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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.
Patients often are tempted to stop medication too soon. They
may feel better and think they no longer need the medication.
Or they may think the medication isn't helping at all. It is
important to keep taking medication until it has a chance to
work, though side effects may appear before antidepressant activity
does. Once the individual is feeling better, it is important
to continue the medication for at least 4 to 9 months to prevent
a recurrence of the depression. 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.
Antidepressant drugs are not habit-forming. However, as is the
case with any type of medication prescribed for more than a
few days, antidepressants have to be carefully monitored to
see if the correct dosage is being given. The doctor will check
the dosage and its effectiveness regularly.
For the small number of people for whom MAO inhibitors are 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.
Medications of any kind-prescribed, over-the counter, or borrowed-should
never be mixed without consulting the doctor. Other health professionals
who may prescribe a drug-such as a dentist or other medical
specialist-should be told of the medications the patient is
taking. Some drugs, although safe when taken alone can, if taken
with others, cause severe and dangerous side effects. Some drugs,
like alcohol or street drugs may reduce the effectiveness of
antidepressants and should be avoided. This includes wine, beer,
and hard liquor. Some people who have not had a problem with
alcohol use may be permitted by their doctor to use a modest
amount of alcohol while taking one of the newer antidepressants.
Anti-anxiety 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. Questions about any antidepressant prescribed,
or problems that may be related to the medication, should be
discussed with the doctor.
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.
Most people who have bipolar disorder take more than one medication
including, along with lithium and/or an anticonvulsant, a medication
for accompanying agitation, anxiety, depression, or insomnia.
Finding the best possible combination of these medications is
of utmost importance to the patient and requires close monitoring
by the physician.
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| Side
Effects |
Antidepressants
may cause mild and, usually, temporary side effects (sometimes
referred to as adverse effects) in some people. Typically these
are annoying, but not serious. However, any unusual reactions
or side effects or those that interfere with functioning should
be reported to the doctor immediately. The most common side
effects of tricyclic antidepressants, and ways to deal with
them, are:
- Dry mouth-it is helpful to drink sips of water; chew sugarless
gum; clean teeth daily.
- Constipation-bran cereals, prunes, fruit, and vegetables
should be in the diet.
- Bladder problems-emptying the bladder may be troublesome,
and the urine stream may not be as strong as usual; the doctor
should be notified if there is marked difficulty or pain.
- · Sexual problems-sexual functioning may change;
if worrisome, it should be discussed with the doctor.
- Blurred vision-this will pass soon and will not usually
necessitate new glasses.
- Dizziness-rising from the bed or chair slowly is helpful.
Drowsiness as a daytime problem-this usually passes soon.
A person feeling drowsy or sedated should not drive or operate
heavy equipment. The more sedating antidepressants are generally
taken at bedtime to help sleep and minimize daytime drowsiness.
- Headache-this will usually go away. Nausea-this is also
temporary, but even when it occurs, it is transient after
each dose.
- Nervousness and insomnia (trouble falling asleep or waking
often during the night)-these may occur during the first few
weeks; dosage reductions or time will usually resolve them.
- Agitation (feeling jittery)-if this happens for the first
time after the drug is taken and is more than transient, the
doctor should be notified. Sexual problems-the doctor should
be consulted if the problem is persistent or worrisome.
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