Often, medications are the first choice in treatment, especially if you’re experiencing a severe depression or suicidal urges. Controlled studies have found that about 65%–85% of people get some relief from antidepressants, compared with 25%–40% of people taking a placebo (a pill with no biologically active ingredient). But the very same drug that works wonders for a friend may fail to ease your symptoms. You may need to try a few different medications to find the one that works best for you with as few side effects as possible. In some cases, a doctor may prescribe a combination of antidepressants or an antidepressant along with a drug to treat anxiety or distorted thinking. A drug combination may be more effective than either drug alone.
Doctors usually first prescribe medications from a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). SSRIs include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). Although the side effects of each drug vary slightly from person to person, you have an equal chance of success on any of these drugs. If you don’t have a good response to the first drug you try, you and your doctor may decide to switch to another.
Improvement may take timeAlthough in a few cases people report a change for the better as quickly as one or two weeks after beginning medication, more often it takes from two to six weeks for antidepressants to ease depression. The lag may reflect the time it takes the medications to affect processes inside the nerve cells and in brain circuits. It’s frustrating but true that side effects may appear before the benefits of a drug become obvious. Once you start to feel better, though, it’s important to take the medication for as long as it’s prescribed to get a full response and avoid a relapse.
While you are using medications, the doctor prescribing them should regularly monitor the dosage and your response. All medical treatments have advantages and disadvantages, and a doctor cannot predict an individual’s response to a given medication. While there’s a good chance that an antidepressant will relieve your symptoms, there’s also a possibility that you’ll encounter side effects. So when you’re about to embark on treatment, it’s important to weigh the potential benefits against the risks. Thankfully, most side effects can be managed or reversed.
Poor response to an antidepressant is often due to an inadequate dose. If the medication doesn’t seem to be working during the first phase of your treatment, don’t be surprised if your doctor suggests increasing the prescribed amount.
Not everyone who takes a drug will be bothered by side effects. If you do experience some, the first step is to report them to your doctor. Your doctor may be able to suggest simple, helpful adjustments. Many side effects disappear once your body becomes accustomed to the medication. Or, if necessary, you can try a different dosage or drug.
Antidepressants are not habit-forming or addictive. However, if you are about to stop taking these medications, your body needs to readjust slowly, so your doctor may instruct you to reduce the dosage gradually. Even if you do this, you may experience uncomfortable or disturbing symptoms. Sometimes these symptoms are mistaken for a recurrence of the illness.
While many antidepressants can be safely combined, some cannot. If you switch medications, you may need a washout period (a stretch of several weeks of taking no drugs) in order to prevent dangerous interactions between a new drug and the lingering effects of the previous one.
Choosing a medicationOne day it may be possible to use biological markers and other indicators to predict exactly which antidepressant will work best for each person. Right now, though, psychiatrists and doctors who prescribe antidepressants choose a particular drug and dosage based on many factors.
Diagnosis. Certain drugs work better for specific symptoms and types of depression. For example, some antidepressants may be better when insomnia is an issue. The severity of your illness or the presence of anxiety, obsessions, or compulsions may also dictate the choice of one drug over another.
Age. As you age, your body tends to break down drugs more slowly. Thus, older patients may need a lower dosage. For children, only a few medications have been studied carefully.
Health. If you have certain health problems, it’s best to avoid certain drugs. For this reason, it’s important to discuss medical problems with a primary care doctor or psychiatrist before starting an antidepressant.
Medications, supplements, and diet. When combined with certain drugs or substances, antidepressants may not work as well, or they may have worrisome or dangerous side effects. For example, taking SSRIs with another type of antidepressant known as monoamine oxidase inhibitors (MAOIs) can be fatal. Combining the herbal remedy St. John’s wort with an SSRI or an MAOI could lead to serious side effects, because this herb boosts serotonin. Likewise, mixing St. John’s wort with other drugs — including certain drugs to control HIV infection, cancer medications, and birth control pills — might lower their effectiveness. Eating certain foods, such as cheeses and pickles, while taking an MAOI can raise your blood pressure to dangerously high levels.
Alcohol or drugs. Alcohol and other substances can cause depression and make antidepressants less effective. Doctors often treat alcohol or drug addiction first if they believe either is causing the depression. In many instances, simultaneous treatment for addiction and depression is warranted.
Mental health and medication history. Depending on the nature and course of your depression (for example, if your depression is long-lasting or difficult to treat), you may need a higher dosage or a combination of drugs. This may also be true if an antidepressant has stopped working for you, which may occur naturally or after you’ve stopped and restarted treatment with it.
Understanding Depression, a report from Harvard Medical School, includes information about medications, therapy, and other treatments that can help people overcome depression and boost the likelihood of a full remission. Reading it and sharing it with loved ones might help improve your life—or the life of someone close to you. And, because depression remains a leading cause of suicide, the information might even be lifesaving.
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Comments: 8
I would also note not to be just looking for the side effects that are listed or that your doctor told you about. Also if you think that something is wrong, you know your body better than anyone, so listen to it! I had a bad reaction to one that developed into a major problem. My gums and the rest of my mouth swelled to the point that I couldn't eat and barely drink. My doctor said that it wouldn't get worse and would go a way, just keep taking them. It got worse and I ended up in the ER.
Far too much economic incentives occur between the drug industry, the treating psychiatrists, and the insuring agencies, which then helps preclude the more sage treatment protocols that address the cognitive and psychoanalytic functions of the client to get to the underlying problems that often lead to depression.
I can state it this way: the client feels powerless - consciously or unconsciously - when only being treated by medication, in much the same way the client felt powerless when the brain's neuronal architecture formed in a "plastic" way throught the brain's stages of childhood development in response to unaddressed stressors or outright mistreatment by primary caretakers. We can argue genetics and other strictly biological factors, but much like cancer, even if one is genetically predisposed to depression, requiring neurosynaptic drug intervention, that still does not address what triggered the disease in the first place. That would be like putting a bandage on cancer sores that have finally burst though the skin, making it obvious that there is a huge and unseen sickness destroying the organs out of sight beneath.
Denmark's socialized health system makes far too much use of drug intervention at the expense of long-term therapy regimes that can address the underlying causes for depression. This has been party to Denmark often being rated by the World Health Organization as having nearly the world's highest suicide rate. While drug intervention is absolutely vital, especially as short-term emergency intervention, it never should come at the expense of the more important treatment of undergoing talk-psychotherapy as well as giving the client the opportunity to learn cognitive techniques to engage in new behavioral patterns in response to stressors.
While such approaches are time consuming and in the short run, more expensive, the cost to society in only addressing depression through medication is far greater. It is important to intervene with medication, but that is only the first step in a long process of getting well. And then there are certain types of depression that truly only need the help of neurosynaptic intervention, but that is more often the exception than the rule. Depression generally hides a well of unconscious hurts.
I cope now in my own ways. I've given up on drugs. The one side effect I hate is chronic insomnia, and my doctor just recently told me I'm pretty much on my own with that since nothing they've tried as worked. Pills don't work. I've even had a doctor give me an injection when I was in the hospital which he said would put me out for an entire night. It lasted three hours. I'm exploring some non-medical things now as there is nothing more medically that can apparently be done and I have not slept through an entire night in close to 20 years. A good night for me would be only waking up 3-4 times.
I've been battling depression, generalized anxiety disorder, obsessive compulsive disorder, attention deficit/hyperactivity disorder, and suicidial tendencies since I was 10. It's taken me until I was 35 (2 years ago) to FINALLY get a "prescription cocktail" of drugs to make my life totally manageable.
I've tried homeopathic (sp?) methods and, honestly, they just didn't work for me. However, a good friend of mine is bi-polar and she manages just fine without drugs. Different strokes, different folks.
Anyway, even though I'm late to this post, I just wanted to say "thanks" for a really good article.