Category Archives: Medication

Researchers Say Laughter Can Help Treat Depression

Depression is common these days and affects around 1 in 4 of the population and if you are diagnosed with depression then you’re likely to be offered anti-depressants which may help, but you also might have to suffer some unpleasant side effects too.

Then again you may be offered some form of psychotherapy which might also work, but unfortunately, there’s either a long waiting list to see a psychotherapist, or there isn’t one available, or you have to pay a small fortune to see one privately.

Now though, an Italian researcher and his colleagues have come up with a possible treatment for depression that is totally free, comes with very positive side effects, and you can have it whenever you want, and it is laughter.

What the researchers are saying is first of all that laughter is a very common behaviour but not many studies have been done to date which closely examines the nature of laughter.

It has already been established that the cortical and subcortical regions of the brain are involved in laughter and that laughter has an impact on the body’s equilibrium, particularly on the neuroendocrine and immune systems.

In their abstract, the researchers also referred to previous evidence that reduction of laughter frequency is a symptom of depression and that an increase in the frequency of laughter could be used as a marker of clinical improvement.

It is also already known that laughter can improve mood directly and can lessen the negative effects of stressful events on psychological well being so the researchers are saying:

“It is possible that the stimulation of particular cerebral regions, involved in depression pathogenesis, and the normalisation of the hypothalamic pituitary adrenocortical system dysfunctions, both mediated by laughter, can counteract efficiently depressive symptoms”.

The researchers also mention that the favourable effects of laughter on social relationships and physical health may have a role in influencing the ability of depressed patients to face their condition.

Now we’ve all heard that laughter is the best medicine and now it looks like that might be true even where depression is concerned. There’s no doubt, a good old belly laugh on a regular basis does wonders for our mood.

Fonzi L, Matteucci G, and Bersani G from Sapienza University in Rome, published their report on how laughter can be effective in the treatment of depression in the February edition of Rivista di Psichiatria

Antidepressant Medication Might Be Good For Your Heart

(Who paid for the study ?  wouldnt surprise me if it was a drugs company)

A study by researchers from the Loyola University Medical Center has revealed that taking certain types of anti depressant medication may have a positive effect on the cardiovascular system.

As people who are suffering from depression are at greater risk from cardiovascular disease, this has got to be good news.

It’s all about serotonin. Serotonin is the ‘feel good’ neurotransmitter and it is already known that serotonin plays a significant role in our moods and in depression.

When a person is depressed, not enough serotonin reaches across the synapse to the postsynaptic cell from the presynaptic cell and too much is taken back in by the presynaptic cell.

A type of antidepressant known as Selective Serotonin Reuptake Inhibitors, or SSRIs, work by inhibiting the reuptake of serotonin by the presynaptic cell so that the postsynaptic cell has a better chance of receiving the serotonin.

Now the researchers have discovered that SSRIs can also slow down the way the blood platelets clump together so could be helpful in conditions such as hardening of the arteries.

The study involved only 50 adults, half of who were taking selective serotonin reuptake inhibitors for depression and half who weren’t.

Blood samples were taken from each of the volunteers at the beginning of the study and then again one month and two months later.

After a month, the researchers treated the platelets with platelet activating substances which would cause the cells to clump together.

What they found was that practically all of the cells clumped together in the blood that was taken from those who weren’t taking SSRIs. The same thing didn’t happen with those who were taking SSRIs, only just over a third of those cells clumped together.

The researchers concluded that the SSRI medication had somehow inhibited or altered platelet’s ability to aggregate. However, the effect also appeared to be temporary.

When the researchers tested the bloods again at the two month point, the platelets of those taking SSRIs clumped together more than they did at the one month point.

The assumption is that SSRIs have a greater impact on platelet clumping earlier on in the treatment, but more research is required in order to establish if this is so.

Consequently, Dr Evangelos Litinas, a researcher in the Center’s pathology department, and his team, extended the study to take more samples after 3 months and will also look at the effects of another type of SSRI.

Post Natal Depression

Post natal depression can be severe. Scientists may soon be able to predict which women are likely to suffer from depression after giving birth.

They have found that women who suffer from severe post natal depression have higher levels of chemicals called thyroperoxidase antibodies in their bloodstream.

The discovery suggests that post natal depression may not – as has been widely assumed – be caused entirely by the psychological and emotional turmoil associated with pregnancy and birth.

The discovery, from a study of 300 pregnant women by Dutch scientists, could enable doctors to identify individuals most at risk.

They could then be given extra help and support.

Researcher Professor Victor Pop, from Tilburg University, said: “This is important. It could improve detection and diagnosis of depression and enable these women to get better help.”
Up to eight out of 10 new mothers are thought to suffer from postnatal depression.

Symptoms

Typically, they become weepy, irritable or slightly depressed about three or four days after the delivery.

The problem usually lasts just a few days, but about 10% of women suffer some form of clinical depression.

About four women per 1,000 who give birth have to be treated in hospital.

Up to 50 women a year commit suicide before their child’s first birthday as a result of postnatal depression or other psychiatric disorders.

Sufferers of postnatal depression include the late Princess of Wales, Mick Jagger’s ex-wife Jerry Hall, model Rachel Hunter, and TV presenter Judy Finnigan.

Heather Welford, an expert in post natal depression at the National Childbirth Trust, told BBC News Online that post natal depression was probably caused by a combination of social and biochemical factors.

However, she said: “A simple, non-invasive test, either biochemical or psychological, that could identify women who are more likely to develop post natal depression would be very useful.”

Social support, counselling and various types of therapy have been shown to be as effective at treating post natal depression as anti-depressants.

An Overview Of Depression Medications

Depression medications seek to alleviate the symptoms of depression by affecting neurotransmitters in the brain.  Neurotransmitters are chemicals that carry messages to different parts of the brain.  These messengers play a role in mood management.

Medications known as antidepressants, which are used in treating depression, can affect the amount of these neurotransmitters in the brain and positively influence a person’s mood state.  The four major kinds of antidepressants are tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors.

Tricyclic Antidepressants

Tricyclic antidepressants were some of the original antidepressants that were used in the treatment of depression symptoms.  They operate mainly by affecting the neurotransmitters serotonin and norepinephrine.

They are effective when it comes to treating depression, but they have a high incidence of side effects so they are not as favoured anymore.  They are still used, however, when other medications are ineffective or produce side effects of their own.

Monoamine Oxidase Inhibitors

MAOIs are another type of antidepressant that were used as antidepressants first came into existence.  Their application is usually limited to patients who do not respond to other types of antidepressant medications.

MAOIs can have interactions with various food products so a strict diet must be adhered to by anyone on these medications.  This is another reason why they are not the preferred form of treatment in most cases.  MAOIs are also used to treat other psychological conditions.

Selective Serotonin Reuptake Inhibitors

These antidepressants are newer to the arsenal of depression-fighting drugs.  They prevent the reuptake of serotonin after that serotonin has triggered a signal in the brain.  This way the same serotonin may continue to trigger signals in the brain as if the amount of serotonin were greater than it actually is.  Selective serotonin reuptake inhibitors tend to have fewer side effects than the older antidepressants.

Serotonin And Norepinephrine Reuptake Inhibitors

These also make the list of newer antidepressant medications.  These antidepressants operate on the same principle as selective serotonin reuptake inhibitors, only they influence the amount of norepinephrine as well as serotonin in the brain.  More of both chemicals trigger the appropriate responses in the brain, and the patient’s mood is thusly affected.  They, too, tend to have fewer side effects than older antidepressants.

The medications used to treat depression seek to ameliorate depression symptoms by affecting the neurotransmitters in the brain.  The process may not be entirely understood, but these antidepressants produce positive results in many depression patients.  With time, the science of depression drugs will only advance further.

Symptoms of Depression

What are the symptoms of depression? As with many mental health problems there are a number of symptoms; it’s very rare for all symptoms to occur in one person. Unsurprisingly, the symptoms of depression include feeling generally miserable, and in addition to this other symptoms are: • Variation of mood over the day. It is often worse in the morning, and improves as the day goes on – but the pattern can be the other way around • Disturbed, sleep usually waking early in the morning and being unable to get back to sleep. This is often because of all the negative thoughts that are racing through your head • A general slowing down of thought, speech and movement • Feelings of anxiety • Tearfulness for no reason • Shorter temper • Lack of energy and constant exhaustion • Inability to enjoy things • Lack of concentration • Difficulty making decisions • Feeling that you are forgetful • Negative thoughts about the future • Feelings of guilt • Loss of identity • Blaming self and low self esteem • Feelings of hopelessness and despair • Unrealistic sense of failure • Loneliness, even when amongst people • Becoming pre-occupied with illness • Loss of appetite and as a result loss of weight, and • Reduced sex drive This presents a very bleak picture. However, it is important to remember that depression is not an absolute; it is not a case of either you are depressed or you are not. There is a progression from simply feeling blue, to the full clinical illness described in this list. Even then, not every symptom will occur. It is also important to remember that depression is treatable, and if you take the right steps, can be avoidable. How common is it? Though we all suffer low moods, from 7% to 12% of men will suffer diagnosable depression in their lifetime. The figure is from 20% to 25% for women. There are many theories as to why the figure is higher for women. The incidence of post-natal depression certainly contributes to the higher number. Other theories include views on the position of women in society, and the difficulties they face in achieving life goals. It could also be that women may tend to be more honest about their emotions than men – and hence their depression is easier to detect. Manic depression and associated symptoms The world would be a very boring place if everybody’s mood was constantly neither happy nor sad. Our mood is rarely completely stable – little things make us feel ‘up,’ or annoyed or sad. Some people are aware of larger patterns in their mood. For some, spring is a time of lifted mood as the weather starts to improve, and winter is a time of lowered mood as the nights draw in. Some women notice distinct changes of mood with different phases of their menstrual cycle. It is not the recurring pattern of these moods that causes problems, it is the severity. In bi-polar disorder the mood swings are not like the normal highs and lows of daily life. It is characterised by extreme mood swings, from deep depression to extreme elation or ‘highs.’ These severe highs and lows may alternate, or there may be long periods of stability between them. Some people with the diagnosis suffer mainly from depression, with only occasional manic phases. During a manic or high phase, people feel enormously energetic and powerful and tend to become hyperactive, going without sleep and starting totally unrealistic schemes or projects. Some people find they are very creative. However, problems arise when the mood spins out of control and the person behaves in ways that they later find deeply embarrassing. It is quite common for someone to lose touch with reality and, for example, run up enormous debts or invite total strangers to their home. There can also be unfortunate consequences of decisions taken while very high in mood. The depressive phase is similar to other forms of depression. It is characterised by a lack of energy and interest in life, low self-esteem, and feelings of guilt and despair. Sometimes the person will be suicidal. The exact causes of bipolar disorder are not known, but stressful life events, irresolvable problems, or emotional damage in childhood may play a part, possibly combined with genetic factors. What are the symptoms? It is important to distinguish between the three elements of this condition: • depressive symptoms • manic symptoms • the cycle of these moods The symptoms of depression are listed above Symptoms of mania can include: • elation • short temper • changing from short temper to elation – and back again very quickly • over activity • easily distracted • not sleeping • over eating • increase in sexual desire • moving very quickly from topic to topic in conversation – making it very difficult for others to keep up • speaking so quickly that it is difficult to understand all the words that the person says • having very grand ideas Then there is the cycle that these sets of symptoms can occur in. This can come in several varieties: • Mixed. It is possible for a person to have many of the symptoms of mania, and yet also suffer from severely depressive thoughts. This is especially so if the person experiencing the mania has insight into what is happening to them. Though the symptoms of mania can sound quite pleasant – it can also feel as though you are losing control • Cycles. Symptoms of mania can be followed by symptoms of depression in an almost regular pattern. These swings in mood can occur over a period of anything from days to months. Less commonly, some people may experience only depression or mania, but within a regular recurring pattern How common is it? About 1% of people will develop bipolar disorder in their lifetime. If you have relatives with bipolar disorder, then your chance of developing it is higher – about 12% of people with a brother or sister with bipolar disorder will develop the condition themselves.

Post Natal Depression

Depression is a state of mind: A powerfully negative mood that interferes with your daily life. Depression is more than sadness. When you are depressed, you are sad, despondent, disinterested, lethargic. You feel hopeless or helpless. You may cry all the time or feel as if you cannot get out of bed in the morning. Depression affects your body as well as your mind. In a severe depression, you may feel as if nothing is pleasant and no one is loveable, least of all you. You may eat less or you may eat more, but less often. You may feel at night as if you are starting to snap out of it, only to awaken in the morning feeling worse. This state may have been brought on by an adversity in your life or it may seem to have settled in on its own, due to a change of seasons or a change of lifestyle or for no apparent reason at all. Over coming depression. All of us are sad at times, and most people are depressed at one time or another. The difference is that sadness is a normal response to a loss or non-preferable change of circumstance, while depression is an extreme response that makes it difficult for you to move beyond the difficulty with which you are confronted. For most people, depression lifts eventually. But sometimes it does not lift soon enough, and you need help to overcome it. There is research that helps to point you in the direction of effective help. There are those who would call depression a disease. A mood is a mood, not a disease. There are more useful and comfortable and less useful and comfortable moods, but neither a terribly bad one nor a terribly good one is a disease, though it is certainly a serious problem to be dealt with. In fact, depression can be a life-threatening problem if the despondency leads one to feel suicidal. However serious it is, it is still a state of mind and body that can be altered with some hard work on your part. Modern sources from physicians to television ads tend to tell you that this disease of depression is caused by a chemical imbalance. There are a few things wrong with that statement. The first is that this implies that if your chemistry is out of balance, you must have a disease and that if this is the case, there is a pill to cure it and if that is the case, you must take the pill as nothing else will do. There are several misleading aspects to this sequence. First, as a biological machine, you go into and out of balance of various sorts of chemicals all the time. Your body works to restore and maintain its equilibrium all day long. For example, when your body is short of fluids, a chemical signal heads to the brain to advise you that there is an imbalance, causing another signal to make you aware of feeling thirsty—but this is only after the imbalance has started the chain of chemical messengers into motion. This is a natural process that occurs frequently and is built in to your body’s natural mechanisms for establishing and maintaining balance. Thus, every imbalance is not a disease, though it is a need that should impel some action to correct it. Unlike thirst and fluid balance, depression is not a very clear cut biological process. First, when it comes to your mood, there is no one chemical responsible. Regardless of what you see on television ads, there is no single neurotransmitter system in charge of whether you are depressed or euphoric. Second, even if there were only one, there is no evidence that it can be simply restored by the addition of a pill, as what a pill contains and how the mindbody system utilizes it are only loosely related. Third, even if there were only one neurotransmitter system implicated in clinical depression, there are other ways to restore the equilibrium than pills. Research indicates that both psychotherapy and regular exercise are quite effective at lifting mood, in fact, with more long-lasting results than medications and better resistance to relapse! 1,2,3 Overcoming depression. Depression, from a biological standpoint, is a low energy state. The organism moves little, does little, and generally consumes little. It is much akin to an animal in hibernation—all the systems slow down, and responses are sluggish. SAD—Seasonal Affective Disorder, is a logical extrapolation of a pretty normal seasonal energy change—in times gone by there was less to do in winter, less light, less food, and less heat, so economizing on energy expenditure was sensible. In modern times, we have light and food and heat, so we technically could expend the same amount of energy in winter as in summer, but indeed, some folks’ systems do not see it that way and begin to hibernate, storing food, moving little, and doing little. It has long been known that exposure to full spectrum light in winter helps counteract SAD. So does increasing your activity levels. So does psychotherapy geared at changing the thought pattern that affirms that it indeed is too hard to activate your system in the cold, dark winter months. Thus, while SAD is essentially an extreme expression of a normal state of being, there are many ways to alter the negative mood that results. In other types of depression that are not seasonal, a variety of causes from having endured a personal tragedy, to an abnormal hormonal reaction to childbirth, to brain damage caused by stroke can be responsible. The great news is that regardless of the cause of your depression, psychotherapy is a very effective method of overcoming it. In particular, the cognitive therapies that teach you to pinpoint your depressive thoughts and replace them with accurate thoughts are highly effective tools for altering a debilitating mood, regardless of cause. However it begins, depression is kept in place with negative thinking. Depression can almost always be successfully alleviated by a single method or a combination of methods, notably some form of cognitive therapy and some imagery or relaxation work and an increase in activity levels. The various schools of cognitive therapy depend upon specific techniques directed at changing your inaccurate thoughts to create a lasting change in mood. Since, regardless of the cause of the depressed mood, it is always sustained and worsened by negative and unrealistic thoughts, the key to achieving a positive mood, or euphoria, lies in changing the thinking. The errors or distortions are identified, disputed rationally, and replaced with accurate assessments of your life situation. Not only does this technique effect mood enhancement, but it also helps you to become relapse-proof, having learned new ways of thinking and new coping skills that can provide lifelong protection against relapse. Unlike cognitive therapy, which has been shown repeatedly to have long-term effects at altering depressed mood, there is significant evidence that much of the relief obtained from antidepressant medications is due to placebo effect and the natural healing that takes place over time.4 Treatment enhancement is often obtained by teaching relaxation techniques or the use of clinical hypnosis or therapeutic imagery, with the goal of quieting the nervous system and healing past inner wounds. Dr. Carol Low, the psychologist at the Center for Conscious Living has been trained in Rational-Emotive Behavior Therapy and Cognitive Behavior Therapy, as well as clinical hypnosis, which form an effective combination of methods to rapidly alleviate even severe depressive symptoms, counteract biological factors that intervene in mood stability, and help you to learn how to avoid depression in the future. You can elevate your mood, discover and develop your inner strengths, build new coping skills, alter stuck thought patterns, and enhance your feelings of self-acceptance, self-efficacy, and self-confidence. References 1) Butler, A. C., & Beck, J. S. (2000). Cognitive therapy outcomes: A review of meta-analyses. Journal of the Norwegian Psychological Association, 37, 1-9. 2) Springen, K, (2004) The Serenity Workout: Regular exercise can strengthen the mind as well as the muscles, and studies show it improves mood, too. Newsweek, 9/27/04. 3) Blumenthal et al. (1999), “Effects of Exercise Training on Older Patients With Major Depression.” Archives of Internal Medicine 159, 2349-56.) “Effects of Exercise Training on Older Patients With Major Depression.” Archives of Internal Medicine 159, pp2349-56.) 4) Kirsch & Sapirstein, (1998) Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication, Prevention & Treatment, 1998.

Herbal remedies for depression – St John’s wort, but is it safe?

Natural, wholesome, inexpensive and available over the counter, St John’s wort seemed to be the dream remedy for depression. Taken all over the world in huge quantities, it has become the pill to pop without guilt or fear, the herbal Prozac that dusted away the blues nature’s way.

The downside is only now emerging. Although studies show that it is effective for mild to moderate depression and two million British people are taking it, you do have to be careful.

The chief drawback is that the remedy, derived from the yellow flowering hedgerow plant, interacts with other drugs causing them to metabolise through the body too quickly. This is obviously very significant for people on the contraceptive pill or the blood-thinning drug warfarin, who are at risk of a stroke.

Herbal remedies for depression. Warnings issued

The Medicines Control Agency issued a warning on March 1st 2000 that patients who are on a long list of drugs should stop taking St John’s wort until they have consulted their GP or pharmacist. Medications for asthma, epilepsy, depression, migraine and heart problems are all implicated.

The authorities in the Irish Republic have gone further by banning the over-the-counter sale of the ancient herbal remedy since January 1st 2000. It is now available only on prescription.

In the United States, the Food and Drugs Administration (FDA) issued a warning in February 2000 that the herb could interfere with drugs used to treat HIV-infected patients. It also raised the possibility of complications for other patients taking similar medication, including those undergoing heart transplants. The FDA cited research showing that for patients taking St John’s wort, the effectiveness of the antiviral drug Indinavir was ‘dulled’.

There have also been some reports from America that St John’s wort can cause nerve damage or cataracts when combined with bright sunlight. This is believable because herbalists have always known that when St John’s wort is used externally, you have to keep out of the sun. Combined with oil, it is used on the skin for paralysis or to treat pain from nerves or shingles.

Researchers have found that hypericin, the active ingredient in St John’s wort, does react with sunlight. This is particularly significant for people who suffer from the ‘winter blues’ or seasonal affective disorder, who might be tempted to combine a course of St John’s wort with light-box therapy – sitting for long periods bathed in bright light.

Herbal remedies for depression

A better alternative to St Johns Wort as an herbal remedy for depression would be high grade EPA fish oil.

EPA fish oil has been scientifically proven to be very effective for depression, bipolar – manic depression and related disorders, and unlike St Johns Wort the side effects are all positive, thick long healthy hair growth, good nails and fantastic skin. High grade omega 3 EPA fish oil taken in the correct dose and strength give count less benefits.

If you are going to use High Grade Omega 3 fish oil EPA as a natural remedy for depression it is imperative that you take the strongest concentrate of EPA fish oil (90%) and in the correct dose daily to give your self the best chance for the EPA to work and give the maximum therapeutic effect.

It has recently been reported that the Epa works best without the DHA , this notion came about from studies that have been performed on people suffering from depression, researchers found that the higher the EPA to DHA ratio the better the results have been.

Depression Medications

Anyone can develop depression. But, treatment is effective in about 80% of identified cases, when treatment is provided. Psychotherapy and medication are the two primary treatment approaches. Antidepressant medications can make psychotherapy more effective, for some people. Someone who is too depressed to talk, for instance, can’t get much benefit from psychotherapy or counseling; but often, the right medication will improve symptoms so that the person can respond better.

This page explains many issues related to the treatment of depression with medication. It is intended to help you understand how and why drugs can be used as part of the treatment of depression. It is important for you to be well informed about depression medication, if you are taking any of these medications, but this is not a “do-it-yourself” manual.

Self-medication can be dangerous. Interpretation of both the signs and symptoms of depression, and identification of possible side effects, are jobs for the professional. The prescription and management of medication, in all cases, must be done by a responsible physician working closely with the patient, his/her psychologist, and sometimes the patient’s family. This is the only way to ensure that the most effective use of medication is achieved with minimum risk of side effects or complications.

depression medication Symptom Relief, Not Cure

Just as aspirin can reduce a fever without clearing up the infection that causes it, psychotherapeutic medications act by controlling symptoms. Like most drugs used in medicine, they correct or compensate for some malfunction in the body. Psychotherapeutic medications do not cure depression. In many cases, these medications can help a person get on with life despite some continuing mental pain and difficulty coping with problems. For example, antidepressants can lift the dark, heavy moods of depression. The degree of response ranging from little relief of symptoms to complete remission depends on a variety of factors related to the individual and the particular disorder being treated.

How long someone must take a psychotherapeutic medication depends on the disorder. Many depressed and anxious people may need medication for a single period perhaps for several months and then never have to take it again. For some depressions, medication may have to be taken indefinitely or, perhaps, intermittently.

Like any medication, psychotherapeutic medications do not produce the same effect in everyone. Some people may respond better to one medication than another. Some may need larger dosages than others do. Some experience annoying side effects, while others do not. Age, sex, body size, body chemistry, physical illnesses and their treatments, diet, and habits such as smoking, are some of the factors that can influence a medication’s effect.

Antidepressant Medications

The kind of depression that will most likely benefit from treatment with medications is more than just “the blues.” It’s a condition that’s prolonged, lasting 2 weeks or more, and interferes with a person’s ability to carry on daily tasks and to enjoy activities that previously brought pleasure.

The depressed person will seem sad, or “down,” or may show a lack of interest in his surroundings. He may have trouble eating and lose weight (although some people eat more and gain weight when depressed). He may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. He may speak of feeling guilty, worthless, or hopeless. He may complain that his thinking is slowed down. He may lack energy, feeling “everything’s too much,” or he might be agitated and jumpy. A person who is depressed may cry. He may think and talk about killing himself and may even make a suicide attempt. Some people who are depressed have psychotic symptoms, such as delusions (false ideas) that are related to their depression. For instance, a psychotically depressed person might imagine that he is already dead, or “in hell,” being punished.

Not everyone who is depressed has all these symptoms, but everyone who is depressed has at least some of them. A depression can range in intensity from mild to severe.

Antidepressants are used most widely for serious depressions, but they can also be helpful for some milder depressions. Antidepressants, although they are not “uppers” or stimulants, take away or reduce the symptoms of depression and help the depressed person feel the way he did before he became depressed.

Antidepressants are also used for disorders characterized principally by anxiety. They can block the symptoms of panic, including rapid heartbeat, terror, dizziness, chest pains, nausea, and breathing problems. They can also be used to treat some phobias.

Your physician will choose a particular antidepressant based on your symptoms. When you begin taking an antidepressant, improvement generally will not begin to show immediately. With most of these medications, it will take from 1 to 3 weeks before changes begin to occur. Some symptoms diminish early in treatment; others, later. For instance, energy level, or sleeping and eating patterns may improve before the depressed mood lifts. If there is little or no change in symptoms after 5 to 6 weeks, a different medication may be indicated, and you should discuss this with your physician. Some people respond better to one medication than to another. There is no certain way to determine which medication will be effective, so your doctor may have to prescribe first one, then another, until an effective one is found. Treatment with medication is continued for a minimum of several months and may last up to a year or more.

While some people have one episode of depression and then never have another, or remain symptom-free for years, others have more frequent episodes or very long-lasting depressions that may go on for years. Some people find that their depressions become more frequent and severe as they get older. For these people, continuing (maintenance) treatment with antidepressants can be an effective way of reducing the frequency and severity of depressions. Those that are commonly used have no known long-term side effects and may be continued indefinitely. The prescribed dosage of the medication may be lowered if side effects become troublesome. Lithium may also be used for maintenance treatment of repeated depressions whether or not there is evidence of a manic or manic-like episode in the past.

The dosage of antidepressants varies, depending on the type of drug, the person’s body chemistry, age, and, sometimes, body weight. Dosages are generally started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects.

There are a number of different types of antidepressant medications available. They differ in their side effects and, to some extent, in their level of effectiveness. Tricyclic antidepressants (named for their chemical structure) used to be the most commonly used medications for treatment of major depressions. Monoamine oxidase inhibitors (MAOIs) were often used for “atypical” depressions in which there are symptoms like oversleeping, anxiety, panic attacks, and phobias. More recently, newer antidepressants have been developed. Several of them are called “selective serotonin reuptake inhibitors” (SSRIs). Some examples of SSRIs are fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). (Luvox has been approved for obsessive-compulsive disorder , and Paxil has been approved for panic disorder.) Though structurally different from each other, all the SSRI antidepressant effects are due to their action on one specific neurotransmitter, serotonin. Two other antidepressants that affect two neurotransmitters serotonin and norepinephrine have also been approved by the FDA. They are venlafaxine (Effexor) and nefazodone (Serzone). All of these newer antidepressants seem to have less bothersome side effects than the older tricyclic antidepressants.

The tricyclic antidepressant clomipramine (Anafranil) affects serotonin but is not as selective as the SSRIs. It was the first medication specifically approved for use in the treatment of obsessive- compulsive disorder (OCD). Prozac and Luvox have now been approved for use with OCD.

Another of the newer antidepressants, bupropion (Wellbutrin), is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin. Wellbutrin has not been associated with weight gain or sexual dysfunction. It is contraindicated for individuals with, or at risk for, a seizure disorder or who have been diagnosed with bulimia or anorexia nervosa.

Questions for Your Doctor About the depression medication

To increase the likelihood that a medication will work well, you and your family must actively participate with the doctor prescribing it. Tell the doctor about your past medical history, other medications being taken, anticipated life changes such as planning to have a baby and, after some experience with a medication, whether it is causing side effects. When a medication is prescribed, you should ask the following questions, recommended by the US Food and Drug Administration (FDA):

  • What is the name of the depression medication, and what is it supposed to do?
  • How and when do I take it, and when do I stop taking it?
  • What foods, drinks, other medications, or activities should I avoid while taking the prescribed medication?
  • What are the side effects, and what should I do if they occur?
  • Is there any written information available about the medication?

On this page, medications are listed with their generic (chemical) names matched with their trade names (brand names used by drug companies). If you cannot find additional information using the trade name, search for information using the generic name.

Side Effects of Antidepressant Medications

1. Tricyclic Antidepressants

There are a number of possible side effects with tricyclic antidepressants that vary, depending on the medication. For example, amitriptyline (Elavil) may make people feel drowsy, while protriptyline (Vivactil) hardly does this at all and, in some people, may have an opposite effect, producing feelings of anxiety and restlessness. Because of this kind of variation in side effects, one antidepressant might be highly desirable for one person and not recommended for another. Tricyclics on occasion may complicate specific heart problems, and for this reason the physician should be aware of all such difficulties. Other side effects with tricyclics may include blurred vision, dry mouth, constipation, weight gain, dizziness when changing position, increased sweating, difficulty urinating, changes in sexual desire, decrease in sexual ability, muscle twitches, fatigue, and weakness. Not all these medications produce all side effects, and not everybody gets them. Some will disappear quickly, while others may remain for the length of treatment. Some side effects are similar to symptoms of depression (for instance, fatigue and constipation). For this reason, the patient or family should discuss all symptoms with the doctor, who may change the medication or dosage.

Tricyclics also may interact with thyroid hormone, antihypertensive medications, oral contraceptives, some blood coagulants, some sleeping medications, antipsychotic medications, diuretics, antihistamines, aspirin, bicarbonate of soda, vitamin C, alcohol, and tobacco.

An overdose of these antidepressants is serious and potentially lethal. It requires immediate medical attention. Symptoms of an overdose of tricyclic antidepressant medication develop within an hour and may start with rapid heartbeat, dilated pupils, flushed face, and agitation, and progress to confusion, loss of consciousness, seizures, irregular heart beats, cardiorespiratory collapse, and death.

2. The Newer SSRI Antidepressants

The most common side effects of these antidepressants are gastrointestinal problems and headaches. Some people complain of insomnia, anxiety, and agitation. Because of the potentially serious interaction between these medications and monoamine oxidase inhibitors, it is advisable to stop taking one medication from 2 to 4 or 5 weeks before starting the other, depending on the specific medications involved. In addition, some SSRIs have been found to affect metabolism of certain other medications in the liver, creating possible drug interactions. As with all medications, be sure to tell your physician if any other doctor, including your dentist, has prescribed any medications for you. This is necessary to prevent potentially dangerous drug interactions.

3. Monoamine Oxidase Inhibitors (MAOIs)

MAOIs may cause some side effects similar to those of the other antidepressants. Dizziness when changing position and rapid heartbeat are common. MAOIs also react with certain foods and alcoholic beverages (such as aged cheeses, foods containing monosodium glutamate (MSG), Chianti and other red wines), and other medications (such as over-the-counter cold and allergy preparations, local anesthetics, amphetamines, insulin, some narcotics, and antiparkinsonian medications). These reactions often do not appear for several hours. Signs may include severe high blood pressure, headache, nausea, vomiting, rapid heartbeat, possible confusion, psychotic symptoms, seizures, stroke, and coma. For this reason, people taking MAOIs must stay away from restricted foods, drinks, and medications. They should be sure that they are furnished, by their doctor or pharmacist, a list of all foods, beverages, and other medications that should be avoided.

Precautions to be Observed When Taking Antidepressants

When taking antidepressants, it is important to tell all your doctors (and dentists) about all medications being used, including over-the-counter preparations and alcohol. Antidepressants should be taken only in the amount prescribed and should be kept in a secure place away from children. When used with proper care, following the doctor’s instructions, antidepressants are useful medications that can control many of the physical symptoms of depression, while you work on changing the life stressors that contributed to its cause.

Medication Precautions

Special Considerations

Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing.

Children

Studies consistently show that about 15 percent of the US population below age 18, or over 9 million children, have been diagnosed with a psychological problem that compromises their ability to function. In children, these disorders may present symptoms that are different or less clear-cut than the same disorders in adults. Younger children, especially, may not talk about what’s bothering them, but this is sometimes a problem with older children as well. For this reason, having both a physician and psychologist evaluate the child is especially important.

There are many psychological treatments that can help children. These include psychotherapy, behavioral therapy, social skills training, parental and family therapy, group therapy and medications. The treatment, or combination of treatments, used for an individual child is based on the child’s diagnosis and individual needs. When your child appears to have a psychological problem, it is very important to consult with a psychologist to determine what should be done.

If a decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, others who have charge of the child) is essential. Children should be watched and questioned for side effects (many children, especially younger ones, do not volunteer information). They should also be monitored to see that they are actually taking the medication and taking the proper dosage.

The use with children of the medications described here is more limited than with adults. In the list of medications, those that have specific indications and dose guidelines for children, as listed in the Physicians’ Desk Reference, are indicated by a double asterisk (**).

The Elderly

Persons over the age of 65 make up 12 percent of the population of the United States, yet they receive 30 percent of prescriptions filled. The elderly generally have more medical problems and often are taking medications for more than one of these problems. In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication.

The elderly may sometimes accidentally take too much of a medication because they forget that they have taken a dose and take another dose. The use of a 7-day pill box is especially helpful to an elderly person.

The elderly, their friends, relatives, and caretakers, need to watch for adverse (negative) physical and psychological responses to medication. Because the elderly often take more medications (prescribed, over-the-counter drugs, and home or natural remedies), the possibility of negative drug interactions is higher.

Pregnant, Nursing, or Childbearing-Age Women

In general, during pregnancy, all medications (including psychotherapeutic medications) should be avoided where possible, and other methods of treatment should be tried.

A woman who is taking a psychotherapeutic medication and plans to become pregnant should discuss her plans with her doctor; if she discovers that she is pregnant, she should contact her doctor immediately. During early pregnancy, there is a possible risk of birth defects with some of these medications, and for this reason:

1) Lithium is not recommended during the first 3 months of pregnancy.

2) Benzodiazepines are not recommended during the first 3 months of pregnancy.

The decision to use a psychotherapeutic medication should be made only after a careful discussion with the doctor concerning the risks and benefits to the woman and her baby. Small amounts of medication pass into the breast milk; this is a consideration for mothers who are planning to breast-feed.

A woman who is taking birth-control pills should be sure that her doctor is aware of this. The estrogen in these pills may alter the breakdown of medications by the body, and/or reducing their efficacy to relieve symptoms of anxiety.

index of Medications

This list pairs the Trade Names of antidepressants with their generic names. Sometimes you can find additional information about a medication under its generic name, that might not be listed under its trade name. As we gather more information about specific medications, we will be adding links from the medication name directly to expanded information on that specific drug. Otherwise, please consult the reference list at the bottom of the page for additional information.

Antidepressant Medications

Trade Name – Generic Name

Adapin – doxepin

Anafranil** – clomipramine

Asendin – amoxapine

Aventyl – nortriptyline

Desyrel – trazodone

Effexor – venlafaxine

Elavil – amitriptyline

Ludiomil – maprotiline

Luvox (SSRI) – fluvoxamine

Marplan (MAOI) – isocarboxazid

Nardil (MAOI) – phenelzine

Norpramin – desipramine

Pamelor – nortriptyline

Parnate (MAOI) – tranylcypromine

Paxil (SSRI) – paroxetine

Pertofrane – desipramine

Prozac (SSRI) – fluoxetine

Remeron – mirtazapine

Serzone – nefazodone

Sinequan – doxepin

Surmontin – trimipramine

Tofranil** – imipramine

Vivactil – protriptyline

Wellbutrin – bupropion

Zoloft (SSRI) – sertraline

References

AHFS Drug Information, 91. Gerald K. McEvoy, Editor. Bethesda, Maryland: American Society of Hospital Pharmacists, Inc., 1991.

Goodwin F.K. and Jamison K.R. Manic-Depressive Illness. New York: Oxford University Press, 1990.

Jensen P.S., Vitiello B., Leonard H., and Laughren T.P. Child and adolescent psychopharmacology: expanding the research base. Psychopharmacology Bulletin, Vol. 30, No. 1, 1994.

Physicians’ Desk Reference, 52nd edition. Montvale, New Jersey: Medical Economics Data Production Company, 1998.