Answers to Your
Questions About Depression and Medication
By Kathy Koshgarian and
Kathy Labriola
WHAT IS DEPRESSION?
Depression is a
serious illness that affects between 30 to 40 million Americans. One out of every four people will experience
at least one extended episode of major depression at some point during their
lives. Only one-fourth to one-half of
those who suffer form depression receives any type of counseling or
medication. The most tragic outcome of
this lack of treatment is that over thirty thousand Americans commit suicide
every year.
Depression is
still poorly understood, and treatment is for from perfect. However, in recent years, intensive research
and advances in science and medicine have led to dramatic improvements in
effective treatments. As a result, many
more options now exist for people suffering from depression, to help them feel
better, do more, and improve their overall quality of life.
If you struggle with depression, creating your own individual strategy
to combat it can seem overwhelming. It
helps to learn about depression through reading, talking with trusted friends
or a counselor, and working with your doctor or primary health care provider to
learn about all the treatment options available to you.
For
many people, one-to-one counseling or psychotherapy is the most effective way
to get a handle on their depression and effectively work to relieve it. Many others find that support groups or
therapy groups provide the most relief from their depression, giving them the
ongoing support to make changes in their lives and pursue their goals. Others successfully use meditation,
hypnotherapy, an exercise program, or herbal treatments to manage and even
overcome their depression. Many people
discover that an alcohol or drug problem or some other type of addiction is at
the root of their depression, and find that participation in 12-step or other
types of addiction recovery
programs dramatically improves their depression. There are many different approaches to
depression, and only you can decide which path is right for you.
In the past few
years, more and more people are utilizing some combination of counseling and
antidepressant medication. Recent
studies indicate that this combination may be the most effective treatment for
depression. If you think that
anti-depressant medication may be right for you as part of you plan for
overcoming depression, this pamphlet can give you more information to help you
make the best possible decision.
WHAT ARE
ANTIDEPRESSANTS?
Anti
depressants are drugs, which help to relieve the symptoms of depression. Many types of antidepressants have been
developed over the past 40 years, and in the past 10 years several new
antidepressants have been developed which are more effective and have fewer
side effects. While it is not understood
exactly how these drugs work, they seem to alter the neurotransmitters in the
brain, which control moods. Some
research indicates that people who are depressed do not have enough Serotonin
and other important chemicals in the brain.
Keeping these levels of chemicals consistent in the brain appears to
stabilize mood, helping people feel better, have more energy, be able to function
more effectively in life and experience more positive feelings.
There are many different types
of antidepressants, varying doses, and many potential side effects. So it is very important to have a thorough
medical to discussion with your health care provider to determine whether
antidepressants may help you, and if so, which medication and dosage may be
right for you. And because it usually
takes at least a few weeks of taking antidepressants before you will start
feeling better, it is important to take these medications exactly as prescribed, and not to skip any doses. Because some of the side effects can be very
unpleasant and even dangerous, it is important that you have follow-up visits
with you health care provider to discuss whether to adjust the dose or change
to a different medication. Many people
go through a process of working with their doctor and trying out two or three
antidepressants and gradually adjusting the dosages before they find the drug
and the dose that gives them the maximum relief of their depression symptoms
with the minimum of side affects.
ANTI-DEPRESSANTS
·
WELLBUTRIN
·
EFFEXOR
·
SERZONE
WELLBUTRIN (bupropion hydrochloride)
Drug Class
Antidepressant
Principle use
To relieve
symptoms of major depression. Also is
used to help people stop smoking.
Common Side Effects
As an antidepressant: nausea or vomiting,
constipation, unusual weight loss, dry mouth, loss of appetite, dizziness,
increased sweating, trembling. As a
smoking cessation aid: Dry mouth, insomnia.
Onset of effect
Usually
takes 1-3 weeks to feel better.
Cautions
Disease
Interaction: Wellbutrin should not be taken if you have a history of seizures,
anorexia nervosa or bulimia.
Work
Use caution until
you see how the medication affects you as drowsiness or lightheadedness can
occur.
Alcohol
It is recommended
to not drink alcohol at all or to drink very little while taking
Wellbutrin. If you drink regularly it is
highly suggested that you taper off alcohol as the possibility of a seizure
while detoxifying from alcohol increases when on Wellbutrin.
Pregnancy
Wellbutrin has
not caused birth defects in animals.
However, it is not recommended that buprenex be taken while pregnant.
Breast Feeding
As with most
medications, buprenex passes into breast milk.
Avoid using while breast-feeding.
Food interaction
No known food interaction.
EFFEXOR
(venlafaxine hydrochloride)
Drug
Class
Antidepressant
Principle uses
To treat symptoms of major depression.
Common Side
Effects
Fatigue,
dizziness or drowsiness, anxiety, dry mouth, changes sense of taste, loss of
appetite, nausea, vomiting, chills, diarrhea, constipation, prickly sensation
of skin, heartburn, increased sweating, runny nose, stomach gas or pain,
insomnia, unusual dreams, weight loss.
Onset of Effect
Takes at least 2 weeks or
more to take effect.
Duration of Action
Unknown.
Dietary Advice
Effexor should be
taken with meals for maximum absorption and to minimize any stomach discomfort.
Special Concerns
Effexor
can cause elevation on blood pressure.
Therefore, blood pressure should be monitored regularly, especially in
the first several months of therapy.
If
you have high blood pressure, it may be advisable for you to take a different
antidepressant rather than Effexor.
SERZONE (nefazodone hydrochloride)
Drug Class
Antidepressant
Principle uses
To
treat symptoms of major depression.
Side Effects
Drowsiness or
dizziness, agitation, dry mouth, confusion, constipation or diarrhea, unusual
dreams, heartburn, fever or chills, insomnia, loss of memory, headache,
flushing, nausea or vomiting, increased appetite.
Onset of Effect
The
full effect may take several weeks.
Precautions
Avoid alcohol,
breastfeeding and pregnancy while taking Serzone. Do not operate heavy equipment or drive until
you determine how the medicine effects you.
Use sugarless gum or candy for relief of dry mouth.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
·
ZOLOFT
·
PAXIL
·
PROZAC
·
LUVOX
·
CELEXA
ZOLOFT (sertraline
hydrochloride)
Drug Class
Antidepressant
(SSRI) Selective Serotonin
reuptake inhibitor
Principal Uses
To treat symptoms
of major depression, obsessive compulsive disorder and panic disorder.
Common Side
Effects
Insomnia, diarrhea, drop in libido, difficulty
becoming sexually aroused or reaching orgasm, decrease in appetite, weight
loss, drowsiness, headache, dry mouth, stomach cramps, abdominal cramps,
abdominal pain, gas, trembling, fatigue, loss of initiative.
Onset of Effect
1-4 weeks for depression to
begin to subside.
Duration of Action:
Unknown
Precautions
Avoid
alcohol
Special concerns
Take Zoloft at
least 6 hours before bedtime to prevent insomnia, unless the drug causes
drowsiness.
PAXIL (paroxetine
hydrochloride)
Drug Class
Antidepressant
(SSRI) Selective Serotonin
reuptake inhibitor
Principle Uses
To treat symptoms
of major depression, obsessive compulsive disorder and panic disorder.
Side
Effects
Insomnia,
dizziness, loss of libido, difficulty with sexual arousal and orgasm, unusual
fatigue, loss of initiative, nausea or vomiting, constipation, difficulty
urinating, headache, trembling.
Onset of Effect
1-4 weeks
Duration of Action
Unknown
Precautions
Avoid
alcohol
PROZAC (fluoxetine
hydrochloride)
Drug Class
Antidepressant (SSRI) Selective Serotonin reuptake inhibitor
Principal Uses
To treat symptoms
of major depression, obsessive compulsive disorder and panic disorder. Prozac has also recently been approved in low
doses to treat the symptoms of premenstrual syndrome (PMS) in women.
Common Side
Effects
Nervousness,
drowsiness, anxiety, insomnia, headache, diarrhea, excessive sweating, nausea,
decreased appetite, decreased initiative.
For men: difficulty getting erections.
For women and men: lack of interest in sex, difficulty becoming aroused
or having orgasm.
Onset of Effect
Often
takes up to 4 weeks to reduce symptoms of depression, so it is very important
to take as prescribed and continue taking it for at least 4 weeks to give it
time to take effect.
Duration of Action
Unknown
Precautions
Avoid
alcohol
LUVOX (fluvoxamine
maleate)
Drug class
Antidepressant (SSRI) Selective Serotonin reuptake inhibitor
Principle use
to treat obsessive-compulsive
disorder
How it works
Luvox
affects Serotonin levels in the brain, which is believed to affect moods,
emotions, and mental states.
Onset of effectiveness:
unknown, usually takes at least two to three weeks to start to show relief of
symptoms.
Common side
effects
Insomnia,
decreased appetite, constipation, dry mouth, drow-siness, heartburn, runny
nose, weight loss, headaches, frequent urination, increased sweating, change in
taste, yawning.
Precautions
Adverse reactions
may be more severe in older people taking the drug.. Avoid alcohol while on this medication. This drug should not be taken by women who
are breast-feeding. Do not drive or
engage in hazardous activity until you are on the drug for at least a few days
and feel certain that it will not impair your ability to do these activities
safely.
CELEXA (citaloprom hydrobomide)
Drug class
antidepressant, SSRI
Principle uses
to treat symptoms of major
depression
Common side
effects
Insomnia or sedation,
anxiety, dry mouth, nausea, increased sweating, less interest in sex, for men:
difficulty maintaining and erection.
Less common side effects
migraine
headaches, fatigue, dizziness, tremors, suicidal feelings, impaired
concentration, anorexia, sinus congestion, muscle pains, for women: increased
menstrual problems.
Onset of effect
takes
between one to four weeks of taking drug
for symptoms of depression to subside somewhat.
Precautions
This
drug has dangerous and even POTENTIALLY FATAL INTERACTIONS with many other
drugs and conditions. Be sure to tell
your doctor about any and all prescription drugs, over the counter medications,
and recreational drugs you are currently taking, including your alcohol use,
and be sure to consult your doctor before starting on any new medications, even
non-prescription medicines. If you are
taking Celexa you should avoid using alcohol or any other central nervous
system depressant drugs, such as sleeping pills, tranquilizers, pain
medications, or any “downs,” as these drugs in combination can lower your heart
rate and breathing to dangerous levels. If you are taking carbamazepine (the
brand name is Tegretol, a drug prescribed for seizures), imipramine (Tofranil,
an anti-depressant and anti-anxiety drug), or Lithium (a drug prescribed for
bi-polar or manic-depressive disorder), it may be advisable for you to discuss
an alternative antidepressant instead of Celexa because of the potentially
dangerous drug interactions. Do
not take Celexa with any MAO inhibitors (a class of antidepressant
drugs) as the combination can be fatal!
If you have a history of seizures, mania, suicide attempts, or kidney or
liver impairment, you may be advised to start on a very low dose of Celexa to
establish safety or to try a different drug instead. Safety in pregnancy has not been established,
and pregnant women are advised not to take this drug.
RESOURCES FOR FURTHER INFORMATION
It
is important that you educate yourself and learn as much as you can about
depression and how to manage it effectively to minimize the negative effects on
your life. The following books are very
down to earth, readable, and full of useful information to help you. Your doctor, counselor, or health care
provider can also provide you with written materials and answer your questions
and concerns about depression.
When
Living Hurts: Directives for Treating Depression, by
Michael Yapko
Depression:
The Mood Disease; by Francis
Mondimore, MD
The
Depression Workbook; by Marie
Ellen Copeland
Clinical
Psychopharmacology Make Ridiculously Simple; by John
Preston and James Johnson, MD
Healthy
Pleasures; by Robert Ornstein and
David Sobel, MD
Feeling
Good: The New Mood Therapy; by
David D. Burns
The Deepest Blue: Women and Depression by Laura Dockett
Queer Blues: The Lesbian and Gay Guide to Overcoming Depression, by Kimeron Hardin and Marny Hall, Ph