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