between the therapist and the depressed person: it takes time to build this rapport. In addition, various treatments in combination may need to be tried before an effective solution is found.

Medication

Determining the most effective prescription and taking medications as directed are both very important in the treatment of depression. An open discussion with your physician and pharmacist is key to learning about your medication and its effects on your mood. It may take time to identify the best type of medication and the most effective dosage. Similarly, it make take several weeks before the medication takes effect and you begin to see improvements in your mood. Some medications may cause side effects, but these usually improve within a few weeks.

Antidepressants

By increasing the amount of certain chemicals in the brain, antidepressants are used to reverse depressive symptoms and to stabilize mood. Antidepressants are generally considered non addictive. It may take between 2 and 5 weeks before you notice significant improvement in your mood, although in some patients, this period of adjustment may be shorter.

There are three main types of antidepressants: new age antidepressants, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOI).

New generation antidepressants

Very specific antidepressants are now available. These carry fewer and milder side effects that other types of antidepressants.

Sepecific serotonin re-uptake inhibitors (SSRI)

Now standard antidepressants, specific serotonin re-uptake inhibitors have also proven useful in the treatment of anxiety.

Common side effects of new generation antidepressants include:

nausea and vomiting headache drowsiness dry mouth

weakness and fatigue dizziness sexual dysfunction

Many of these side effects are present only at the beginning of treatment and many new antidepressant with more specific actions and fewer side effects are continually being introduced.

Generic Name	Trade Name
Fluoxetine	Prozac
Fluvoxamine	Luvox
Paroxetine	Paxil
Sertraline	Zoloft
Nefazodone	Serzone
Venlafaxine	Effexor

Tricyclic antidepressants

Developed in 1958 by Swiss scientists looking for a successful way to treat schizophrenia, imipramine, released under the brand name Tofranil, signalled a new line of defense against encroaching depression: tricyclics. As it happened, imipramine was not all that effective in the treatment of schizophrenia; it did, however, greatly improve depressed patients' mood.

In other words, prior to the development and release of tricyclics over a half century ago, psychiatrists had very few choices when it came to treating severely depressed patients. They could choose amphetamines or convulsive (electroshock) therapy.

The oldest and until recently, the most commonly prescribed antidepressants, tricyclic antidepressants are used less often today because of their side effects. For instance, older tricyclic antidepressants used for treating bipolar disorder may be more likely to trigger a manic episode than other depression drugs. This is because tricylic antidepressants work by increasing levels of serotonin and norepinephrine in the brain; however, because these medications increase the risk of mania, they are not always recommended for bipolar disorder. What's more, the FDA concluded, in 2004, that antidepressant medications increase the risk of suicidal thinking and behavior in children and adolescents affected by depression and other psychiatric disorders.

Although a less popular choice than today's new generation of antidepressants, tricyclics are still an important tool for patients who do not respond to other types of medications.

Generic Name	Trade Name
Amitriptyline	Elavil, Levate, Novopriptyn
Doxepin	Sinequan, Tridapin
Desipramine	Norpramin
Trimipramine	Surmontil
Imipramine	Tofranil, Impril, Novopramine
Nortiptyline	Aventyl
Protriptyline	Triptil
Clomipramine	Anafranil

Similar to tricyclic antidepressants, the following are also used to treat depression.

Generic Name	Trade Name
Trazadone	Desyrel
Amoxapine	Asendin
Maprotiline	Ludiomil

Common side effects of antidepressants include:

drowsiness weakness and fatigue blurred vision difficulty urinating and/or constipation

increased heart rate impaired memory dry eyes and/or dry mouth dizziness and/or lightheadedness

Monoamine oxidase inhibitors (MAOI)

Prescribed when other antidepressants have not been successful, monoamine oxidase inhibitors are not routinely used because they are known to cause adverse interactions with other drugs and certain foods. If your doctor prescribes an MAOI for you, he or she will also provide you with a list of foods, beverages, and other medications to avoid.

Generic Name	Trade Name
Phenelzine	Nardil
Tranyleypromine	Parnate

Known as a RIMA—a reversible inhibitor of monoxamine oxidase A, Moclobemide (Manerix) is a relatively new drug that is very specific in how it works. Unlike other MAOIs, Moclobemide doesn't require that patients follow a special diet.

There are also other drugs that can help boost the effectiveness of antidepressant treatments. These drugs include L-Tryptophan (Tryptan), Buspiron (Buspan),and Pindolol (Visken).

Tranquiliziers and sedatives

Tranquilizers such as Valium, Serax, Ativan, or Rivotril are used to ease anxiety. Usually prescribed for short-term, intermittent use because they may be habit forming, sedatives are used to ease depressive symptoms during the short time you are waiting for antidepressants to take effect.

Antipsychotics

By supplementing mood stabilizers and often needed in large doses for temporary use or in smaller doses for longer-term use, antipsychotic medications, because of their side effects, must be carefully monitored.

Common side effects of antipsychotics include:

drowsiness dry mouth blurred and/or double vision loss of balance muscle weakness and/or muscle spasms

Stiff arms and/or legs Tremors Restlessness and a need to keep moving Shuffling walk Weight gain

Lithium

Most commonly used to treat bipolar disorder (also called manic depression), lithium is also known to be effective in the treatment of depression. Lithium is believed to affect nerve conduction in the brain. Its effect is felt in about 10 to 14 days, and the troublesome side effects will likely occur in the first few weeks before they diminish. These side effects include:

thirst increased urination and/or diarrhea nausea trembling fingers and/or hands

fatigue lightheadedness weight gain swelling, particularly in the hands and feet

Because long-term use of lithium can affect the kidneys and thyroid gland, your doctor will want to check your renal and thyroid function regularly.

Anti-convulsants

By affecting electrical activity in the brain, anti-convulsants are commonly used in the treatment of epilepsy and other disorders that cause seizures. However, because they help stabilize mood, certain types of anti-convulsants such as Valproic Acid (Depakene, Epival) and Carbamazepine (Tegretol) are useful in the treatment of depression.

Taking medication is important

It's estimated that between 10 and 60 percent of patients stop taking prescribed medication at some point during treatment of their depression. There are many reasons for this.

Forgetting

Some people simply forget because taking medication is not part of a regular routine. Taking medication should become a regular habit. Try to make taking your medication a part of your daily routine. Keep medications in a convenient place so it's there when you need it. If you take several pills or medications every day, a dosette can help organize your medications.

Be sure to ask your doctor or pharmacist what to do if you forget to take your medication and miss a dose. Don't assume you can simply "double up" and take two pills at your next dose: the effects can be harmful.

Not accepting the illness

Other patients refuse their medication because it is a reminder of their illness—one they haven't yet accepted. These patients may want medication to be a cure rather than simply a treatment.

Uncomfortable side effects

Some patients may not take their medications because of the uncomfortable side effects they cause. People commonly experience dry mouth, fatigue, nausea, and weight gain. Not taking medication or failing to take it as prescribed is not the answer to undesirable side effects. Instead, talk to your doctor or health care professional. By changing your medication, the dosage, or by treating these side effects, they can be reduced or eliminated.

While you may attribute such things as lethargy, fatigue, and confusion to your depressive illness, these may actually be the result of serious side effects or drug interactions. Some medications are potentially dangerous when combined with other drugs, alcohol, or certain foods. Keep your use of over-the-counter medications to a minimum and be sure to talk to your doctor about the possible side effects of your medication.

Confusion

An irregular schedule, a chaotic lifestyle, living with a number of medical conditions, stress, taking multiple medications—all of these can make a person feel confused or disoriented.

Complacency

If it's been some time since the last depressive episode, it's easy to feel a false sense of confidence or security. You may feel you are better or cured—that you no longer need medication.

Failing to take medication or not taking it as prescribed can cause a relapse of depressive symptoms. For this reason, be sure to talk to your doctor or health care professional before trying any change or in the event you choose to discontinue your medication. Read labels and special instructions carefully. Some medications must be taken at certain times, some with food, and others on an empty stomach. If the instructions are unclear, be sure to ask your doctor or pharmacist for clarification.

Keeping a drug profile

As part of your treatment, your doctor or health care professional may have you keep track of your medication. A drug profile is a list of all the prescription medications and over-the-counter medications you take on a regular basis and includes:

• the name of the medication and the dosage
• the reasons you take it
• when you take it
• who prescribed it
• whether it is/was effective
• any side effects associated with it

This drug profile will help all those involved in your health care. For instance, it provides a clear record of all the drugs and combinations of drugs you have tried in the past, whether they were effective, and any side effects. This information will be particularly useful if you change physicians.