| Depression can be treated effectively | | | | blood levels to ensure that patients |
| with antidepressant medications and | | | | receive the optimum dose. Recent data |
| psychological therapies. Research | | | | have raised questions about the safety |
| suggests that antidepressant medications | | | | of these medications in patients with |
| and psychotherapy are equally effective | | | | heart disease; therefore, patients with |
| for treating mild to moderate cases of | | | | heart disease should avoid them. |
| depression. For more severe cases, | | | | Patients over 40 years old should have a |
| medications are clearly superior. | | | | cardiogram prior to starting a TCA. |
| Electroconvulsive therapy (ECT) is the | | | | MAOIs (Parnate, Nardil) |
| most effective treatment for depression | | | | This class of drug is also an older type |
| with psychotic symptoms or when | | | | of antidepressant with a number of side |
| depression is life threatening. | | | | effects. However, it is often selected |
| Antidepressant Medications | | | | to treat ?atypical depression? which is |
| There are different classes of | | | | characterized by excessive sleep, |
| antidepressant medications and each type | | | | overeating, somatic complaints (many |
| has different side effects. Fortunately, | | | | complaints about body parts hurting), |
| all classes of antidepressants are | | | | and a hypersensitivity to perceived |
| effective. The patient and doctor just | | | | slights from others. When other classes |
| have to find the one that works best for | | | | of drugs have failed, these types of |
| the individual. In fact, 60 to 70% of | | | | drugs are prescribed. |
| depressed patients who are given an | | | | Common side effects: Mild to moderate |
| antidepressant recover from their | | | | dry mouth, blurred vision, constipation, |
| depression in three to six weeks, | | | | urinary hesitancy, insomnia or |
| provided that the dose is sufficient and | | | | overstimulation, and orthostatic |
| that the patients take their medication | | | | hypotension (lightheadedness upon |
| each day as prescribed. | | | | standing that may lead to falls). |
| The goal of treatment is complete relief | | | | Usage: While one is taking MAOIs, he/she |
| of depressive symptoms, not just partial | | | | must follow a special diet. |
| relief. Patients should be open with | | | | Specifically, he/she must avoid foods |
| their doctors about how they feel after | | | | that are high in the amino acid tyramine |
| they begin taking an antidepressant. If | | | | (naturally aged meats and cheeses, |
| they feel better after three to six | | | | microbrewed or home brewed beers, some |
| weeks, but their symptoms are still | | | | red wines, and flat beans such as fava |
| present, the doctor will likely increase | | | | beans). Also, if one is taking this type |
| the dose of the antidepressant that they | | | | of drug, he/she must avoid |
| are taking. If they cannot tolerate a | | | | over-the-counter cold remedies that |
| higher dose, the doctor will likely | | | | contain the decongestant, |
| switch to another medication. If one?s | | | | pseudoephedrine. Ingesting these foods |
| symptoms are no better or worse after | | | | or this decongestant may cause a |
| three or four weeks, the doctor should | | | | potentially fatal hypertensive crisis. |
| suggest that the patient try a different | | | | Patients over 40 should have a |
| antidepressant. | | | | cardiogram before starting a MAOI. |
| SSRIs (e.g. Zoloft, Prozac, Paxil, | | | | Issues to Discuss With Your Doctor |
| Luvox) | | | | Patients should spend time talking with |
| Psychiatrists and primary care | | | | their doctors about which type of drug |
| physicians prescribe these drugs more | | | | will work best for their particular |
| than any other class of antidepressants. | | | | depressive symptoms. |
| The side effects are tolerable and the | | | | Patients should ask about the side |
| drugs are convenient to use. | | | | effects that they might experience while |
| Common side effects: Side effects of | | | | they are taking the drug. |
| this class of medication include sleep | | | | They should find out what type of |
| changes (insomnia or sedation), stomach | | | | monitoring will be necessary to ensure |
| upset, mild headache, anxiety or | | | | that they are using the drugs safely. |
| restlessness, and changes in sexual | | | | They should find out how long they are |
| performance (decreased libido and/or | | | | expected to take the drug. |
| decreased physical sensations). | | | | Psychotherapy |
| Restlessness and changes in sexual | | | | There are a number of effective |
| performance can be counteracted with | | | | psychotherapies that have been developed |
| small doses of an additional medication | | | | specifically to treat depression, |
| and the other side effects usually last | | | | including cognitive-behavioral therapy, |
| for only a few days. | | | | interpersonal psychotherapy, and |
| Usage: These drugs only need to be taken | | | | short-term or focused psychodynamic |
| once a day, which makes them convenient. | | | | psychotherapy. Clinical trials show that |
| (Usually, Luvox is taken twice a day.) | | | | these approaches are equally effective |
| They do not require any special | | | | as antidepressant medications for |
| monitoring other than a doctor's | | | | patients with mild to moderate |
| evaluation to determine whether they are | | | | depressive symptoms. Basically, these |
| effective in relieving one's depressive | | | | therapies target one or more aspects of |
| symptoms. They are also safe in | | | | a patient?s thoughts, feelings, or |
| overdose. | | | | personal interactions that bring on and |
| SNRIs (Effexor, Serzone) | | | | sustain an episode of depression. |
| This class of drugs is also | | | | Patients should avoid therapies that |
| well-tolerated and easy to use. | | | | seem open-ended or that have poorly |
| Common side effects: Overall, the side | | | | defined goals. More information about |
| effects are similar to the SSRIs, | | | | specific types of pscyhotherapies can be |
| although the SNRIs generally cause fewer | | | | found in the Psychotherapy section of |
| sexual side effects than the SSRIs. The | | | | the Mental Health Center. |
| SNRIs can also produce dry mouth, mild | | | | ECT (Electroconvulsive Therapy) |
| constipation, and urinary retention | | | | ECT involves the deliberate induction of |
| (excessive build-up of urine in the | | | | a brain seizure by passing a small |
| bladder). At higher doses, venlafaxine | | | | electrical current through the brain. |
| (a type of SNRI) may cause high blood | | | | This treatment is recommended for |
| pressure; therefore, patients should | | | | patients with severe, chronic |
| have their blood pressure checked while | | | | depression, medication resistant |
| taking this medication. The SNRIs are | | | | depression, catatonia, or serious |
| safe in overdose. | | | | medical problems. ECT has a success rate |
| Usage: These drugs are usually taken | | | | of over 80% and can produce a rapid |
| twice a day. | | | | remission of symptoms within one to |
| Bupropion (Wellbutrin) | | | | three weeks. However, ECT cannot prevent |
| Common side effects: Anxiety, | | | | a relapse. Patients who have completed a |
| restlessness, and insomnia. At high | | | | course of ECT are prescribed |
| doses it may cause seizures, so it is | | | | antidepressant medication, or they |
| not a good choice for individuals with | | | | receive ECT once a month to prevent |
| epilepsy or brain injuries. | | | | recurrence. ECT is performed on an |
| Usage: One must take Bupropion two or | | | | inpatient or outpatient basis and |
| three times a day to limit its side | | | | requires general anesthesia. Overall, |
| effects, although an extended release | | | | modern ECT is considered general safe, |
| form is available that can be used once | | | | but there is a varying degree of risk of |
| or twice a day. This drug may cause | | | | memory loss and confusion. The memory |
| seizures when taken in large amounts. | | | | loss varies from person to person. Some |
| Mirtazapine (Remeron) | | | | individuals lose only memories |
| This is a relatively new antidepressant. | | | | surrounding each ECT treatment, while |
| | | | others lose entire chunks of memories of |
| Common side effects: Sedation and weight | | | | significant past life events. This side |
| gain. | | | | effect should be thoroughly discussed |
| Usage: Because mirtazapine is sedating, | | | | with your doctor before proceeding with |
| it is taken once a day at night. This | | | | ECT treatment. |
| drug is safe in overdose. | | | | Treatment Resistant Depression |
| TCAs (e.g. Elavil, Pamelor, Norpramin) | | | | If two adequate antidepressant regimens |
| This is one the oldest classes of | | | | fail to help an individual, he/she is |
| antidepressants. These drugs tend to | | | | considered to have treatment resistant |
| have more side effects and require | | | | depression and should see a psychiatrist |
| closer monitoring to ensure their | | | | immediately. |
| safety. They may also be fatal in | | | | Treating Relapses |
| overdose. Nevertheless, they remain | | | | Once depression is under control, |
| effective antidepressants. Many patients | | | | patients should continue taking their |
| find them to be helpful when the newer | | | | antidepressant medications at the same |
| medications have failed. | | | | dose for nine to twelve months to |
| Common side effects: Sedating, dry | | | | prevent a relapse. After a second |
| mouth, blurred vision, constipation, | | | | depressive episode, the doctor may |
| urinary hesitancy, orthostatic | | | | prescribe an antidepressant for as long |
| hypotension (lightheadedness upon | | | | as two years. Patients who have had |
| standing that may lead to falls), | | | | three or more episodes of depression |
| tremor, excitement, heart palpitations, | | | | have a very high risk of recurrence. |
| and weight gain. | | | | These patients may need to take an |
| Usage: Patients with closed-angle | | | | antidepressant for an indefinite period |
| glaucoma may not use this class of drug. | | | | (possibly for life) to decrease the |
| Sometimes it is necessary to monitor TCA | | | | chance of future depressive episodes. |