ANYONE can develop depression. But the good news is that treatment is successful
in about 80% of identified cases. Psychotherapy and medication are the two primary
treatment approaches. Antidepressant medications can make psychotherapy more
effective for some people. Someone who is too depressed to talk, for instance, may
not get much benefit from psychotherapy or counselling; but often, the right
medication will improve symptoms so that the person can respond better.
"Regarding depression as 'just' a chemical imbalance wildly misconstrues the
disorder. It is not possible to explain either the disease or its treatment based solely
on levels of neurotransmitters," says Yale University neurobiologist Ronald Duman,
Ph.D.
It is important for you to be well informed about medications for depression if you
are taking any of these medications, but this is not a "do-it-yourself' column. Self-
medication can be dangerous. Interpretation of both the signs and symptoms of
depression, and identification of possible side effects, are jobs for the professional.
The prescription and management of medications, in all cases, must be done by a
physician working closely with the patient, his/her psychologist, and sometimes the
patient's family.
Medication - not a cure all
Just as paracetamol can bring down a fever with- out clearing up the infection that
causes it, psychotherapeutic medications act by controlling symptoms. Like most
drugs used in medicine, they correct or compensate for some malfunction in the
body.
Psychotherapeutic medications do not cure depression. In many cases, these
medications can help a person get on with life despite some continuing mental pain
and difficulty coping with problems. For example, antidepressants can lift the dark,
heavy moods of depression. The degree of response ranging from little relief of
symptoms to complete remission depends on a variety of factors related to the
individual and the particular disorder being treated.
As to how long a person must take a psychotherapeutic medication depends on the
disorder. Many depressed and anxious people may need medication for a single
period, perhaps for several months, and then never have to take it again. For some
cases of depression, medication may have to be taken indefinitely or, perhaps, from
time to time. Like any medication, psychotherapeutic medications do not generate the
same effect in everyone. Some people may respond better to one medication than
another. Some may need larger dosages than others. Some experience annoying side-
effects, while others do not. Age, sex, body size, body chemistry, physical illnesses
and their treatments, diet, and habits such as smoking, are of the factors that can
influence a medication's effect.
Types of depression medication
Antidepressant drugs are effective in the treatment of major depression of moderate
and severe degree including major depression associated with physical illness and
that following childbirth; they are also effective for dysthymia (lower grade chronic
depression). Antidepressants were first used in the late 1950s. Now they are divided
into three main classes:
• Tricyclic drugs (TCAs)
TCAs and related antidepressants can be roughly divided into those with additional
sedative properties and those that are less so. Agitated and anxious patients tend to
respond best to the sedative compounds whereas withdrawn and apathetic patients
will often obtain most benefit from the less sedating ones. Those with sedative
properties include amitriptyline, clomipramine, dosulepin (dothiepin), doxepin,
maprotiline, mianserin, trazodone, and trimipramine. Those with less sedative
properties include amoxapine, imipramine, lofepramine, and nortriptyline.
• Monoamine oxidase inhibitors (MAOIs)
MAOIs are used for all types of depression. They have also been used when
"atypical" features are present with the depression such as excessive sleeping,
overeating and anxiety. Some examples are phenelzine, isocarboxazid and
tranylcypromine. Phobic patients and depressed patients with atypical,
hypochondriacal, or hysterical features are said to respond best to MAOls.
• Selective serotonin reuptake inhibitors (SSRIs)
These were developed in the 1980s and are the most commonly prescribed today.
Citalopram, escitalopram, fluoxetine, fluvox- amine, paroxetine, and sertraline
selectively inhibit the re-uptake of serotonin (5-hydroxytryptamine, 5-HT); they are
termed selective serotonin re-uptake inhibitors (SNRIs). Serotonin and
Norepinephrine Reuptake Inhibitors (SNRIs) are newer "reuptake inhibitors" that
work on blocking the reuptake of different neurotransmitters (brain chemicals). An
example would be Venlafaxine. In general SNRIs cause fewer side-effects than
TCAs and MAOIs.
Another type is bupropion, which is a dopamine reuptake blocking compound. It
acts on the neuro-transmitters dopamine and norepinephrine.
How effective is depression medication?
Many people find great relief by using antidepressants. They can be effective in
giving a quick response, to relieve suffering in severe cases of depression. But the
long-term use of antidepressants is far from the being the answer to depression.
Also, as we have seen, if you are depressed, you need to learn the skills necessary to
avoid depression in the future, not just treat the symptoms with drugs.
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