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Medication and Depression - What's the best way to treat depression?

Many people who live with depression – defined as a potentially debilitating disease that leaves you unable to function due to extended, long-term bouts of deep sadness – are able to find recovery through talk therapy and time. But there are also those who can’t seem to get through the depression on counseling and psychotherapy alone – they need the assistance of medication.

Medication has long been proven an effective intervention and a beneficial addition to the treatment of a person suffering with symptoms of depression. The trick is to find the right cocktail of antidepressants, because as your doctor will tell you, not all antidepressants work the same way, and not all antidepressants are effective for every person. Your physician will talk to you about what your own particular symptoms are, what the potential side effects of the medication is, how long you’ll have to take them, and how they’ll be able to help.

Antidepressants, which are sometimes used to treat anxiety as well, work by affecting your neurotransmitters, which are chemicals in the brain. There are three neurotransmitters known to be associated with depression, and they are serotonin, dopamine and norepinephrine.

Emily’s story

I was 15 when I first started feeling symptoms of depression. I wasn’t unpopular, per se, but I didn’t have a giant group of girlfriends. I could kind of move from one crowd to the other and no one really turned me away, but no one really embraced me, either. I wasn’t considered particularly pretty, I had no guys chasing me, and my marks were just okay. I spent a lot of time feeling inadequate and just never quite enough.

In college, my depression started to deepen. I was really proud of the fact I got accepted, and the first day I remember going to class and feeling like I had a new start. There were like a thousand kids in one class and no one seemed to be close to anyone, so I was like, “Yes! Everyone’s like me.” But then I ended up at the student square, where all these different groups were trying to encourage all the freshmen to join their clubs, and I just couldn’t see myself in any one of them. And then it felt like high school all over again, because no one was exactly trying to flag me down.

I stayed in school for exactly a semester and a half, and then I dropped out. I ended up finishing an office administration course at a local college which was only a year long, and I got a job at a real estate office answering phones after that. I’m not knocking answering phones – an honest living is a good living – but it really affected my self-esteem to have to admit I was a college dropout.

I met my husband there; he’s a broker and he’s really good. It turns out I actually had a knack for sales, and I eventually completed a real estate course and started selling houses. After about a year and a half, we got pregnant.

Because my depression was never professionally treated, when I gave birth and was diagnosed with postpartum depression, my emotional state was shot. I should have been so happy and content that I had this beautiful new baby, that my husband and I were making a great living, and I actually turned out okay, despite anything that I thought of myself. But I was in tears all the time and tried to get a sitter for my baby all the time, even though I wasn’t doing anything. My mother-in-law would always want the baby, of course, and she’d pick Cassie up and I’d lock myself in my bedroom and cry for hours. My husband urged me to see a therapist. I did. I went once a week.

After about six or seven months, my husband found me on our bed just shaking uncontrollably and sobbing so hard I felt like my eyes were popping out of my face. I couldn’t feel my lips. My skin was covered in thick tears, and he held me and said, ‘Honey. I think we need to bring you in.’

I started yelling and saying, no, no, they’re just going to give me pills, and I don’t want pills. I was still nursing and I was just mortified to think the medication was going to pass into my breast milk and into Cassie. But Andrew was so good… he reminded me that there was more than just one option. I could either stop nursing and take the medication, or I could keep nursing and take the medication as long as I was assured it was safe, or I could do nothing and stay like this, and affect my daughter negatively anyway.

The next day I was in my doctor’s office. This isn’t going to be the same story or decision for everyone, so I’m not making any suggestions here – I’m just sharing my story. I decided that I’d been nursing for six months, and we could make the move to formula. I wanted to be healthier for my daughter, and this was our best route. I could take the medicine, go to therapy, and finally be present for her the way she deserved me to be.

I was on antidepressants for a year, and I was good for about three years. After I relapsed, I went back to my doctor right away – this time, I didn’t wait and I didn’t fight. For me, I have faith that medication gets my chemistry back where it needs to be. I’m less afraid of the medication than I am of falling back to where I was, which was such a dark, desperate place.

Medication for depression not for everyone, I get it. But for me it was a blessing and something that I needed to pull me out when nothing else could.  

What are the benefits of antidepressants?

Combined with talk therapy, antidepressants can be very effective in treating depression. They can improve your mood, your appetite, your focus and your sleep, as well as lifting other symptoms that occur with depression, like restlessness, fatigue, exhaustion and agitation. If you are thinking about suicide, antidepressants can decrease the symptoms that trigger those thoughts as well.


What are the different types of antidepressants?


There are several different types of antidepressants. They are Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants and Monoamine Oxidase Inhibitors (MAOIs). There are also Atypical Antidepressants.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs), which were intentionally developed as antidepressants in the 70s, work by inhibiting the reuptake of serotonin, making more serotonin available for your body to use.

SSRIs are particularly helpful for depression, panic disorder, obsessive compulsive disorder (OCD), generalized anxiety disorder, post-traumatic stress disorder (PTSD) and social anxiety disorder. Experts say that SSRIs are generally safe for even frail or vulnerable patients, and generally speaking don’t result in weight gain. It takes about four to six weeks of regular use before you’ll start to see the benefits, and a full 12 weeks before you start feeling any kind of significant difference. Some have reported feeling worse in the first two weeks of use.

Many people find SSRIs to be their best option because they have fewer side effects than other medication types. Still, side effects can include nausea, sexual dysfunction, headaches, sleeplessness, agitation and a worsening of symptoms.

Here is a list of some SSRIs you might recognize:

Prozac (fluoxetine)
Celexa (citalopram)
Lexapro (escitalopram)
Paxil (paroxetine)
Zoloft (sertraline)
Luvox (fluvoxamine)
Viibryd (vilazodone)
 
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
 
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), which were first brought to market in the early 90s, work similarly to SSRIs, but in addition to inhibiting the reuptake of serotonin, they inhibit the reuptake of norepinephrine as well. For people who are suffering from exhaustion or fatigue (which experts refer to as depression with psychomotor retardation), or patients with chronic fatigue syndrome or fibromyalgia, which is a long-term condition that causes pain all throughout the entire body), SNRIs may be helpful.

Side effects of SNRIs are nausea, dry mouth, dizziness, insomnia, tiredness, constipation, or increased anxiety. In some cases, you may experience changes in sexual function, or you may find yourself excessively sweating. Generally, however, professionals will say that side effects are often mild and go away after the first few weeks. If you find that one SNRI isn’t working for you, another may do the trick.

Here is a list of some SNRIs you might recognize:

Effexor (venlafaxine)
Cymbalta (duloxetine)
Savella (milnacipran)
Fetzima (levomilnacipran)
Pristiq (desvenlafaxine)
 
Tricyclic Antidepressants
 
Tricyclic antidepressants were developed in the 1950s. Some people know them as tetracyclic or cyclic. They are often used to treat obsessive compulsive disorder (OCD) and depression, and work by increasing two mood-altering chemicals in the brain: norepinephrine and serotonin. It’s believed that TAs increase the levels of these chemicals by stopping nerve endings from drawing these chemicals back into the tissue.
 
These types of medications are known to have more side effects than newer options. Some of the side effects of tricyclic antidepressants include dry mouth, dizziness, lightheadedness, sweating, drowsiness, blurred eyesight, urinary retention, heart tremors, low blood pressure, confusion, weight gain, lowered sex drive, racing heartbeat, sexual difficulties, and restlessness. If you are under 25 or over 65, have diabetes, heart problems, glaucoma, liver disease, or are taking other mood-altering drugs, consult your doctor before taking tricyclic antidepressants. You should also not be drinking alcohol if you are taking tricyclic antidepressants.
 
Here are some examples of tricyclic antidepressants you might recognize:
 
Elavil (mitriptyline)
Norpramin (desipramine)
Asendin (amoxapine)
Anafranil (clomipramine)
Pamelor (nortriptyline)
Tofranil (imipramine)
Vivactil (protriptyline)
Surmontil (trimipramine)
Sinequan (doxepin)
Maprotiline
 
Monoamine Oxidase Inhibitors (MAOIs)
 
These are the oldest class of antidepressants still available on the market today. They were first used in the 1950s, and are used to treat depression, and other psychological or psychiatric disorders, including panic disorder, bipolar disorder, social anxiety disorder, post-traumatic stress disorder (PTSD), anorexia and bulimia, and even Parkinson’s disease. They work by balancing specific chemicals by inhibiting monoamine oxidase, an enzyme in the brain.
 
It’s not typical for doctors to turn to MAOIs first, because so many newer and more effective options are so widely available. Side effects of MAOIs include: nausea, diarrhea, constipation, drowsiness, headache, insomnia, dizziness, skin reactions, weight gain, skin tingling, difficulty urinating, agitation, low blood pressure, muscle pain, sexual dysfunction, and dry mouth.
 
The risk of experiencing side effects with MAOIs is higher than other antidepressants, especially when taken with specific drugs or even certain foods. Your doctor may tell you to avoid the following foods: caffeine (including tea, coffee and soda), chocolate, some fruits (bananas, dried fruits, raspberries, overripe fruits), beer, red wine, certain liqueurs, anchovies, caviar, beef, chicken liver, pepperoni, bologna, salami, cured meats, aged cheese, yogurt, sauerkraut, fava beans, shrimp paste and herring. Consult your doctor for a full list of foods and beverages to avoid.
 
Some examples of monoamine oxidase inhibitors include:
 
Marplan (isocarboxazid)
Emsam (selegiline)
Parnate (tranylcypromine)
Nardil (phenelzine)
 
Atypical Antidepressants
 
Atypical antidepressants don’t fall into any of the above categories. They are known to work by changing dopamine, serotonin or norepinephrine, but each of these medications work differently from one another.
 
Like with other antidepressants, there is a possibility that you will experience side effects. Some will go away after the first few weeks, but if they persist and are uncomfortable, your physician may opt for a different medication.
 
Here is a list of antidepressants approved by the Food and Drug Administration (FDA):
 
Trintellix (vortioxetine)
Trazodone
Nefazodone
Wellbutrin, Aplenzin, Forfivo XL (bupropion)
Remeron (mirtazapine)
 
Because these are atypical medications, every one of the medications listed above have different side effects. Some of them cause dry mouth or dizziness, while others cause insomnia. Some cause constipation, while others cause diarrhea. Some increase appetite, causing weight gain, while others cause nausea (which means you’ll likely be turning food away). It’s been said that this classification of antidepressants has the smallest risk of sexual dysfunction.


How do I know what antidepressant medication is right for me?


While it’s a great idea to read as much as you can about medication and the possibility of helping you recover from depression, it’s best to see your doctor. From the side effects you see above, list the ones you would find most troubling, and let your doctor know – he or she will try to find a medication for your depression with the smallest likelihood of causing that set of side effects. If you do start one medication and it doesn’t work for you, you will be provided other options.
 
Are antidepressants effective – and safe – for teens?
 
If you are a teenager or the parent of a child or teen, and are looking for depression medication options, it’s a good idea to consult with a medical professional. Teens with depression may have a family history, and other factors must also be considered, including hormonal changes and developmental factors. Each of the antidepressant medication categories above can be helpful for a teen looking into antidepressant medication.
 
If you want to know more about medication and depression, see your family doctor. You can also visit our location in Springfield Virginia to make an appointment with a mental health professional who can lead you in the right direction.


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