To become familiar with depression overall, I recommend starting with the Depression Overview online tutorial, Getting Back on Track: A Depression Overview. It is a course developed by Kaiser Permanente's Regional Health Education team. Through a series of interactive exercises you will learn about the different types of depression, common symptoms, causes, and treatment options. The tutorial is self-paced, and I encourage you to engage in all the modules to get the full benefit of this class.
Antidepressants are medications that work on neurotransmitters (chemicals that one nerve uses to communicate with other nerves). By increasing the amount of these compounds that circulate in the brain, these medications are able to relieve symptoms of depression and anxiety for many people. In addition, they have multiple other uses including the treatment of social phobias, obsessive compulsive disorders and a variety of other problems. They are not addicting, although some must be reduced slowly to avoid withdrawal symptoms. They usually require three to four weeks to work, sometimes longer. We commonly use them for a minimum of six to twelve months for short-term conditions, but long-term or recurrent conditions often require on-going long-term treatment. Thus far, no problems have been found with long-term use of antidepressants.
There can be interactions between antidepressants and other medications, so it is a good idea for us to discuss your medications when we start them or if another doctor prescribes new medications for you. The most common kind of interaction is that the antidepressant can change the way your body metabolizes another drug, potentially making it stronger or weaker.
Just as it is true that bleeding sometimes occurs in people who are wearing bandages, it is also true that thoughts about suicide sometimes occur in people taking antidepressants.
In March 2004, the FDA issued a directive that the 10 most commonly used antidepressants (fluoxetine, paroxetine, sertraline, bupropion, citalopram, fluvoxamine, mirtazapine, nefazodone, esitalopram, and venlafaxine) shall carry a warning that thoughts about suicide sometimes occur in people taking antidepressants. The findings have been noted in antidepressant studies of children and adolescents. Even though to date there have not been specific concerns raised about depressed adults being treated in primary care settings, the FDA chose to issue the directive for all patients as a precautionary measure.
The essence of the FDA direction is to advise patients of the possibility that thoughts about suicide may arise, particularly at the onset of treatment and with changes in treatment (dosage and/or medication changes), and to encourage patients to inform their doctor or therapist immediately if these thoughts occur. Regardless of the treatment option selected, patients should be screened for suicidal ideation, intent, or plan when they are diagnosed with major depression, with each follow-up visit for depression, and with any adjustments in treatment.
Antidepressants continue to be effective, first line treatment for appropriately selected adult patients with major depression seen in primary care. With appropriate surveillance for suicidal ideation, intent, and plan, antidepressants can continue to be safely used for the overwhelming majority of adult primary care patients with major depression.
It is known that treatment of depression significantly reduces both suicidal thoughts and acts. Nonetheless, it is important to monitor the risk of someone harming themselves, no matter which treatment they are receiving. I will inquire about any such thoughts, feelings, or plans that you might have at your visits. If you find that you are thinking seriously about ending your life, you should let others know as soon as possible, whether or not you are taking medication for your condition.
In general, antidepressants are very safe. Minor side effects are not uncommon and often decrease with time. Let me know if you are experiencing severe or unusual side effects. Sometimes we need to switch medications. If I am not available, ask to speak with my nurse. Also, the pharmacist can help with questions about medications.
Here is a list of some common side effects:
- Upset stomach - This can be minimized by taking the medication with food, but often goes away after a few days.
- Headache - If this happens to you, try taking some aspirin, Tylenol, or Motrin DO NOT USE Motrin if you also take Lithium. This side effect also usually disappears after several days.
- Vivid dreams - Most patients ignore this. Such changes in your dreams may either continue, or go away on their own after a few months.
- Nervousness or problems with sleep - Let me know if this happens. We can often solve the problem by decreasing your dose, changing medications, or adding medications.
- Decrease in sex drive or change in sexual performance - Again, tell me if this is a side effect that is bothering you. The are are a few things we can try to deal with this problem.
- Sensitivity to the sun - It is best to wear sunscreen if you are taking antidepressants. Some people are much more likely to sunburn while they take the medications.
- Memory problems - This is fairly rare, and memory most often improves with the benefits of antidepressant medication. However, some people notice that they may have difficulty being able to come up with the right names for things or remembering what they were doing. If this is severe, let me know. Usually the problem can be eliminated by switching to another medication.