TAKING CONTROL
Your doctor will take many factors into consideration when selecting an antidepressant. from your other medical conditions and medications to the nature of your depression--mild or severe, brief or long term, with or without psychotic features. This decision is often far more complex than it seems.
And the more severe or complicated your depression, the more likely it is that your local doctor will refer you to the care of an expert, most likely to a psychiatrist who is well versed in the actions, benefits and drawbacks of the dozens of antidepressants available today.
Many patients with mild depression are now started on selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Luvox and Zoloft. (Prozac was the first SSRI and its introduction in the late 1980s was a milestone in depression treatment because it offered an alternative to cruder, less precise drugs.) SSRIs are relatively safe to use if you have another illness, even a psychiatric one such as
obsessive-compulsive disorder, panic disorder, social phobia or bulimia. In fact, these conditions often improve with the addition of SSRIs. Easy to manage and usually taken only once a day. SSRIs are less likely than older drugs to cause annoying reactions that might tempt you to stop taking them. And their side effects (mild nausea, headache, diarrhoea) tend to fade once your body adjusts. For some, there is a loss of interest in sex.
Once a treatment of choice, tricyclic antidepressants (TCAs) still have a special place in the panoply of drug options, with names such as Tofranil. On the plus side, they're proven entities--psychiatrists know what to expect when prescribing them--and they can offer significant relief from depression. On the downside, their side effects (drowsiness, dry mouth, blurry vision and often weight gain) have now relegated these drugs to second-choice status. However, if insomnia accompanies depression, doctors may take advantage of the drowsiness side effect and prescribe a small dose of a TCA at bedtime.
The newer antidepressants have a unique mechanism of action and aren't classified in any of the preceding groups. Venlafaxine (Efexor) and nefazodone (Serzone) have a dual neurotransmitter action, changing brain levels of both serotonin and noradrenaline. If serotonin is affected more than noradrenaline, as with Serzone, the effect is sedation. If the reverse, you may feel stimulated, as with Efexor,
Some types of depression appear to be related to low levels of the brain neurotransmitter serotonin. This is because neurons sending the serotonin reabsorb, or reuptake, too much of the chemical (above left). Anti-depressant drugs called selective serotonin reputake inhibitors (SSRIs) work by preventing this reuptake (above right), allowing more serotonin to be delivered to the receiving neurone--and to the brain in general.
ALTERNATIVE REMEDIES
Despite enthusiasm for them, few herbs or other natural methods have proved to be effective for depression. This incudes megavitamins, acupunture and electrosleep therapies. Popular herbs such as valerian, ginseng, St john's wort and the supplement SAMe continue to be dogged by questions over purity, dosage, safety and lack of evidence (there are few well-designed studies).
Recent research has only increased concerns, however. A 2002 journal of the Americans Medical Association study found one of the oldest and most popular herbal anti-depressants--St John's wort--ineffective for 340 people who were moderately to severely depressed. Mild depression wasn't studied, however, and many herbalists were quick to point out that the herb was never meant to treat major depression.
St. John's wort has at least 10 compounds with pharmacological action, so talk with your doctor. Recent findings indicate that it can alter the effectiveness of other drugs, including blood thinners, oral contraceptives, AIDS/HIV drugs and even other antidepressants.
ANTIDEPRESSANT DRUGS have a powerful appeal: Australian statistics show that antidepressants rose by almost 50 % during the 1990s, to about 8.3 million prescriptions being written in 1998.
- Steel yourself for a search. The odds that the first anti-depressant you take will lift your depression are only 65%. So don't be surprised if you have to try a few before setting on one(or a combo). The good news: increasingly sophisticated antidepressants are becoming available.
- Investigate what's worked for family members. If a parent or other close relative with depression improved by taking a certain antidepressant, mention this to your doctor. Often the same drug will work best for you too.
- Tell your doctor about herbs you take. Many herbs and supplements interact with prescription antidepressants, blunting their action or causing serious reactions.
- Stick with it. The longer you stay in treatment--therapy or medication--the less likely you are to endure another depressive episode.
- keep a diary. It often helps to write down how you are feeling. Writing helps organise thoughts and can identify destructive thinking patterns. You might want to also show the diary to your doctor or counsellor.
- Take your suicidal feelings seriously. This is an emergency. Talk to someone. Call your doctor. Go to the hospital. Decide to sign a contract promising not to hurt yourself.
Your doctor will take many factors into consideration when selecting an antidepressant. from your other medical conditions and medications to the nature of your depression--mild or severe, brief or long term, with or without psychotic features. This decision is often far more complex than it seems.
And the more severe or complicated your depression, the more likely it is that your local doctor will refer you to the care of an expert, most likely to a psychiatrist who is well versed in the actions, benefits and drawbacks of the dozens of antidepressants available today.
Many patients with mild depression are now started on selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Luvox and Zoloft. (Prozac was the first SSRI and its introduction in the late 1980s was a milestone in depression treatment because it offered an alternative to cruder, less precise drugs.) SSRIs are relatively safe to use if you have another illness, even a psychiatric one such as
obsessive-compulsive disorder, panic disorder, social phobia or bulimia. In fact, these conditions often improve with the addition of SSRIs. Easy to manage and usually taken only once a day. SSRIs are less likely than older drugs to cause annoying reactions that might tempt you to stop taking them. And their side effects (mild nausea, headache, diarrhoea) tend to fade once your body adjusts. For some, there is a loss of interest in sex.
Once a treatment of choice, tricyclic antidepressants (TCAs) still have a special place in the panoply of drug options, with names such as Tofranil. On the plus side, they're proven entities--psychiatrists know what to expect when prescribing them--and they can offer significant relief from depression. On the downside, their side effects (drowsiness, dry mouth, blurry vision and often weight gain) have now relegated these drugs to second-choice status. However, if insomnia accompanies depression, doctors may take advantage of the drowsiness side effect and prescribe a small dose of a TCA at bedtime.
The newer antidepressants have a unique mechanism of action and aren't classified in any of the preceding groups. Venlafaxine (Efexor) and nefazodone (Serzone) have a dual neurotransmitter action, changing brain levels of both serotonin and noradrenaline. If serotonin is affected more than noradrenaline, as with Serzone, the effect is sedation. If the reverse, you may feel stimulated, as with Efexor,
Some types of depression appear to be related to low levels of the brain neurotransmitter serotonin. This is because neurons sending the serotonin reabsorb, or reuptake, too much of the chemical (above left). Anti-depressant drugs called selective serotonin reputake inhibitors (SSRIs) work by preventing this reuptake (above right), allowing more serotonin to be delivered to the receiving neurone--and to the brain in general.
ALTERNATIVE REMEDIES
Despite enthusiasm for them, few herbs or other natural methods have proved to be effective for depression. This incudes megavitamins, acupunture and electrosleep therapies. Popular herbs such as valerian, ginseng, St john's wort and the supplement SAMe continue to be dogged by questions over purity, dosage, safety and lack of evidence (there are few well-designed studies).
Recent research has only increased concerns, however. A 2002 journal of the Americans Medical Association study found one of the oldest and most popular herbal anti-depressants--St John's wort--ineffective for 340 people who were moderately to severely depressed. Mild depression wasn't studied, however, and many herbalists were quick to point out that the herb was never meant to treat major depression.
St. John's wort has at least 10 compounds with pharmacological action, so talk with your doctor. Recent findings indicate that it can alter the effectiveness of other drugs, including blood thinners, oral contraceptives, AIDS/HIV drugs and even other antidepressants.
ANTIDEPRESSANT DRUGS have a powerful appeal: Australian statistics show that antidepressants rose by almost 50 % during the 1990s, to about 8.3 million prescriptions being written in 1998.
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