Clinical depression is a collection of symptoms characterized by low mood, low self-esteem and the loss of pleasure in activities that are normally enjoyable. It is a disabling condition that can adversely affect all aspects of a person’s life and 3.4 percent of people with clinical depression commit suicide. Fortunately, a variety of medications are able to manage clinical depression. These medications can be classified into the following categories:
- Selective serotonin reuptake inhibitors
- Serotonin-norepinephrine reuptake inhibitors
- Tricyclic antidepressants
- Monoamine oxidase inhibitors
Selective Serotonin Reuptake Inhibitors
SSRIs work by increasing the level of serotonin in the brain, which is a mood elevator. They are currently the preferred medication for severe depression due their broad effect on depression and relatively mild side effects. Common SSRIs include escitalopram (Cipralex, Lexapro), fluoxetine (Prozac) and sertraline (Lustral, Zoloft). Patients who don’t respond to the first SSRI are typically switched to another SSI, which improves the patient’s condition in nearly half of all cases. SSRIs typically have limited effectiveness against mild and moderate depression.
Serotonin Norepinephrine Reuptake Inhibitors
SNRIs elevate the levels of the mood elevators serotonin and norepniphrine. They include desvenlafaxine (Pristiq), duloxetine (Cymbalta), milnacipran (Ixel) and venlafaxine (Effexor). SNRIs are the newest type of anti-depressants and have side effects that are generally similar to those of SSRIs, although they are slightly less severe. SNRIs are typically administered in low doses at first and then gradually increased until the therapeutic level is reached. Similarly, a patient must taper off SNRIs gradually to minimize the risk of side effects.
Tricyclics are so-named because their chemical structure is characterized by three carbon rings. This is an older class of anti-depressants that have more side effects than SSRIs. Tricyclics are typically used only when patients do not respond to the newer anti-depressants, especially inpatients. Many tricyclics are available, although amitriptyline is the most common tricyclic still in use.
A monoamine oxidase inhibitor reduces the ability of monoamine oxidase, which breaks down monoamine neurotransmitters. MAOIs are typically used only when all other types of anti-depressants have failed due to their interactions with other drugs which can be lethal. They are most effective in treating atypical depression, in which the patient can experience an improvement in mood when a positive event occurs. The most recent form of MAOI is Emsam, which is a transdermal patch of selegiline that was approved by the FDA in 2006.Read More
Studies have shown that there is a close relationship between antidepressants and weight loss, depending on the type of antidepressant used. There are many medications that have been researched and shown to have a link between antidepressants and weight loss. How the relationship between antidepressants and weight loss is dependant on several factors, such as a major increase in a patient’s metabolism, the ability to burn off more calories which overlap with faster metabolism, and can reduce appetites in patients, causing the patients to ignore or eliminate food cravings and avoid sudden binging on food. Better mental states such as higher happiness and optimism are also shown to be a link between antidepressants and weight loss.
One of the leading factors in the research between antidepressants and weight loss include reports of a faster metabolism in patients. This a chemical process deep within our bodies; the right types of antidepressants alter our thyroid glands, which produces hormones that aid our metabolisms and aid in weight loss. Antidepressants and weight loss research also show that antidepressants can decrease the release of a hormone called prolactin, which allows more thyroid hormones to be produced. When all of this occurs, there are ultimately more thyroid hormones in our system, which really jump starts our metabolism and causes rapid weight loss.
The studies between antidepressants and weight loss have also shown reports that patients are granted more energy from the medications, which then allows them to run out and burn calories more easily and more quickly. Some of the top antidepressants that are capable of this effect include Wellbutrin, Adderall, and Dexedrine. While prescribed for other problems such as ADD and ADHD in this day and age, they can still be used for antidepressant purposes, as well as being shown to be a link between antidepressants and weight loss and boosting the efficiency of other medications.
One of the mental side effects that have been shown through antidepressants and weight loss research is the increase of happiness and optimism in patients. When this occurs in a patient, it leads to more confidence and energy to move around a lot more and partake in physical, productive activities. Needless to say, changes such as these aids greatly in helping to lose weight, and this is one of the greatest benefits that have come about through antidepressants and weight loss research.
Even with all of this information, be careful not to rely on these medications too much for weight problems, as there is still nothing better than proper dieting and exercise. However, if you need medication for depression and could stand to lose a few pounds, the studies between antidepressants and weight loss should aid you immensely. As the research between antidepressants and weight loss is carried out daily, more benefits are discovered, and techniques to refine medication to take advantage of this research are uncovered, look forward to better and stronger medication that will work more effectively than any other medication before it.Read More
“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.”
“Engage the depressed person in conversation and listen carefully and do not disparage feelings expressed, but point out realities and offer hope, and lastly do not ignore remarks about suicide, Report them to the depressed person’s therapist.”
“It is important to keep taking medication until it has a chance to work, though side effects (see section on Side Effects, pages 19 20) may appear before antidepressant activity does.”
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.
If you feel drowsy or sedated you should not drive or operate heavy equipment.
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.
Antidepressant Medication Side Effects
“Substantial evidence from neuroscience, genetics, and clinical investigation shows that depressive illnesses are disorders of the brain.”
“Engage the depressed person in conversation and listen carefully and do not disparage feelings expressed, but point out realities and offer hope, and lastly do not ignore remarks about suicide, Report them to the depressed person’s therapist.”
Before starting a new medication, ask the doctor to tell you about any side effects you may experience. 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 the newer antidepressants (SSRIs and others) are:
- Headache will usually go away.
- Nausea also temporary, but even when it occurs, it is short lived after each dose.
- Insomnia and nervousness (trouble falling asleep or waking often during the night) may occur during the first few weeks but are usually resolved over time or with a reduction in dosage.
- Agitation (feeling jittery) notify your doctor if this happens for the first time after the drug is taken and is persistent.
- Sexual problems consult your doctor if the problem is persistent or worrisome. Although depression itself can lower libido and impair sexual performance, SSRIs and some other antidepressants can provoke sexual dysfunction. These side effects can affect more than half of adults taking SSRIs. In men, common problems include reduced sexual drive, erectile dysfunction, and delayed ejaculation. For some men, dosage reductions or acquired tolerance to the medication reduce sexual dysfunction symptoms. Although changing from one SSRI to another has generally not been shown to be beneficial, one study showed that citalopram (Celexa) did not seem to cause sexual impairment in patients who had experienced such events with another SSRI.
Some clinicians treating men with antidepressant associated sexual dysfunction report improvement with the addition of bupropion (Wellbutrin) or sildenafil (Viagra) to ongoing treatment. Be sure to discuss the various options with your doctor and inquire about other interventions that can help.
Tricyclic antidepressants have different types of side effects:
- Dry mouth drinking sips of water, chewing sugarless gum, and cleaning teeth daily is helpful.
- Constipation adding bran cereals, prunes, fruit, and vegetables to your diet should help.
- Bladder problems emptying the bladder may be troublesome, and the urine stream may not be as strong as usual; notify your doctor if there is marked difficulty or pain. This side effect may be particularly problematic in older men with enlarged prostate conditions.
- Sexual problems sexual functioning may change; men may experience some loss of interest in sex, difficulty in maintaining an erection or achieving orgasm. If they are worrisome, discuss these side effects youre your doctor.
- Blurred vision will pass soon and will not usually necessitate a new glasses prescription.
- Dizziness rising from the bed or chair slowly is helpful.
- Drowsiness as a daytime problem usually passes soon. If you feel drowsy or sedated you should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.
Therapy can help the child deal with his past in a healthy manner, and to learn ways to cope with the very difficult process of growing up.
A good diagnostic evaluation will include a complete history of symptoms, when they started, how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and what treatment was given.Read More
(What you should do being depressed)
- Notice aspects of yourself worth honoring and celebrating.
- Remember — not all of who you are as a person is depressed.
- Recognize the internal negative voice of depression and name it as “depression”.
- Stay socially connected in some way to other people. Talk with others about the depression, in moderation.
- Get yourself out of the house for at least one hour every day.
- Exercise, eat well, and develop a regular sleep schedule.
- Limit yourself from telling a negative story to three times a day.
- Read — preferably novels of triumph, good fortune, and positive outcomes.
- Do something interesting to keep your mind focused on the task at hand.
- Meditate to quiet your mind and relax your body.
- Get a massage — treat yourself to one or ask a friend to give you one.
- Stay creative — take a night school course, paint, garden, visit a museum.
- Keep your living quarters clean.
- Seek out counseling with a therapist who is committed to moving you forward as quickly as possible.
(What you shouldn’t do being depressed)
- Don’t become immobilized by this experience — get active in some way.
- Don’t let depression keep you silenced.
- Don’t let the depression isolate you.
- Don’t incessantly talk to yourself and others about the depression.
- Don’t overindulge in anything.
- Don’t take other people’s medication.
- Don’t let “worst-case scenario” thinking take over.
- Don’t believe that you know what others are thinking about you; you are not a mind-reader.
Bad Professional Advice
Lynn Carpenter grew frightened of her daughter Sheena’s deterioration and one night called the family doctor where a doctor on call (it was a Sunday and their regular doctor was not at the office) was very adamant that Sheena receive treatment right away. But when she brought Sheena to the regular family doctor a couple of days later he dismissed the seriousness of Sheena’s eating disorder.
“He told us that we caught it in time and assured me that Sheena would work it out,”
Looking back now Lynn realizes that
“If I’d have followed my own instincts and got Sheena the intense therapy that she needed who knows what would have happened. Instead I took my doctors advice and I’ll never forgive myself for that.”
Sheena needed therapy to sort out what was behind her desperate circumstance but instead the Carpenter family doctor told Sheena to gain twenty pounds. She did what the doctor ordered, but without any other supportive help, the restricting and purging continued.
Sheena’s world became even more isolated and involved with depression and bulimia as she would spend hours studying the recipe books that filled her bedroom’s bookshelves. She became an expert on ingredients and their exact caloric count. At grocery stores she could become transfixed for ten minutes or more while fondling a piece of fruit or vegetable.
At home her mother became increasingly frustrated and distraught.
“She would just move her food around the plate, or she would eat it and put it in a napkin. I never knew when I would find regurgitated food somewhere in her room. It was very disruptive to our family life…,”
she says, her voice trailing off.
Eventually Lynn herself began therapy to try and make sense of the confusion and lack of answers surrounding Sheena’s disordered eating.
“I went because I couldn’t cope with Sheena’s eating disorder and because I didn’t understand it.”
Lynn tried to bribe her daughter to get some help and at one point she did get her into a hospital out patient program. But Carpenter feels as though she only agreed to this simply to please her mother and she soon dropped out of the program.
On the advice of a therapist Lynn moved Sheena into an apartment of her own in the hope that this would help her build some confidence and strength to fight the eating disorder. Today she still feels allot of guilt about that decision.
“I was so afraid of her dying at home, which she almost did in May. But,”
she sighs sadly,
“I just wish I would have followed my gut.”
Sheena was getting more and more ill. One day in the spring of 1994 at 57 pounds she lost total control of her bodily functions and then went into seizure. This landed her in the hospital and eventually onto the hospital’s psychiatric ward.
At first Lynn Carpenter was grateful. She thought her daughter would finally get the help she needed, or at the very least the experience would scare her so much that she would then agree to do anything to ensure that she would never end up on that ward again. However neither outcomes happened. “She would call me saying ‘why mom, why are you doing this to me?'” She finally agreed that if the hospital stopped force feeding her she would eat on her own. But she was made to eat infront of the nurses station while staff locked the washrooms so she could not purge afterwards.
She pleaded with the doctor in charge of her care to start therapy but according to Lynn Carpenter her pleas were in vain.
“Basically the doctor said that the body had to be healthy before the mind could be healthy.”
Three months into her hospital stay, distressed and distraught Lynn accepted her daughters pleas to leave.
It took Sheena’s doctor a full month to call Lynn asking where her daughter was.
“There was no way she should have been on the same ward as patients with other kinds of mental illness,”
“Depression is just not like any other kind of illness.”
On the advice of a therapist Sheena moved into her own apartment. Although she was only fifty five pounds she even landed a job as a security guard. Again Lynn believed that Sheena was showing signs of improvement. But after no not returning her calls for a couple of days Sheena’s mother got worried and went over to see if she was alright. She found her twenty two year old daughter lying dead on the kitchen floor.
Carpenter was devastated; she simply couldn’t believe that Sheena had died.
“She was so strong minded. She never believed she would die from depression. She would always say to me ‘mama, this will never take me away.'”
I wondered how many other mothers have wanted to believe this hopeful message. At a particularly bleak period, about a year before her death, Sheena and her mother discussed a suicide pact.
“I never thought I could ever live without her,”
she tells me. Carpenter speaks both vividly, as though it all happened yesterday and with a wisdom and understanding that only time and experience could have given her.
“I couldn’t bear the thought that I could survive without her for one year – forget about six. But here I am and now I know I am meant to live.”
Read A Mother’s Story.Read More
Six years ago Lynn Carpenter lost her only child, Sheena, to depression and bulimia. Lynn states, “When Sheena died friends of mine back home couldn’t believe that someone in North America could starve to death.” These same friends had a logical solution ” ‘why don’t you just force her to eat, just shove food in her mouth.’ ” If it were only that easy and the complexities of depression and bulimia were that simple Lynn would not have lost her daughter.
There was a time, well before Carpenter realized that Sheena had an eating disorder, when she held similar views.
“Look, I had no idea what an eating disorder was. I used to get angry with Sheena for not eating. But I had no idea what was going on, I had nowhere to go and no one to talk to.”
Sheena’s Deadly Recruitment
Sheena Carpenter always wanted to be a model and at the age of fourteen she went to a modeling agency to have her potential assessed. What happened there, Lynn Carpenter believes, is what triggered Sheena’s eating disorder. “At the time I thought it would be beneficial because it would help to give her some self-confidence.” Instead what she received was a list of cosmetic surgeons specializing in facial liposuction. The agency told Sheena that if her face was a bit thinner she may perhaps have some potential as a model. “I just ripped the paper out of her hand and told her that until she was of age there was no way I would allow her to do this to herself,” says Carpenter, still visibly angry.
Sheena became obsessed with the modeling agency’s advice. By attempting to re-shape the way her face looked, her weight dropped to seventy five pounds. She began to wear layers of clothing, trackpants under her jeans and large sweaters as a way to hide what was happening to her body, and to keep her body warm. But it wasn’t until Carpenter came upon Sheena purging in the washroom of their home when she was eighteen that she fully confronted the reality that something was wrong with her daughter.
When Sheena was nineteen she took her savings – all two thousand dollars of it – and had the liposuction treatment. The perfect results were , predictably, “disappointing” to her. Sheena went back to an even stricter self-starvation and purging regime because
“She thought they hadn’t made her face thin enough,”
says her mother.
Carpenter says she never really considered that the messages for young women in North American society were in any way harmful.
“I didn’t have a problem with any of that stuff before. Now,”
she says and leans towards me with a lowered, quietly seething voice,
“I cannot watch Fashion TV or beauty pageants. Too many girls think that’s what they have to look like to become successful as a woman. I have a lot of issues with that now.”
Carpenter admits that she too had issues about her body growing up.
“I always hated my own body,”
she tells me candidly,
“and I had very little confidence. Sheena grew up with that; kids become their environment.”
I wonder if the “environment” she is speaking about includes the fashion TV and other perfect body shaping media forms she had just mentioned, or whether she, like so many other mothers, was placing all the blame on herself.
Read the continuation of a Mother’s Story: Death of a Daughter.Read More