cont. from

Antidepressant Medications

The kind of depression that will most likely benefit from treatment with medications is more than just "the blues." It's a condition that's prolonged, lasting 2 weeks or more, and interferes with a person's ability to carry on daily tasks and to enjoy activities that previously brought pleasure.

The depressed person will seem sad, or "down," or may show a lack of interest in his surroundings. He may have trouble eating and lose weight (although some people eat more and gain weight when depressed). He may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. He may speak of feeling guilty, worthless, or hopeless. He may complain that his thinking is slowed down. He may lack energy, feeling "everything's too much," or he might be agitated and jumpy. A person who is depressed may cry. He may think and talk about killing himself and may even make a suicide attempt. Some people who are depressed have psychotic symptoms, such as delusions (false ideas) that are related to their depression. For instance, a psychotically depressed person might imagine that he is already dead, or "in hell," being punished.

Not everyone who is depressed has all these symptoms, but everyone who is depressed has at least some of them. A depression can range in intensity from mild to severe.

Antidepressants are used most widely for serious depressions, but they can also be helpful for some milder depressions. Antidepressants, although they are not "uppers" or stimulants, take away or reduce the symptoms of depression and help the depressed person feel the way he did before he became depressed.

Antidepressants are also used for disorders characterized principally by anxiety. They can block the symptoms of panic, including rapid heartbeat, terror, dizziness, chest pains, nausea, and breathing problems. They can also be used to treat some phobias.

Your physician will choose a particular antidepressant based on your symptoms. When you begin taking an antidepressant, improvement generally will not begin to show immediately. With most of these medications, it will take from 1 to 3 weeks before changes begin to occur. Some symptoms diminish early in treatment; others, later. For instance, energy level, or sleeping and eating patterns may improve before the depressed mood lifts. If there is little or no change in symptoms after 5 to 6 weeks, a different medication may be indicated, and you should discuss this with your physician. Some people respond better to one medication than to another. There is no certain way to determine which medication will be effective, so your doctor may have to prescribe first one, then another, until an effective one is found. Treatment with medication is continued for a minimum of several months and may last up to a year or more.

While some people have one episode of depression and then never have another, or remain symptom-free for years, others have more frequent episodes or very long-lasting depressions that may go on for years. Some people find that their depressions become more frequent and severe as they get older. For these people, continuing (maintenance) treatment with antidepressants can be an effective way of reducing the frequency and severity of depressions. Those that are commonly used have no known long-term side effects and may be continued indefinitely. The prescribed dosage of the medication may be lowered if side effects become troublesome. Lithium may also be used for maintenance treatment of repeated depressions whether or not there is evidence of a manic or manic-like episode in the past.

The dosage of antidepressants varies, depending on the type of drug, the person's body chemistry, age, and, sometimes, body weight. Dosages are generally started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects.

There are a number of different types of antidepressant medications available. They differ in their side effects and, to some extent, in their level of effectiveness. Tricyclic antidepressants (named for their chemical structure) used to be the most commonly used medications for treatment of major depressions. Monoamine oxidase inhibitors (MAOIs) were often used for "atypical" depressions in which there are symptoms like oversleeping, anxiety, panic attacks, and phobias. More recently, newer antidepressants have been developed. Several of them are called "selective serotonin reuptake inhibitors" (SSRIs). Some examples of SSRIs are fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). Though structurally different from each other, all the SSRI antidepressant effects are due to their action on one specific neurotransmitter, serotonin. Three other antidepressants that affect two neurotransmitters serotonin and norepinephrine have also been approved by the FDA. They are venlafaxine (Effexor), duloxetine (Cymbalta) and nefazodone (Serzone). All of these newer antidepressants seem to have less bothersome side effects than the older tricyclic antidepressants.

The tricyclic antidepressant clomipramine (Anafranil) affects serotonin but is not as selective as the SSRIs. It was the first medication specifically approved for use in the treatment of obsessive- compulsive disorder (OCD). Prozac, Luvox and Zoloft have since been approved for use with OCD.

Another of the newer antidepressants, bupropion (Wellbutrin), is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin. Wellbutrin has not been associated with weight gain or sexual dysfunction. It is contraindicated for individuals with, or at risk for, a seizure disorder or who have been diagnosed with bulimia or anorexia nervosa.

next: Side Effects of Antidepressants

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Reviewed: 01/2006