Depression Treatments

The Need For Antidepressant Therapy

The aim of this brief summary is to improve your basic knowledge about a major treatment course you might pass through if you are not already into it – ANTIDEPRESSANTS.  

TREATING MAJOR DEPRESSION WITH ANTIDEPRESSANT THERAPY- BRIEFLY PAST AND PRESENT

As far back as three decades ago, antidepressants have become the treatment of choice for people with major depression. Although before the second World War, these category of medications were not in existence.

The 1950s proved to be a major discovery era as two drugs, one an antipsychotic and the other a tuberculosis medication, were accidentally found to elevate the moods of depressed individuals. Since then, many new substances of this category has been synthesized, specifically targeted towards the treatment of depression.

As improvements came in medicine, many more of these medications have been developed that specifically target the particular neural pathways of depression, with less generalized neural impact, and therefore far fewer side effects.

HOW ANTIDEPRESSANT THERAPY HELPS

Accepted theories describe a connection between the biochemical causes of mood disorders and a deficiency of any of the three brain neurotransmitters 

  • serotonin,
  • norepinephrine
  • dopamine.

Although antidepressants don’t actually create more of serotonin, norepinephrine and dopaminefor the brain, instead, they are believed to improve their availability by limiting the reabsorption of these chemicals into the brain’s nerve cells.

This increases the amounts of neurotransmitters available in the space (synapse) between the sending and receiving cells. This in turn causes a better nervous transmission from cell to cell, resulting in an elevation of mood.

CLASSES OF ANTIDEPRESSANTS

There are three main groups of antidepressants. The first and oldest group is the Tricyclics; examples include Imipramine (Tofranil) and Amitriptyline (Elavil).

Like the other antidepressants, tricyclics take two to four weeks to begin working, and six to eight weeks to achieve full effectiveness. Their side effects may include dry mouth, blurred vision, sexual dysfunction, fatigue, weight gain, constipation, and abnormalities in the cardiovascular system. Such discomforts can often deter a person from staying on the medication long enough for the beneficial effects to begin to be felt.

The second group of antidepressants is called Monoamine oxidase (MAO) inhibitors, or MAOIs for short (examples are Nardil and Parnate). Monoamine oxidase is an enzyme that breaks down neurotransmitters. Hence, by inhibiting the production of MAO, these drugs increase the amount of neurotransmitters retained in the synapses.

Keep in mind that this class of antidepressants have dietary restrictions to enhance maximal effect. You should not take these medications with foods that contain the amino acid tyrosine-such as aged cheese, beer, wine, chocolate and liver.

(You should always be on the lookout if you are to use MAO Inhibitors)

The third and most recently developed class of antidepressants is known as the SSRIs – Selective Serotonin Reuptake Inhibitors. This group, which includes Prozac, Zoloft, Celexa and Paxil, is as effective as the tricyclics in treating depression, but generally has fewer and milder side effects. Nonetheless, the SSRIs may be highly agitating for some patients (producing anxiety and insomnia), who thus may require additional sleeping medications.

Finally, there exists a class of “atypical” antidepressants that includes Serzone, Effexor and Wellbutrin.

WHICH IS BEST?

Many times, that question is asked. The answer remains – No one class of antidepressant is better than any other. Instead the question should be ‘’ Which one will work for you?”

It cannot be overstated that different medications work for different people, depending on the complex interaction between an individual’s biochemistry and the drug’s pharmacology. This is why finding the right medication is often a matter of trial and error and good medical follow-through.

How long should medication be taken?

The short answer is that this is something you will want to discuss with your doctor. The two of you will want to decide if in the future your body can rebalance its biochemistry on its own.

Some people have only one major episode and never need treatment again (just as some individuals suffer just one heart attack or one bout with cancer). Others heal from depression, go off medication and continue to feel well until a later date, when the depression returns. This usually requires going back on medication and/or engaging in other forms of treatment until the episode passes.

Finally, some folks discover that as soon as they stop medication, their symptoms return. These people usually need to take antidepressant medication on a long-term basis in order to correct underlying biochemical imbalances. As mentioned earlier, if you need to stay on medication to remain well, try not to think of this as a personal weakness.

If your body requires assistance to remain in balance, it is no different than having any other illness that requires medication (e.g., insulin for diabetes, antihypertensive drugs for high blood pressure, cholesterol-lowering drugs for heart disease).

Unfortunately, studies show that 70 percent of patients prematurely discontinue their medication-or discontinue their medication abruptly rather than gradually. Such premature or abrupt cessation is associated with a 77 percent increase in the rate of relapse or recurrence of the depressive episode. The moral of the story is do not make any changes in your medication regimen without telling your physician.

Remember These

  • Antidepressants do not get you “high”; neither are they addictive.
  • They work by reestablishing the right proportion of neurotransmitters in your brain so that nerve impulses can be effectively communicated from cell to cell.
  • In the start-up period of taking antidepressants there may be a trade-off. While waiting for the medication to take effect, you may have to endure side effects which may (or may not) be temporary, before you know if the antidepressant will work for you.
  • It may take several trials on different drugs before the right one is found. This is the problem with antidepressants. Many people get tired of the side effects and are not patient enough until they find which medication is well suited for them.

For those persons who find relief from the hell of depression, after different trials of these medications, enduring the side effects may well be worth the discovery of a medication that gets you better. Moreover, in many instances the side effects are temporary and drop out with continued usage.

It is also important to note that in a small minority of cases, some people experience a recurrence of depression while still on medication, a phenomenon known as “Prozac poop-out.” When this occurs, relief may be attained by changing medications or dosages under careful medical supervision.

 

5/5
This book will not solve your problems or cure your depression. It will however give you the guidance you may need to help yourself deal with the depression you feel and keep you from spiraling downward. It will take time, commitment and some patience with yourself. You have to be willing.
James Clasby
5/5
I am a licensed psychotherapist. This is a very good "how to" book for both the therapist and the person dealing with depression. Very much telling you what to do to get positive results I also can say it does not require a therapist to use the book and implement the approach to get positive results. Good stuff.
Henry Orlando

Get Involved In Your Treatment

To increase the likelihood that a medication will work well, patients and families must actively participate with the doctor prescribing it.

Questions you should ask include:

  • What is the name of the medication and what is it supposed to do?
  • When and how often do I take it, and when do I stop taking it, if at all?
  • What, if any, food, drinks, other medications or activities should I avoid while taking the prescribed medication?
  • What are the potential side effects, and what should I do if they occur?
  • What written information is available about the medication?
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