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