Medication Information

Introduction

People feel sad from time to time. This can be healthy and a natural reaction to events in people’s lives. In depression, this feeling of sadness is almost continuous and may have no obvious causes. In severe or 'clinical' depression, this feeling becomes overwhelming and can make you feel quite unable to cope, and hopeless about the future.

Approximately one person in six experiences depression of some kind in the course of their lifetime and one in 20 experiences clinical depression. At any one time, about one in 10 people will have some symptoms of depression. Of course, people who are depressed do not always seek help and even if they do, they may not always be diagnosed as depressed, so these figures are only estimates.

About twice as many women as men seek help for depression, though this may reflect the greater readiness of women to discuss their problems. Depression is especially common in older people, and the highest incidence of first attacks occurs between 55 and 65 in men and between 50 and 60 in women.

Anti-depressants

Anti-depressant drugs act by increasing the activity of those brain chemicals which affect the way we feel. Anti-depressants are thought to help 2 out of 3 of people with depression to some degree.  Tricyclic antidepressants, such as dothiepin, imipramine, and amitryptyline are often prescribed for moderate to severe depression. These usually take up to two weeks to start working and may have side effects.

Newer antidepressant drugs (SSRIs and SNRIs) target specific chemical 'messengers' in the brain. The most well known SSRI is fluoxetine (Prozac) but there are several other brands. These newer drugs are popular because they tend to have fewer side effects than older drugs.

Lithium carbonate is sometimes prescribed to people with severe depression. High levels of lithium in the blood are dangerous so anyone taking lithium must have regular blood tests.

If you are prescribed drugs for depression you will probably be advised to take them for at least six months - or longer if you have a previous history of depression. You may experience withdrawal effects if you stop taking anti-depressant drugs, particularly if you stop suddenly. These effects can include headache, nausea, dizziness and even hallucinations. Always consult your doctor before stopping taking anti-depressants. Do not stop taking medication suddenly, as the withdrawal effects may be severe.

Side-effects of anti-depressants

The various classes of antidepressants have different side effect profiles, although most have been associated with sedation, dry mouth, constipation, blurred vision, dizziness, and low blood pressure. Common side effects of SSRIs include difficulty sleeping, loss of appetite, headache, anxiety, flushing or sweating, and sexual dysfunction. The atypical antidepressants have similar effects, but are not associated with sexual dysfunction.

To greater or lesser extents, the tricyclics tend to cause some sedation. This may lessen with time. On the other hand, if a person is having difficulty sleeping or feels agitated, the sedating effects may be helpful. In addition to the effects listed above, the tricyclics may increase sensitivity to the sun, and infrequently cause abnormal heart rhythms or seizures in people with seizure disorders. MAOIs (Monoamine Oxidase Inhibitors) can cause low blood pressure, but the main concern with these drugs is the potential for a dangerous interaction with certain foods. Foods containing tyramine (such as aged cheeses, pickled fish, and red wines) can cause the release of norepinephrine from nerve endings, but in the presence of MAOIs there is decreased ability to metabolize this neurotransmitter, and severe high blood pressure can result. It is important for people receiving antidepressants to check with their physician or pharmacist before adding or discontinuing prescription and/or over-the-counter drugs.

Other Uses for Antidepressants

Antidepressants are used for several conditions in addition to depression. They are frequently used in the management of premenstrual dysphoric disorder (PMDD). PMDD consists of a group of debilitating mood and physical symptoms that occur up to two weeks before menstruation and cease after menses begins. The most common symptoms are depression, tension, anger, irritability, mood swings, headache, bloating, and changes in appetite and sleep. Several SSRIs have been used to reduce hot flushes in menopausal women and some cancer survivors who are on anti-estrogens (for breast cancer) or anti-androgens (for prostate cancer). Zyban® is used in some smoking cessation programs. Antidepressants are also used in treating obsessive-compulsive disorders, bulimia and some cases of anxiety.

Herbal Therapy

St. John's Wort (Hypericum perforatum) is a herb that has been widely used in Europe for the treatment of depression. It is available over-the-counter in many pharmacies and health food stores. Although it may have some merit in treating mild to moderate depression of limited duration, it is not recommended at this time for major depression. It appears to have multiple actions, including inhibition of MAO and inhibition of serotonin uptake.

There are many drug interactions with St. John’s Wort. It can increase the metabolism of some drugs, including birth control pills and the protease inhibitors used in the treatment of AIDS, thus decreasing their effects. By decreasing the effects of cyclosporine, rejection of some transplanted hearts has occurred. The potential for many other interactions exists. There is also increased sensitivity to the sun with St. John’s Wort. Current studies are underway about its place in therapy. In any event, St. John’s Wort, as well as other herbal supplements should be taken only after consultation with a physician or pharmacist.

Anti-depressants and therapy

Some people find the use of anti-depressants can be of use as a prelude to undertaking therapy, allowing them to feel in control enough to explore issues, thoughts and feelings which otherwise may have felt too engulfing or overwhelming. Throughout therapy, it may be useful if the client feels open to discuss how they feel about anti-depressants, the perceived effects and any changes in amounts or prescription that have occurred.

There is more information about depression, anxiety and stress in the client information section of this site.