When considering antidepressant medication, there are 3 extremely important things to remember:
- It is important to advise your doctor of any medications you are taking and any health conditions you may have as certain medications when taken together, or when taken under certain circumstances can cause serious health problems, even death.
- Some antidepressant 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.
- The warning below is mandated by the FDA.
IMPORTANT SAFETY INFORMATION – Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Antidepressants increased the risk of suicidality (suicidal thinking and behavior) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of antidepressants in children, adolescents or young adults must balance the risk to clinical need. Patients of all ages started on antidepressant therapy should be closely monitored and observed for clinical worsening, suicidality or unusual changes in behavior, especially at the beginning of therapy or at the time of dose changes.
This risk may persist until significant remission occurs. Families and caregivers should be advised of the need for close observation and communication with the prescriber.
Types of Antidepressants
There are several types of antidepressant medications used to treat depressive disorders. These include newer medications, chiefly the selective serotonin reuptake inhibitors (SSRIs), the serotonin-norepinephrine reuptake inhibitors (SNRIs)*, 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 or another medication added to increase the effect. 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. For individuals with bipolar disorder or chronic major depression, medication may have to be maintained indefinitely.
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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.
Questions about any antidepressant prescribed, or problems that may be related to the medication, should be discussed with the doctor.
*duloxetine (tradename Cymbalta®) an SNRI antidepressant by Eli Lilly and Company has been approved for the treatment of depression and neuropathic pain.
Antidepressant Medication 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 from the SSRIs:
- 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) and fatigue or sleepiness: these may occur during the first few weeks; dosage reductions, changing the time you take your medication 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.
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.
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