What You Need To Know – Antidepressants And Herbs In The Treatment Of Depression
Virginia Duffy asked:
What Is Depression? People use the word depression loosely to mean a number of different moods. I prefer to use the term “clinical depression” to distinguish the type of depression that may improve with medication. Clinical depression is more than the “blues” or sadness. It is not something a person can “just get over” or talk themselves out of. Clinical depression is at least partially based on brain biochemical imbalance (we are still in early stages of understanding this) and often runs in families. Stress and psychological factors also play an important role, although we do not fully understand the causes and factors that result in clinical depression.
Common symptoms of depression include sad or irritable mood, loss of interest / energy, poor or excessive sleep and appetite, difficulty with concentration and memory, and physical complaints. Medication is often necessary in serious depression and MAY be helpful with less severe types.
Types Of Depression: There are four types of depression listed in the current Diagnostic and Statistical Manual (DSM 4 TR). The intent of this manual is to help those in the mental health field make accurate diagnoses. One of its goals is to make the diagnosis more consistent between providers. Unfortunately it is often used haphazardly.
1. Adjustment Disorder With Depressed Mood: A reaction to a stressor. (Loss of a loved one, job, physical illness, move etc.) This type of disturbed mood is usually mild and self-limiting. When symptoms last longer than 6 months another type of depression should be considered. Counseling, therapy and support may be sufficient treatment. Medication is not usually necessary.
2. Dysthymia : A chronic low-level depression. It can be very debilitating and may be a part of the personality. It also can be difficult to treat with medication; therapy is recommended.
3. Major depression: A severe form of depression with multiple symptoms as described above. Medication is necessary and usually very effective. Therapy may be helpful after acute symptoms have abated. Suicide potential must be monitored. This can be severe enough to cause psychotic (loss of reality) symptoms, such as delusions and hallucinations.
4. Bi-Polar 1 Disorder: A cycle of depression and elevation of mood (hypomania or mania). This can be very severe, with psychotic symptoms. Antidepressants may be avoided due to risk of switching the mood to mania. This condition needs expert psychiatric treatment usually with mood stabilizing medication. (By the way there is a significant amount of confusion and disagreement about this diagnosis especially between Bipolar 1 and Bipolar 2 disorders. Bipolar 2 disorder is less severe and medication is often not necessary.)
Differential Diagnosis (problems that may be confused with depression)
Hypothyroidism (low thyroid) Grief Substance abuse Chronic pain Anxiety Side effects of medication
Target Symptoms Of Depression: Identifying and describing specific target symptoms is crucial if treatment is to be monitored and its’ effectiveness evaluated. It is easy to forget how severe symptoms were when depression is resolved. The more specific the target symptoms are, the better to keep track of changes. Some examples of target symptoms are listed below.
Sleep Disturbance (difficulty falling or staying asleep, awakening often during the night, early morning awakening, oversleeping) Concentration / Memory Problems Low Energy Level Irritability Physical symptoms Change in appetite (decreased or increased) Lack Of Motivation / Interest Mood Changes (sadness, anger hopelessness)
Selective Serotonin Reuptake Inhibitors (SSRIs) the most commonly used antidepressants.
SSRIs have been on the market for over 20 yrs. They increase levels of serotonin in the brain. Serotonin is a substance that allows chemical activity in the brain (neurotransmitter). Serotonin is known to play a role in depression and anxiety. SSRIs are used for treatment of depression, anxiety, Obsessive-compulsive disorder (OCD), and occasionally other illnesses. (Fibromyalgia, chronic fatigue, pain).SSRIs have much fewer side effects than the older antidepressants (tricyclics such as Elavil); they are not as lethal in overdose, and work well for most people. They are much more expensive then tricyclics. All SSRI’s are effective although side effects may differ somewhat. Because individuals are different, some may react more positively to one particular medication then to another. Choosing between the SSRI’S is usually dependent on the side effect profile (see below), and the prescriber’s and patient’s preference and experience. They are usually the first choice in depression and often the first choice in anxiety disorders. With anxious patients it is helpful to start low and increase the dose slowly in order to minimize the side effect of activation. Anxious patients can be very sensitive to this side effect. Higher doses of medications are often needed in Obsessive Compulsive disorder and Panic disorder.
1. Prozac TM
This may be more activating initially. It has a long half-life and therefore stays in the system longer. Once a day dosing is usual; recently Prozac introduced a once a week dose.
2. Paxil TM
May be more calming initially, weight gain can be a problem. Once a day dosing is the norm.
3. Zoloft TM
May have fewer interactions with other medications. Weight gain may be a problem. May cause more stomach upset and diarrhea. Once a day dosing is the norm.
4. Luvox TM
Sometimes used for OCD, multiple dosing. Not used frequently in US. Needs higher doses that may cause drowsiness.
5. Celexa TM
Said to be “more” selective for a particular type of serotonin and therefore thought to have less side effects and interactions. May have less weight gain. Once a day dosing is the norm.
6. Lexapro TM
Similar to Celexa some feel it was manufactured because the patent on Celexa was running out. Said to work quicker then the other SSRIs.
Side Effects – SSRI’s
Most SSRI’s have similar side effects. Some patients do better on one than on another. This cannot be determined before a trial of the medication is given.
1. Nausea
This is a common problem. Taking the medication with food helps and this side effect. It usually passes in time.
2. Headache
This is usually mild and goes away with time (about one week) if it continues it may be necessary to change medication.
3. Activation or Sedation
Patient can feel either activated (hyper, jittery) or sedated. Patients with anxiety / panic are more likely to feel activated. To avoid this start with a low dose and increase as tolerated. Sedation will often disappear with time but occasionally a change in medication is necessary.
4. Sexual dysfunction
This can be a significant problem with some antidepressants. Use may result in decreased sexual interest or ability. Most common treatments for sexual dysfunction include: drug holidays (holding the drug for one or two days once the patient is stable, (cannot be done with Prozac due to staying in the body longer), changing medication, or using an additional medication. (Some such drugs include: Periactin, Amantadine, Yohimbine, Ginkgo others. All have only limited success.) Talk to your prescriber if this is an issue for you.
5. Weight Gain
This can be a problem that is often not taken seriously enough. Weight gain may start after you have been on the medication for a while. It may be necessary to change to a different antidepressant.
6. Agitation / Aggression
There has been some anecdotal reports about patients becoming more aggressive on SSRIs. The research does not support this. However, that concern should be taken seriously, and attempts made to avoid a drug the patient is concerned about. The same is true about the reports of increased suicide.
Tricyclic Antidepressants
This is an older class of antidepressants that are no longer the first choice. They can have severe side effects including sedation, weight gain, effects on the heart, and drug interactions. These drugs are used in anxiety, depression and some pain syndromes. They are much less expensive than SSRI’s. These drugs are lethal in overdose!
Other Antidepressants
These drugs are thought to affect a number of neurotransmitters (serotonin, dopamine, nor-epinephrine being the major ones.)
1. Wellbutrin TM
This should not be used in patients with a history of seizures. Said to cause less sexual dysfunction and weight gain. Now has a sustained release formula but still is usually given twice a day. This is the same drug as Zyban, which is used for smoking cessation. Obviously, they should not be used together.
2. Trazodone TM
This is not a very effective antidepressant; it is however very helpful for sleep and may be used in low doses for anxiety. It should be used in caution with men due to possible priaprism (This is an involuntary erection that in the worst case may not go away).
3. Effexor XR TM
Thought to have fewer interactions. Less weight gain and sexual dysfunction.
4. Serzone TM
Needs multiple dosing, may be more sedating (at least at first), and said to have less sexual dysfunction. Should not be used with Trazodone
What Is Depression? People use the word depression loosely to mean a number of different moods. I prefer to use the term “clinical depression” to distinguish the type of depression that may improve with medication. Clinical depression is more than the “blues” or sadness. It is not something a person can “just get over” or talk themselves out of. Clinical depression is at least partially based on brain biochemical imbalance (we are still in early stages of understanding this) and often runs in families. Stress and psychological factors also play an important role, although we do not fully understand the causes and factors that result in clinical depression.
Common symptoms of depression include sad or irritable mood, loss of interest / energy, poor or excessive sleep and appetite, difficulty with concentration and memory, and physical complaints. Medication is often necessary in serious depression and MAY be helpful with less severe types.
Types Of Depression: There are four types of depression listed in the current Diagnostic and Statistical Manual (DSM 4 TR). The intent of this manual is to help those in the mental health field make accurate diagnoses. One of its goals is to make the diagnosis more consistent between providers. Unfortunately it is often used haphazardly.
1. Adjustment Disorder With Depressed Mood: A reaction to a stressor. (Loss of a loved one, job, physical illness, move etc.) This type of disturbed mood is usually mild and self-limiting. When symptoms last longer than 6 months another type of depression should be considered. Counseling, therapy and support may be sufficient treatment. Medication is not usually necessary.
2. Dysthymia : A chronic low-level depression. It can be very debilitating and may be a part of the personality. It also can be difficult to treat with medication; therapy is recommended.
3. Major depression: A severe form of depression with multiple symptoms as described above. Medication is necessary and usually very effective. Therapy may be helpful after acute symptoms have abated. Suicide potential must be monitored. This can be severe enough to cause psychotic (loss of reality) symptoms, such as delusions and hallucinations.
4. Bi-Polar 1 Disorder: A cycle of depression and elevation of mood (hypomania or mania). This can be very severe, with psychotic symptoms. Antidepressants may be avoided due to risk of switching the mood to mania. This condition needs expert psychiatric treatment usually with mood stabilizing medication. (By the way there is a significant amount of confusion and disagreement about this diagnosis especially between Bipolar 1 and Bipolar 2 disorders. Bipolar 2 disorder is less severe and medication is often not necessary.)
Differential Diagnosis (problems that may be confused with depression)
Hypothyroidism (low thyroid) Grief Substance abuse Chronic pain Anxiety Side effects of medication
Target Symptoms Of Depression: Identifying and describing specific target symptoms is crucial if treatment is to be monitored and its’ effectiveness evaluated. It is easy to forget how severe symptoms were when depression is resolved. The more specific the target symptoms are, the better to keep track of changes. Some examples of target symptoms are listed below.
Sleep Disturbance (difficulty falling or staying asleep, awakening often during the night, early morning awakening, oversleeping) Concentration / Memory Problems Low Energy Level Irritability Physical symptoms Change in appetite (decreased or increased) Lack Of Motivation / Interest Mood Changes (sadness, anger hopelessness)
Selective Serotonin Reuptake Inhibitors (SSRIs) the most commonly used antidepressants.
SSRIs have been on the market for over 20 yrs. They increase levels of serotonin in the brain. Serotonin is a substance that allows chemical activity in the brain (neurotransmitter). Serotonin is known to play a role in depression and anxiety. SSRIs are used for treatment of depression, anxiety, Obsessive-compulsive disorder (OCD), and occasionally other illnesses. (Fibromyalgia, chronic fatigue, pain).SSRIs have much fewer side effects than the older antidepressants (tricyclics such as Elavil); they are not as lethal in overdose, and work well for most people. They are much more expensive then tricyclics. All SSRI’s are effective although side effects may differ somewhat. Because individuals are different, some may react more positively to one particular medication then to another. Choosing between the SSRI’S is usually dependent on the side effect profile (see below), and the prescriber’s and patient’s preference and experience. They are usually the first choice in depression and often the first choice in anxiety disorders. With anxious patients it is helpful to start low and increase the dose slowly in order to minimize the side effect of activation. Anxious patients can be very sensitive to this side effect. Higher doses of medications are often needed in Obsessive Compulsive disorder and Panic disorder.
1. Prozac TM
This may be more activating initially. It has a long half-life and therefore stays in the system longer. Once a day dosing is usual; recently Prozac introduced a once a week dose.
2. Paxil TM
May be more calming initially, weight gain can be a problem. Once a day dosing is the norm.
3. Zoloft TM
May have fewer interactions with other medications. Weight gain may be a problem. May cause more stomach upset and diarrhea. Once a day dosing is the norm.
4. Luvox TM
Sometimes used for OCD, multiple dosing. Not used frequently in US. Needs higher doses that may cause drowsiness.
5. Celexa TM
Said to be “more” selective for a particular type of serotonin and therefore thought to have less side effects and interactions. May have less weight gain. Once a day dosing is the norm.
6. Lexapro TM
Similar to Celexa some feel it was manufactured because the patent on Celexa was running out. Said to work quicker then the other SSRIs.
Side Effects – SSRI’s
Most SSRI’s have similar side effects. Some patients do better on one than on another. This cannot be determined before a trial of the medication is given.
1. Nausea
This is a common problem. Taking the medication with food helps and this side effect. It usually passes in time.
2. Headache
This is usually mild and goes away with time (about one week) if it continues it may be necessary to change medication.
3. Activation or Sedation
Patient can feel either activated (hyper, jittery) or sedated. Patients with anxiety / panic are more likely to feel activated. To avoid this start with a low dose and increase as tolerated. Sedation will often disappear with time but occasionally a change in medication is necessary.
4. Sexual dysfunction
This can be a significant problem with some antidepressants. Use may result in decreased sexual interest or ability. Most common treatments for sexual dysfunction include: drug holidays (holding the drug for one or two days once the patient is stable, (cannot be done with Prozac due to staying in the body longer), changing medication, or using an additional medication. (Some such drugs include: Periactin, Amantadine, Yohimbine, Ginkgo others. All have only limited success.) Talk to your prescriber if this is an issue for you.
5. Weight Gain
This can be a problem that is often not taken seriously enough. Weight gain may start after you have been on the medication for a while. It may be necessary to change to a different antidepressant.
6. Agitation / Aggression
There has been some anecdotal reports about patients becoming more aggressive on SSRIs. The research does not support this. However, that concern should be taken seriously, and attempts made to avoid a drug the patient is concerned about. The same is true about the reports of increased suicide.
Tricyclic Antidepressants
This is an older class of antidepressants that are no longer the first choice. They can have severe side effects including sedation, weight gain, effects on the heart, and drug interactions. These drugs are used in anxiety, depression and some pain syndromes. They are much less expensive than SSRI’s. These drugs are lethal in overdose!
Other Antidepressants
These drugs are thought to affect a number of neurotransmitters (serotonin, dopamine, nor-epinephrine being the major ones.)
1. Wellbutrin TM
This should not be used in patients with a history of seizures. Said to cause less sexual dysfunction and weight gain. Now has a sustained release formula but still is usually given twice a day. This is the same drug as Zyban, which is used for smoking cessation. Obviously, they should not be used together.
2. Trazodone TM
This is not a very effective antidepressant; it is however very helpful for sleep and may be used in low doses for anxiety. It should be used in caution with men due to possible priaprism (This is an involuntary erection that in the worst case may not go away).
3. Effexor XR TM
Thought to have fewer interactions. Less weight gain and sexual dysfunction.
4. Serzone TM
Needs multiple dosing, may be more sedating (at least at first), and said to have less sexual dysfunction. Should not be used with Trazodone
Antidepressants and Prostate Cancer
Julia Maloney asked:
SSRI is a category of antidepressant and it means Selective Serotonin Reuptake Inhibitor. Celexa (Citalopram) is part of this class, and it is used for the treatment of depression. This medicine is known as a mood elevator.
SSRI medicines works by increasing the effectiveness of the brain neurotransmitter serotonin. Some recent studies have shown that it is very important to switch one SSRI with another if the patient is not respond to the first one. A waiting period in-between is not necessary. An alternative to Celexa is Lexapro.
Celexa is a good solution for the deadly combination – coronary artery disease and depression.
Like any other drug, there are some possible side effects:
- dizziness, drowsiness, trouble sleeping, dry mouth, nausea, diarrhea, increased sweating, headache;
- mental/mood changes, tremors;
- muscle restlessness, stiffness or weakness, fever, rash or muscle/joint pain;
- swelling of hands, feet or face or change in amount of urine.
If these effects persist or worsen, notify your doctor.
Here are some precautions :
- tell your doctor about any allergies, mental conditions, liver or kidney disease;
- use caution when performing tasks like driving;
- use only when clearly needed during pregnancy;
- breast-feeding while using this drug is not recommended.
There are some hot news about Celexa. It could be the next cure for prostate cancer problems. Some studies since 2004 had report that Celexa contains Paroxetine – a substance that reduce hot flashes, for men who are under a hormone therapy, in an attempt to heal the prostate cancer.
Never take Celexa by yourself for any reason. You should consult a doctor, because this drug could be a real hope for defeating prostate cancer.
Do not start or stop Celexa or any other medicine without doctor or pharmacist approval.
Pain Management
SSRI is a category of antidepressant and it means Selective Serotonin Reuptake Inhibitor. Celexa (Citalopram) is part of this class, and it is used for the treatment of depression. This medicine is known as a mood elevator.
SSRI medicines works by increasing the effectiveness of the brain neurotransmitter serotonin. Some recent studies have shown that it is very important to switch one SSRI with another if the patient is not respond to the first one. A waiting period in-between is not necessary. An alternative to Celexa is Lexapro.
Celexa is a good solution for the deadly combination – coronary artery disease and depression.
Like any other drug, there are some possible side effects:
- dizziness, drowsiness, trouble sleeping, dry mouth, nausea, diarrhea, increased sweating, headache;
- mental/mood changes, tremors;
- muscle restlessness, stiffness or weakness, fever, rash or muscle/joint pain;
- swelling of hands, feet or face or change in amount of urine.
If these effects persist or worsen, notify your doctor.
Here are some precautions :
- tell your doctor about any allergies, mental conditions, liver or kidney disease;
- use caution when performing tasks like driving;
- use only when clearly needed during pregnancy;
- breast-feeding while using this drug is not recommended.
There are some hot news about Celexa. It could be the next cure for prostate cancer problems. Some studies since 2004 had report that Celexa contains Paroxetine – a substance that reduce hot flashes, for men who are under a hormone therapy, in an attempt to heal the prostate cancer.
Never take Celexa by yourself for any reason. You should consult a doctor, because this drug could be a real hope for defeating prostate cancer.
Do not start or stop Celexa or any other medicine without doctor or pharmacist approval.
Pain Management
