Antidepressants

What You Need to know About Depression Medication





If you’re suffering from major depression, antidepressant medication may relieve some of your symptoms. Antidepressants aren’t a silver bullet for depression, and they come with their own side effects and dangers. Plus, recent studies have raised questions about their effectiveness.
Learning the facts about antidepressants and weighing the benefits against the risks can help you make an informed and personal decision about whether medication is right for you.
Is depression caused by a chemical imbalance in the brain?


You’ve seen it in television ads, read it in newspaper articles, maybe even heard it from your doctor: depression is caused by a chemical imbalance in the brain that medication can correct. According to the chemical imbalance theory, low levels of the brain chemical serotonin lead to depression and depression medication works by bringing serotonin levels back to normal. However, the truth is that researchers know very little about how antidepressants work. There is no test that can measure the amount of serotonin in the living brain – no way to even know what a low or normal level of serotonin is, let alone show that depression medication fixes these levels.
While antidepressant drugs such as Prozac increase serotonin levels in the brain, this doesn’t mean that depression is caused by a serotonin shortage. After all, aspirin may cure a headache, but it doesn’t mean that headaches are caused by an aspirin deficiency. Furthermore, many studies contradict the chemical imbalance theory of depression. Experiments have shown that lowering people’s serotonin levels doesn’t always lower mood, nor does it worsen symptoms in people who are already depressed. And while antidepressants raise serotonin levels within hours, it takes weeks before medication kicks in to relieve depression. If depression were due to low serotonin, there wouldn’t be an antidepressant medication lag.

How effective are antidepressants?


Researchers agree that when depression is severe, medication can be helpful – even life saving. However,research shows that antidepressants fall short for many people. A major government study released in 2006 showed that less than 50 percent of people become symptom-free on antidepressants, even after trying two different medications. Furthermore, many who do respond to medication slip back into major depression within a short while, despite sticking with drug treatment.
Other studies show that the benefits of depression medication have been exaggerated – with some researchers concluding that, when it comes to mild to moderate depression, antidepressants are only slightly more effective than placebos.
If you have severe depression that’s interfering with your ability to function, medication may be right for you. However, many people use antidepressants when therapy, exercise, or self-help strategies would work just as well or better – minus the side effects. Therapy can also help you get to the bottom of your underlying issues and develop the tools to beat depression for good.
Side effects of antidepressant medication


The types of drugs used in the treatment of depression are selective serotonin reuptake inhibitors (SSRIs), “atypical” antidepressants, and the older tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs). Side effects are common in all antidepressants and for many people, the side effects are serious enough to make them stop taking the medication.
Side effects of SSRIs (selective serotonin reuptake inhibitors)


The most widely prescribed antidepressants come from a class of medications known as selective serotonin reuptake inhibitors (SSRIs).
The SSRIs include:

• Fluoxetine (Prozac)
  
• Fluvoxamine (Luvox)
  
• Sertraline (Zoloft)
  
• Paroxetine (Paxil)
  
• Escitalopram (Lexapro)
  
• Citalopram (Celexa)
  

The SSRIs act on a chemical in the brain called serotonin. Serotonin helps regulate mood, but it also plays a role in digestion, pain, sleep, mental clarity, and other bodily functions. As a result, the SSRI antidepressants cause a wide range of side effects.
Common side effects include sexual problems, drowsiness, sleep difficulties, and nausea. While some side effects go away after the first few weeks of drug treatment, others persist and may even get worse.
In adults over the age of 65, SSRIs pose an additional concern. Studies show that SSRI medications may increase the risk for falls, fractures, and bone loss in older adults. The SSRIs can also cause serious withdrawal symptoms if you stop taking them abruptly.

Side effects of atypical antidepressants


There are a variety of newer depression drugs, called atypical antidepressants, which target other neurotransmitters either alone or in addition to serotonin. Some of the brain chemicals they affect include norepinephrine and dopamine.
The side effects vary according to the specific drug. However, many of the atypical antidepressants can cause nausea, fatigue, weight gain, sleepiness, nervousness, dry mouth, and blurred vision.
The atypical antidepressants include:

Bupropion (Wellbutrin) Venlafaxine (Effexor) Duloxetine (Cymbalta)

Mirtazapine (Remeron) Trazodone (Desyrel) Nefazodone (Serzone)

Side effects of older depression drugs


Tricyclic antidepressants and MAOIs (monoamine oxidase inhibitors) are older classes of antidepressants. Their side effects are more severe than those of the newer antidepressants, so they are only prescribed as a last resort after other treatments and medications have failed.

Antidepressant withdrawal


Once you’ve started taking antidepressants, stopping can be tough; many people have withdrawal symptoms that make it difficult to get off of the medication.
If you decide to stop taking antidepressants, it’s essential to taper off slowly. If you stop abruptly, you may experience a number of unpleasant withdrawal symptoms such as crying spells, extreme restlessness, dizziness, fatigue, and aches and pains. These withdrawal symptoms are known as antidepressant discontinuation syndrome. Antidepressant discontinuation syndrome is especially common when you stop taking Paxil or Zoloft. However, all medications for depression can cause withdrawal symptoms.
Depression and anxiety are also common symptoms when withdrawing from antidepressants. When depression is a withdrawal symptom, it’s often worse than the original depression that led to drug treatment in the first place. Unfortunately, many people mistake this withdrawal symptom for a return of their depressive illness and resume medication, creating a vicious circle.
In order to avoid antidepressant withdrawal symptoms, never stop your medication “cold turkey.” Instead, gradually taper your dose, allowing for at least 1-2 weeks between each dosage reduction. This tapering process may take up to several months, and should be monitored under a doctor's supervision.
Antidepressants and suicide risk


There is a danger that, in some people, antidepressant treatment will cause an increase, rather than a decrease, in depression. In fact, the U.S. Food and Drug Administration requires that all depression medications include a warning label about the increased risk of suicide in children and young adults. The suicide risk is particularly great during the first month to two months of treatment.
Anyone taking antidepressants should be closely watched for suicidal thoughts and behaviors. Monitoring is especially important if this is the person’s first time on depression medication or if the dose has recently been changed. Signs that medication is making things worse include anxiety, insomnia, hostility, and extreme agitation—particularly if the symptoms appear suddenly or rapidly deteriorate. If you spot the warning signs in yourself or a loved one, contact your doctor or therapist immediately.

Exploring your depression treatment options


Antidepressants aren’t a cure. Medication may treat some symptoms of depression, but can’t change underlying contributions to depression in your life. Antidepressants won’t solve your problems if you’re depressed because of a dead-end job, a pessimistic outlook, or an unhealthy relationship. That’s where therapy and other lifestyle changes come in.
Studies show that therapy works just as well as antidepressants in treating depression, and it’s better at preventing relapse once treatment ends. While depression medication only helps as long as you’re taking it, the emotional insights and coping skills acquired during therapy can have a more lasting effect on depression. However, if your depression is so severe that you don't have the energy to pursue treatment, a brief trial of antidepressants may boost your mood to a level where you can focus on therapy.
In addition to therapy, other effective treatments for depression include exercise, meditation, relaxation techniques, stress management, support groups, and self-help steps. While these treatments require more time and effort initially, their advantage over depression medication is that they boost mood without any adverse effects
Self-help for depression


Depression recovery begins with positive daily lifestyle choices. If you cultivate supportive relationships, challenge negative thoughts, and nurture your physical health, you can help yourself, slowly but surely, overcome your depression.