Posted by Aurora on Tue, 05/08/2012 - 3:47 PM
TREATMENT OF DEPRESSION
Affecting 121 million people worldwide(1), depression is considered a treatable condition. Without treatment there can be actual physiological changes to parts of the brain that that affect mood, thinking, sleep, appetite and behavior(2). "[R]esearch suggests that many people benefit from a combination of medication and therapy."(3)
Diagnosis of depression is determined considering number, duration and severity of the following symptoms: depressed mood, loss of interest or pleasure in normal activities, changes in sleep patterns, changes in appetite or weight, slowed or restless movements, fatigue and loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating or making decisions, recurring thoughts of death or suicide.
There are four main categories of medications that treat depression:
1) SSRIs - Selective Serotonin Reuptake Inhibitors
[i.e., Prozac, Celexa, Paxil, Lexapro, Fluvoxamine, Zoloft]
2) SNRIs - Serotonin and Norepinephrine Reuptake Inhibitors
[i.e., Effexor, Cymbalta, Meridia]
3) TCAs - Tricyclic Antidepressants
[i.e., Elavil, Tofranil, Pamelor]
4) MAOIs - Monoamine Oxidase Inhibitors
[i.e., Nardil, Parnate]
Other anti-depressants such as Remeron and Wellbutrin do not fall into these categories.
"Approximately 60 to 70 percent of patients respond to the first antidepressant that is prescribed or to an increased dosage of that drug...," according to Mitchell Mathis, M.D. of the FDA(4). For others switching to a different medication or adding a medication increases their chances of being symptom-free. About 10 percent are medication treatment resistant and need to explore other options with their physician such as electroconvulsive therapy (ECT) or the more recent deep brain stimulation of the vagus nerve (VNS) or repetitive transcranial magnetic stimulation (rTMS)(5). The NIMH recommends antidepressants be taken for 6 to 12 months or longer if needed(6). Dr. Mathis also states that "Depression tends to be chronic and requires everyday treatment just like high blood pressure."(7)
Patients should always discuss with their prescribing physician all medication warnings, side effects, and contraindications. Regarding taking antidepressants during pregnancy, the patient should carefully weigh with her physician the risk of depression relapse against any and all risks to the baby. Patients with migraines should be aware that taking SSRIs or SNRIs with Triptans may cause life-threatening Serotonin Syndrome.
- Elizabeth S. York, M.Ed., LPC, LMFT