Treatment of depression with antidepressants, efficiency and disadvantages

 Treatment of depression with antidepressants

Antidepressants have a peculiar place in the public mind. Almost every family in the UK will have someone taking these drugs ; yet , the media are often very hostile to them with disparaging te rms such as “happy pills” (ANTIDEPRESSANTS)used to cast aspersions on their efficacy and utility ( Nutt 2003a ) . Mor eover , claims that they may cause suicidal ideation particularly in young people have lead to warning labels in the USA. Yet , despite the repeated media criticism , the use of antidepressants continues to be wid espread. S o what are the reasons for this? The first is that they are effective and the disorders they are used to treat are very common.

Depression is predicted to be largest cause of d isability in the world by 2020 ( Murray and Lopez 1997) and is now exceeding that of cardiovascular disease in many western countries (ma king it number one there already) . Moreover , several of the anxiety disorders are also in the top ten causes of disability , and these also respond very well to antidepressant treatment. In their primary target of depression , the antidepressants are effective treatments of the acute phase with a number needed to treat (NNT) of about 6 , which compares favourably with treatments in other branches of medicin e. However , when used in the long term to prevent recurrence of depression , they become even more effective with an NNT of 3 (Geddes et al 2003).
This makes them one of the most effective of any medicine: for comparison the NNT of statins to prevent the re currence of a myocardial infarction is about 20. Similar efficacy is seen in their secondary indications of the treatment of anxiety disorders. Moreover , the desire of many countries to reduce the prescribing of benzodiazepines has lead to a switch to the new antidepressants , particularly the selective serotonin reuptake inhibitors (SSRIs) that have greater efficacy and are much freer from problems such as abuse and withdrawal ( Nutt 2003b ) . Although the SSRIs take several weeks to work and can even worsen anxiety at the start of treatment after a few weeks , they become very effective anxiolytic treatments with efficacy exceedi ng that of the benzodiazepines . The SSRIs also have uses in other indications such as pain, some sleep disorders and some sexual problems (particularly SSRIs for premature ejaculation).
There are other factors underlying this increase in use. The most important one is that the newer an tidepressants are extremely safe drugs. Before their invention , the most commonly used antidepressants were those of tricyclic structure such a s amitriptyline and duselepin.
However , these are very toxic in overdose due to their combination of noradrenaline reuptake blocking properties and marked anticholinergic actions on the heart. At the peak of their use , they were the most common cause of drug overdose death in the UK, and still today kill hundr eds of people a year (Nutt 2005) . Patients with depression are at very high risk of suicide , and before the onset of the SSRIs , many used their antidepressants to kill themselves.
Details here

David Nutt

Imperial College London

Taking anti-depressants

Taking anti-depressants.Why am I telling you this? Apart from my constant desire to make everything about me?
Well I think it's important to say. Don't worry, I'm not going down the "spokesman for mental health" route. I just thought I'd share some information and my experience so far to help lessen the stigma attached to it.

And that's the thing. I've always been very open when talking about mental health issues. I talk about it on stage, to my friends and family, I even organised an Edinburgh Fringe show on the subject. It was only when I started taking anti-depressants about five weeks ago that the stigma became real for me. And it was a self-imposed stigma. I only told my very closest friends that I had started taking them, the ones I thought would be the most understanding. Thankfully they were, even the ones who said "I presumed you were on them anyway".
On Saturday I was at a conference and went to take my meds after lunch. I caught myself surreptitiously taking my daily tablet so that no one would see or notice. I did it without really thinking why and realised afterward that I was worried someone would ask what I was taking. I was worried that someone would see and would think "Look at yer man, he's on pills for his nerves". That somehow it would mark me out as being abnormal in some way which is just ridiculous. So in order to mitigate that, I thought I'd put it out in the open if it means others will be more willing to tackle it.
So why anti-depressants? 
Well, just over a month ago, I was made redundant. This in itself wasn't a reason to fall into a depression. In fact I was delighted to be made redundant. As my friends or those who follow my Facebook feed will know, I didn't like my job. I hated it. Over the past five years it had slowly eroded my self-confidence and sense of self-worth down to the point where I dreaded every day I had to go into the office. It's partly for this reason that I started doing stand-up comedy.
What leaving my job did for me was give me time to think and to start making some changes in my life. I realised that I hadn't been myself in quite a while. A good number of years. I needed to do something about that in order to get my life back and be the person I used to be.
Having depression is hard to explain to people who have never experienced it. By that I mean people who haven't been effected by it on a daily basis. Having one bad day now and then where you "can't even" doesn't count. For me, I'd have good days and bad days. The bad overwhelmingly outnumbering the good ones. The thing is, I'd try and rationalise it and tell myself that the bad days were normal days. I was always anxious about something from the moment I woke up to the moment I fell asleep. I'd be anxious about going to work, anxious about what mood my boss would be in with me, anxious about meeting people, anxious about driving to a gig, anxious about doing the gig etc etc (you get the idea). When one hurdle was jumped, I'd immediately move on to the next one and start worrying about that. It was like having a constant weight on my shoulders while trying to keep 100 plates spinning on sticks.
It was also very easy for me to fall into a black mood over the most insignificant thing. Things that most people would take in their stride could ruin a day for me. Someone being rude to me at work, some perceived slight or a snarky comment on Facebook could leave me fed up for a day. That's not to say the people involved weren't pricks, it's just that I didn't handle it very well and I let it effect me way more than it should. It also had the effect of making me want to isolate myself from people. I wouldn't want to leave the house to do anything other than go to gigs. Even a trip to the cinema would be an ordeal as even before I'd leave the house, I'd already be fixating on which person in the cinema would ruin the film for me by talking or kicking my seat. I wasn't much fun to be around a lot of the time.
So about six weeks ago I went to the doctor and explained how things had been for me. They were really great. Very understanding. They listened to what I said, nodded in recognition and said that all I had told them was typical of someone who was depressed and could benefit from the use of anti-depressants. I was very wary at first, worried that the pills would in some way change me. Make me someone who wasn't the "real" me. That I'd be zombified in some way. My biggest worry was that if I was numb to everything, I wouldn't be funny anymore and I'd struggle to write anything for stand-up again (You were never funny Christian).
I gave it some thought for a week, reading up on the anti-depressants that the doctor suggested and finally made the decision to give them a go. And I'm glad I did. It's probably the best decision I've made in years. Within a few weeks I was feeling much much better.

Again it's hard to explain but that feeling of anxiousness has eased significantly. It's not there as a constant. I'm a lot more positive about things. Don't get me wrong, I still get irritated when someone's a prick, I just doesn't ruin my day anymore. Or even my minute. I still angry get about things except it's about the right things.
Others have noticed a change too, saying I'm more like my old self. More confident, positive and a lot more pleasant to be around (I hope). I feel happier. Not happy. But happier. And that's a good start.
Watch video documentary antidepressants
So what was my point? My point is this. If you're feeling depressed (and I know there's a few of you reading this), don't put off doing something about it. It doesn't make you weak. It makes you stronger. Go and see someone about it. A doctor, a therapist or a counsellor. But do go and see someone. It's made a huge difference to me so far, all I can do is encourage you to do the same.

Antidepressants Medicines

Not only does it take time to get an accurate depression diagnosis, finding the right medication to treat depression can be a complicated, delicate process. Someone may have a serious medical problem, such as heart disease or liver or kidney disease, that could make some antidepressants unsafe. The antidepressant could be ineffective for you or the dose inadequate; there may not have been enough time to see an effect, or the side effects could be too bothersome -- leading to a failure of treatment.
As you approach taking antidepressants to treat depression, it is important to keep these points in mind:
Only about 30% of people with depression go into full remission after taking their first course of antidepressants. That’s according to a 2006 study funded by the National Institutes of Health. Those who got better were more likely to be taking slightly higher doses for longer periods.
Some antidepressants work better for certain individuals than others. It's not uncommon to try different depression medicines during treatment.
Some people need more than one medicine for depression treatment.
Antidepressants carry a boxed warning about increased risk compared to placebo for suicidal thinking and behavior in children, adolescents, and young adults 18-24 years old.
Working with your doctor, you can weigh the risks and benefits of treatment and optimize the use of medication that best relieves your symptoms.

 What is an antidepressant?

Antidepressants, sometimes in combination with psychotherapy, are often the first treatment people get for depression. If one antidepressant doesn't work well, you might try another drug of the same class or a different class of depression medicines altogether. Your doctor might also try changing the dose. In some cases, your doctor might recommend taking more than one medication for your depression.

antidepressants Medicines Cause Certain Side Effects:

Although all antidepressants can cause side effects, some are more likely to cause certain side effects than others.

Side Effect	Medicines Most Likely To Cause This Side Effect
Nausea/vomiting	Venlafaxine (Effexor, Effexor XR) Paroxetine (Paxil)
Weight gain	Mirtazapine (Remeron, Remeron SolTab) Between 2 and 7 pounds in 6 to 8 weeks
Diarrhea	Sertraline (Zoloft)
Sleepiness	Trazodone (Desyrel)
Sexual problems (such as decreased sex drive or difficulty getting an erection)	Paroxetine (Paxil, Paxil CR) Escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR), or sertraline (Zoloft) had more sexual side effects than bupropion (Wellbutrin, Wellbutrin SR®, Wellbutrin XL)

What happens if I stop taking my antidepressant?

Some people have symptoms after they stop taking certain antidepressant medicines. These are called withdrawal symptoms. Withdrawal symptoms include headache, dizziness, light-headedness, nausea, and anxiety. You should never stop taking your medicine without first talking with your doctor.
More people had these symptoms after they stopped taking paroxetine Paxil, Paxil CR and venlafaxine Effexor, Effexor XR.
Fewer people had withdrawal symptoms after they stopped taking fluoxetine Prozac, Prozac Weekly).
Antidepressant medication, used under the guidance of a mental health professional, may relieve your depression symptoms. But antidepressants also come with side effects and dangers. What’s more, recent studies have raised questions about their effectiveness. At the very least, it’s clear that medication alone usually isn’t enough—you also may need therapy and lifestyle changes. Learning the facts about antidepressants and weighing the benefits against the risks can help you make an informed and personal decision about what’s right for you.
http://www.helpguide.org/articles/depression/antidepressants-depression-medication.htm

 

We are sick with one of the most misunderstood epidemics, Depression.

This documentary is a very useful explanation for people who have depression to understand what is normal and what is not in our thoughts and mind. Also, and I think more important is for people who do not have depression, to understand us and that really is not in our brain.  

 
We are not crazy, we are sick with one of the most misunderstood epidemic of the 21st century depression.

If you’re taking an antidepressant, there’s a good chance it’s not necessarily for depression.
According to recent data released by the National Center for Health Statistics, antidepressants are the third most common prescription drug taken by Americans. However, not all these drugs are administered to patients for depression and anxiety – nor does a psychiatrist always prescribe them. Instead, doctors say, antidepressants are often recommended to patients by primary care physicians and are used to treat a surprising assortment of non-psychological condition.

How to treat depression, tips, antidepressants

Depression, disease of the 21st century. In the cycle of technological and information progress, the disease is one of the most dangerous.

Information from Wikipedia: "Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of well-being. People with depressed mood can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable or restless. They may lose interest in activities that were once pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details or making decisions, and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present. Depressed mood is a feature of some psychiatric syndromes such as major depressive disorder, but it may also be a normal reaction to life events such as bereavement, a symptom of some bodily ailments or a side effect of some drugs and medical treatments".

How to treat depression?

On this page you can find information about the treatment of depression from the best experts. 

Getting help for depression:  http://www.webmd.com/depression/default.htm

Treating depression:
Learn more about treatment for depression in men, women, and older adults, as well as the problem of treatment-resistant depression.

Depression Treatments

Learn all about different depression treatment options. Find out about depression medicines and other depression remedies to see which may work best for you.

Depression Medicines

There are many types of depression medicines today. Learn about antidepressants -- the effects and side effects -- and work with your doctor to select the best depression medicine for your symptoms.

Psychotherapy

Find out how talk therapy works to lift mood and help patients with depression improve coping skills.

Electric Shock Treatment

Electroconvulsive therapy, or ECT, is used for severe depression or when depression medicines fail to work. Find out more about ECT and who might benefit most.

Interpersonal Therapy

Learn about interpersonal therapy for depression in children and addresses group sessions, techniques, and what to expect.

Psychodynamic Therapy

Find out about the effectiveness of psychodynamic therapy for depression.

Cognitive Behavioral Therapy

Learn why cognitive behavioral therapy might be used to treat depression, how this approach works, and what to expect in sessions.

Depression in Special Situations

Learn all about depression in special situations, including depression in men and how it’s different from depression in women. Find out about depression in older adults and treatment-resistant depression.

Depression in Women

Depression in women is increasingly common. Find out the symptoms of depression in women and what medical treatment can do to manage these depression symptoms.

Depression in the Elderly

Depression in seniors is often confused with signs of serious illnesses or grieving. Learn the specific symptoms of depression in older adults and talk to your doctor.

Treatment-Resistant Depression

Treatment-resistant depression should be taken very seriously. Find out who’s at risk for treatment-resistant depression and how a doctor can help manage the symptoms.

Antidepressant Withdrawal

Why does someone have withdrawal symptoms after taking antidepressants and how can it be overcome? WebMD explains.

Antidepressants to Treat Depression:

It is important to note that you should not drink alcoholic beverages while taking antidepressant medicines, since alcohol can seriously interfere with their beneficial effects.
In October 2004, the FDA determined that antidepressant medications may increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider.

Antidepressants to Treat Depression
There are several types of depression medications (antidepressants) used to treat depression and conditions that have depression as a component of the disease, such as bipolar disorder. These drugs improve symptoms of depression by increasing the availability of certain brain chemicals called neurotransmitters. It is believed that these brain chemicals can help improve emotions.

Antidepressants: Anafranil, Adapin, Aventyl, Elavil, Endep, Norpramin, Pamelor, Pertofrane, Sinequan, Surmontil, Tofranil, Vivactil, Zonalon
Type of Medication: These medicines are tricyclic antidepressants (TCAs) which work by increasing the available amount of serotonin and/or norepinephrine in the brain.    
Side Effects: Dry mouth, blurred vision, increased fatigue and sleepiness, weight gain, muscle twitching (tremors), constipation, bladder problems such as urine retention, dizziness, daytime drowsiness, increased heart rate, sexual problems.

Antidepressants: Emsam, Eldepryl, Nardil, Marplan, Parnate, Zelapar
Type of Medication: Monoamine oxidase inhibitors (MAOIs) increase the amount of norepinephrine and serotonin in the brain
Side Effects: Must avoid certain foods and medications to avoid dangerous interactions. Serious side effects may include: headache, heart racing, chest pain, neck stiffness, nausea and vomiting. If you experience any of these symptoms, seek medical care immediately.

Antidepressants: Celexa, Lexapro, Luvox, Paxil, Pexeva, Prozac, Sarafem, Zoloft
Type of Medication: Selective serotonin reuptake inhibitors, or SSRIs, work by increasing the amount of serotonin, a neurotransmitter found in the brain.    
Side Effects: Sexual problems including low sex drive or inability to have an orgasm are common but reversible, dizziness, headaches, nausea right after a dose, insomnia, feeling jittery.

Antidepressants: Aplenzin, Budeprion, Buproban Forfivo, Wellbutrin Wellbutrin SR
Type of Medication: Bupropion may increase the amounts of the neurotransmitters norepinephrine and dopamine in the brain.    
Side Effects: Weight loss, decreased appetite, restlessness, insomnia, anxiety, constipation, dry mouth, diarrhea, dizziness, seizures.

Antidepressants: Cymbalta, Effexor, Fetzima, Khedezla, Pristiq
Type of Medication: These drugs increase the levels of the neurotransmitters serotonin and norepinephrine in the brain.    
Side Effects: Drowsiness, blurred vision, lightheadedness, strange dreams, constipation, fever/chills, headache, increased or decreased appetite, tremor, dry mouth, nausea. Remeron can be sedating. Cymbalta may increase sweating and blood pressure and also cause fatigue and reduced energy.

Antidepressants: Desyrel, Ludiomil, Oleptro
Type of Medication: These drugs block various neurotransmitter chemicals to some degree.
Side Effects: Desyrel and Oleptro may cause drowsiness, fatigue, tremor, headache, dry mouth, nausea, and vomiting. Ludiomil may cause headache, dizziness, dry mouth, fatigue, daytime sleepiness, and sweating.

Types of antidepressants:
Tricyclic antidepressants (TCAs) are some of the first antidepressants used to treat depression. They primarily affect the levels of two chemical messengers (neurotransmitters), norepinephrine and serotonin, in the brain. Although these drugs are effective in treating depression, they have more side effects, so they usually aren't the first drugs used.
Monoamine oxidase inhibitors (MAOIs) are another early form of antidepressant. These drugs are most effective in people with depression who do not respond to other treatments.  Substances in certain foods, like cheese, beverages like wine, and medications can interact with an MAOI, so these people taking this medication must adhere to strict dietary restrictions (see below). For this reason these antidepressants also aren't usually the first drugs used.
Selective serotonin reuptake inhibitors (SSRIs) are a newer form of antidepressant. These drugs work by altering the amount of a chemical in the brain called serotonin.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another newer form of antidepressant medicine. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine.