The first step to getting appropriate treatment for depression is a
physical examination by a physician. Certain medications as well as
some medical conditions such as a viral infection can cause the same
symptoms as depression, and the physician should rule out these
possibilities through examination, interview, and lab tests. If a
physical cause for the depression is ruled out, a psychological
evaluation should be done, by the physician or by referral to a
psychiatrist or psychologist.
Treatment choice will depend on the outcome of the evaluation. There
are a variety of antidepressant medications and psychotherapies that
can be used to treat depressive disorders. Some people with milder
forms may do well with psychotherapy alone. People with moderate to
severe depression most often benefit from antidepressants. Most do
best with combined treatment: medication to gain relatively quick
symptom relief and psychotherapy to learn more effective ways to
deal with life's problems, including depression. Depending on the
patient's diagnosis and severity of symptoms, the therapist may
prescribe medication and/or one of the several forms of
psychotherapy that have proven effective for depression.
Electroconvulsive therapy (ECT) may be recommended for individuals
whose depression is severe or life threatening or who cannot take
antidepressant medication or find other relief.
Standard Medications
There are several types of antidepressant medications used to treat
depressive disorders. These include newer medications—chiefly the
selective serotonin reuptake inhibitors (SSRIs)—the tricyclics, and
the monoamine oxidase inhibitors (MAOIs). The SSRIs—and other newer
medications that affect neurotransmitters such as dopamine or
norepinephrine—generally have fewer side effects than tricyclics.
Sometimes the doctor will try a variety of antidepressants before
finding the most effective medication or combination of medications.
Sometimes the dosage must be increased to be effective. Although
some improvements may be seen in the first few weeks, antidepressant
medications must be taken regularly for 3 to 4 weeks (in some cases,
as many as 8 weeks) before the full therapeutic effect occurs.
For questions on benefits or side effects of specific medications,
see
www.drugs.com
Some medications must be stopped gradually to give the body time to
adjust.
Never
stop taking an antidepressant without consulting the doctor for
instructions on how to safely discontinue the medication.
For individuals with bipolar disorder or chronic major depression,
medication may have to be maintained indefinitely.
For the small number of people for whom MAO inhibitors are
considered the best treatment, it is necessary to avoid certain
foods that contain high levels of tyramine, such as many cheeses,
wines, and pickles, as well as medications such as decongestants.
The interaction of tyramine with MAOIs can bring on a hypertensive
crisis, a sharp increase in blood pressure that can lead to a
stroke. The doctor should furnish a complete list of prohibited
foods that the patient should carry at all times. Other forms of
antidepressants require no food restrictions.
Antianxiety drugs or sedatives are not antidepressants. They are
sometimes prescribed along with antidepressants; however, they are
not effective when taken alone for a depressive disorder.
Stimulants, such as amphetamines, are not effective antidepressants,
but they are used occasionally under close supervision in medically
ill depressed patients.
Lithium has for many years been the treatment of choice for bipolar
disorder, as it can be effective in smoothing out the mood swings
common to this disorder. Its use must be carefully monitored, as the
range between an effective dose and a toxic one is small. If a
person has preexisting thyroid, kidney, or heart disorders or
epilepsy, lithium may not be recommended. Fortunately, other
medications have been found to be of benefit in controlling mood
swings. Among these are two mood-stabilizing anticonvulsants,
carbamazepine (Tegretol®) and valproate (Depakote®).
Both of these medications have gained wide acceptance in clinical
practice, and valproate has been approved by the Food and Drug
Administration for first-line treatment of acute mania. Other
anticonvulsants that are being used now include lamotrigine (Lamictal®)
and gabapentin (Neurontin®): their role in the treatment
hierarchy of bipolar disorder remains under study.
Source: National Institutes of Health
Side effects of antidepressants are numerous, and particular concern
has arisen regarding their use by children, for whom they have not
been well tested. An increase in suicidal thoughts among children on
some of these drugs has resulted in re-labeling of the medication
and banning their use in some countries.
Copyright ©2007 Association for Comprehensive
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