The kind of depression that will most likely benefit from treatment with medications is more than just “the blues.” It is a condition that is prolonged, lasting two weeks or more, and interferes with a person’s ability to carry on daily tasks and to enjoy activities that previously brought pleasure.
The depressed person will seem sad, or “down,” or may show a lack of interest in his surroundings. That person may have trouble eating and lose weight (although some people eat more and gain weight when depressed). He may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. She may speak of feeling guilty, worthless, or hopeless. He may complain that his thinking is slowed down. She may lack energy, feeling “everything’s too much,” or she might be agitated and jumpy.
A person who is depressed may cry. He may think and talk about killing himself and may even make a suicide attempt. Some people who are depressed have psychotic symptoms, such as delusions (false ideas) that are related to their depression. For instance, a psychotically depressed person might imagine that she is already dead, or “in hell,” being punished.
Not everyone who is depressed has all these symptoms, but everyone who is depressed has at least some of them. A depression can range in intensity from mild to severe.
Antidepressants are used most widely for serious depression, but they can also be helpful for some milder depressions. Antidepressants, although they are not “uppers” or stimulants, take away or reduce the symptoms of depression and help the depressed person feel the way he did before he became depressed.
Antidepressants also are used for anxiety disorders. They can block the symptoms of panic, including rapid heartbeat, terror, dizziness, chest pains, nausea and breathing problems. They also can be used to treat some phobias.
The physician chooses a particular antidepressant based on the individual patient’s symptoms. When someone begins taking an antidepressant, improvement generally will not begin to show immediately. With most of these medications, it will take from one to three weeks before changes begin to occur.
Some symptoms diminish early in treatment; others, later. For instance, a person’s energy level or sleeping or eating patterns may improve before his depressed mood lifts. If there is little or no change in symptoms after five to six weeks, a different medication may be tried. Some people will respond better to one than another.
Since there is no certain way of determining beforehand which medication will be effective, the doctor may have to prescribe first one, then another, until an effective one is found. Treatment is continued for a minimum of several months and may last up to a year or more.
While some people have one episode of depression and then never have another, or remain symptom-free for years, others have more frequent episodes or very long-lasting depressions that may go on for years.
Some people find that their depressions become more frequent and severe as they get older. For these people, continuing (maintenance) treatment with antidepressants can be an effective way of reducing the frequency and severity of depressions. Those medications that are commonly used have no known long-term side effects and may be continued indefinitely.
The prescribed dosage of the medication may be lowered if side effects become troublesome. Lithium also can be used for maintenance treatment of repeated depressions regardless of whether there is evidence of a past manic or manic-like episode.
Antidepressant dosage varies, depending on the type of drug, the person’s body chemistry, age, and, sometimes, body weight. Dosages are generally started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects.
There are a number of antidepressant medications available. They differ in their side effects and, to some extent, in their level of effectiveness. Tricyclic antidepressants (named for their chemical structure) are more commonly used for treatment of major depressions than are monoamine oxidase inhibitors (MAOIs), but MAOIs are often helpful in so-called “atypical” depressions in which there are symptoms like oversleeping, anxiety, panic attacks, and phobias.
The last few years have seen the introduction of a number of new antidepressants. Several of them are called “selective serotonin reuptake inhibitors” (SSRIs). Those available at the present time in the United States are fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). Luvox has been approved for obsessive-compulsive disorder , and Paxil has been approved for panic disorder.
Though structurally different from each other, all the SSRIs’ antidepressant effects are due to their action on one specific neurotransmitter, serotonin. Two other antidepressants that affect two neurotransmitters, serotonin and norepinephrine, also have been approved by the FDA. They are venlafaxine (Effexor) and nefazodone (Serzone). All of these newer antidepressants seem to have less bothersome side effects than the older tricyclic antidepressants.