Q&A: Antidepressants
Aug 28, 2009
By Mike Herscher
In recent years, antidepressants have become increasingly popular and are now the most frequently prescribed drugs in the United States. In 2007, an estimated 30 million Americans spent about $12 billion on antidepressants. With this increased use comes increased awareness of both the benefits as well as the drawbacks of these medications. This article will explain some of the factors to consider when deciding if taking medication for depression is right for you.
There are many different kinds of antidepressants with varying side effects and effectiveness. One common class of antidepressant is called the selective serotonin reuptake inhibitors, or SSRIs. These drugs, such as Prozac, Paxil, and Zoloft, are thought to work by changing the activity of a chemical in the brain called serotonin which seems to play a role in depression. These drugs tend to have fewer and less severe side effects than most other classes of antidepressant and are therefore frequently the first drug a doctor will prescribe for depression. Side effects can include dry mouth, insomnia, sexual problems, headache, and drowsiness. These reactions are present in a large percentage of patients taking SSRIs, although they frequently disappear with continued use of the drug.
A newer class of antidepressants called "SNRIs," or sometimes "SSNRIs," which includes the drugs Effexor and Cymbalta, affects serotonin as well as another chemical in the brain, norepinephrine. Side effects of these drugs include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased heart rate and increased cholesterol levels can also occur. These drugs may be slightly more effective at relieving depression than the SSRIs, and also are useful at relieving the pain symptoms that may be present in some depressed patients.
While all of these drugs can have undesirable side effects, they also allow many people to live normal lives which would otherwise not be possible. It is easy to stigmatize antidepressants as "lifestyle" drugs, especially since they have become so commonplace, but for many suffering from moderate or severe depression, they can literally be a lifesaver.
What other treatments for depression are there besides medication?
For mild or moderate depression, various forms of psychotherapy, or "talk therapy," can be effective treatment without antidepressant medication. In this therapy, the patient meets with a trained therapist and discusses their feelings, thoughts, and behavior. There are several different kinds of psychotherapy, and you can talk to your doctor about which kind might be right for you. For severe depression, psychotherapy may be used in addition to medication.
What about "alternative" treatments for depression?
While alternative treatments, those beyond the scope of Western medicine, may be useful in treating mild depression, they have not been shown to work well for moderate or severe depression. Some treatments include meditation, acupuncture, exercise, St. John's Wort, a molecule called SAM-e, and omega-3 fatty acids. Any "natural" supplement can have side effects and interact with other medicine you might be taking, so talk with your doctor before taking an herbal supplement such as St. John's Wort.
I've heard that antidepressants can increase suicidal thoughts. Is that true?
In 2004, the FDA began requiring antidepressants to carry a warning stating that the drugs could lead to increased suicidal thoughts or behavior in children and adolescents. It is still unclear whether these drugs actually increase the likelihood of suicide or whether they decrease its likelihood by treating depression. If you are considering giving an antidepressant to a child or adolescent, you should talk with your doctor about this issue.
How long will I have to take antidepressants for?
Some people have a single episode of depression and take antidepressants for 6 to 12 months, while others may need to take medication indefinitely. There is no evidence that long-term use causes any persistent side effects that do not subside when the medication is discontinued.
Patients may need to take the medication for four to six weeks to get the full benefit of the drug. Once they are ready to stop taking it, they may need to stop gradually in order to avoid withdrawal symptoms that can include dizziness, fatigue, nausea, headaches, and anxiety. Despite these discontinuation symptoms, antidepressants are not considered to be addictive.
Where can I learn more about depression treatments?
The following websites and phone numbers can help you to learn more about depression treatments:
The National Institue of Mental Health
http://www.nimh.nih.gov/health/topics/depression/index.shtml
(866) 615-6464
Depression and Bipolar Support Alliance
http://www.dbsalliance.org
(800) 826-3632
Article funded through the Asian Health Initiative of Tufts Medical Center
In recent years, antidepressants have become increasingly popular and are now the most frequently prescribed drugs in the United States. In 2007, an estimated 30 million Americans spent about $12 billion on antidepressants. With this increased use comes increased awareness of both the benefits as well as the drawbacks of these medications. This article will explain some of the factors to consider when deciding if taking medication for depression is right for you.
There are many different kinds of antidepressants with varying side effects and effectiveness. One common class of antidepressant is called the selective serotonin reuptake inhibitors, or SSRIs. These drugs, such as Prozac, Paxil, and Zoloft, are thought to work by changing the activity of a chemical in the brain called serotonin which seems to play a role in depression. These drugs tend to have fewer and less severe side effects than most other classes of antidepressant and are therefore frequently the first drug a doctor will prescribe for depression. Side effects can include dry mouth, insomnia, sexual problems, headache, and drowsiness. These reactions are present in a large percentage of patients taking SSRIs, although they frequently disappear with continued use of the drug.
A newer class of antidepressants called "SNRIs," or sometimes "SSNRIs," which includes the drugs Effexor and Cymbalta, affects serotonin as well as another chemical in the brain, norepinephrine. Side effects of these drugs include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased heart rate and increased cholesterol levels can also occur. These drugs may be slightly more effective at relieving depression than the SSRIs, and also are useful at relieving the pain symptoms that may be present in some depressed patients.
While all of these drugs can have undesirable side effects, they also allow many people to live normal lives which would otherwise not be possible. It is easy to stigmatize antidepressants as "lifestyle" drugs, especially since they have become so commonplace, but for many suffering from moderate or severe depression, they can literally be a lifesaver.
What other treatments for depression are there besides medication?
For mild or moderate depression, various forms of psychotherapy, or "talk therapy," can be effective treatment without antidepressant medication. In this therapy, the patient meets with a trained therapist and discusses their feelings, thoughts, and behavior. There are several different kinds of psychotherapy, and you can talk to your doctor about which kind might be right for you. For severe depression, psychotherapy may be used in addition to medication.
What about "alternative" treatments for depression?
While alternative treatments, those beyond the scope of Western medicine, may be useful in treating mild depression, they have not been shown to work well for moderate or severe depression. Some treatments include meditation, acupuncture, exercise, St. John's Wort, a molecule called SAM-e, and omega-3 fatty acids. Any "natural" supplement can have side effects and interact with other medicine you might be taking, so talk with your doctor before taking an herbal supplement such as St. John's Wort.
I've heard that antidepressants can increase suicidal thoughts. Is that true?
In 2004, the FDA began requiring antidepressants to carry a warning stating that the drugs could lead to increased suicidal thoughts or behavior in children and adolescents. It is still unclear whether these drugs actually increase the likelihood of suicide or whether they decrease its likelihood by treating depression. If you are considering giving an antidepressant to a child or adolescent, you should talk with your doctor about this issue.
How long will I have to take antidepressants for?
Some people have a single episode of depression and take antidepressants for 6 to 12 months, while others may need to take medication indefinitely. There is no evidence that long-term use causes any persistent side effects that do not subside when the medication is discontinued.
Patients may need to take the medication for four to six weeks to get the full benefit of the drug. Once they are ready to stop taking it, they may need to stop gradually in order to avoid withdrawal symptoms that can include dizziness, fatigue, nausea, headaches, and anxiety. Despite these discontinuation symptoms, antidepressants are not considered to be addictive.
Where can I learn more about depression treatments?
The following websites and phone numbers can help you to learn more about depression treatments:
The National Institue of Mental Health
http://www.nimh.nih.gov/health/topics/depression/index.shtml
(866) 615-6464
Depression and Bipolar Support Alliance
http://www.dbsalliance.org
(800) 826-3632
Article funded through the Asian Health Initiative of Tufts Medical Center
Article Reference: http://www.sampan.org/show_article.php?display=2066
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