How do medications treat depression?

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Most people treated for depression with medication and therapy respond well. In fact, a significant number need only take medication for a year or less. While in decades past, some resisted taking medication for depression, research studies (and studies of research studies) have proven conclusively that depression is a treatable medical illness. If your symptoms persist, seek a doctor's help and do not fear any stigma involved with treatment.

Dr. William B. Salt, MD
Gastroenterologist

SAMe (s-Adenosyl methionine), a dietary supplement, is a prescription drug for depression in Europe, but it is available in the United States without prescription and promoted as a natural product for the treatment of depression or arthritis. SAMe contains an important compound that is produced by all living cells, which is involved in the regulation of several hormones and neurotransmitter chemical messengers, such as serotonin and epinephrine.

Dr. Pina LoGiudice, LAc, ND
Naturopathic Medicine Specialist

SAMe stands for S-adenosylmethionine, and is a naturally occurring chemical in the body based on the amino acid methionine; it helps boost a number of neurotransmitters. With depression, SAMe tends to work quickly, often lifting mood within days rather than weeks, whereas most other supplements and drugs take longer.

It has been shown to be very useful for Parkinson's disease patients with depression, and some studies suggest it may be most beneficial in the senior population. Other studies show it to be safe for children too, and preliminary research shows it may be safe in pregnancy, though more research is needed.

Dosing for SAMe starts slowly. Usually, we recommend a dosage of 200mg twice daily, for the first day, then increase to 400mg twice daily on day three, then to 400mg three times daily on day 10, and finally to the full dose of 400mg four times daily.

The most commonly prescribed medications for depression, panic disorder, eating disorders, and obsessive-compulsive disorder (see below) are SSRIs, including fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), which work by allowing more serotonin to be available in your brain. Antidepressants are not a quick fix—it can take a few weeks before you begin to feel better. During that time you need to assess your feelings and moods and have the prescribing doctor adjust the medication accordingly, but it’s more of a slow fix than a quick one.

SSRIs prevent serotonin from being taken up and broken down as fast, leaving it active in the synaptic spaces for a few nanoseconds longer, where it does its thing to make you feel good. SSRIs are not addicting but some patients may find them very helpful and stay on them for years, while others may be able to forgo them after a few months. They do not change your personality or make you a different person; they allow your brain's own natural serotonin to do its own thing and help you re-find you.

There are many different kinds of medications used to treat depression. They are often called antidepressants. Some of these have been around for decades; some are newer medications, or different formulations of previous medications (such as extended release tablets); and some medicines are being researched and tested.

The primary medications used to treat depression include selective serotonin-reuptake inhibitors (SSRIs), trycyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Each of these medications acts on chemicals in the brain, known as neurotransmitters, related to moods and behavior. These medications can be prescribed by a primary healthcare practitioner or a psychiatrist.

If you are considering medication treatment for depression, be aware that once you begin treatment, it may take a few weeks, or up to 6 weeks, to notice improvements in your mood. You should take your medication regularly for full therapeutic effect. In some cases, the dose of the medication may need to be changed, or an alternate medication considered. It can take some time to determine the right medication and the right dose for you.

Depression, anxiety, and pain are often very challenging to treat. Treatment of these conditions often requires many medications and many adjustments to your medications to find the right combination and right dose. If you are concerned about your medications and your overall well being and want to make changes, it is important to find a doctor that you trust and are confident in his or her ability to listen and address your concerns about your symptoms and responses to medications.

When making changes to your medications, you will want to work closely with your doctor, especially if you are trying to decrease your doses. To stop medications that affect mood and behavior, it is recommended to slowly decrease the dose over time so that your body can adjust easier and avoid side effects of stopping the medicine too quickly. Discuss your fears about getting off your medicines with your doctor. You may want to ask your doctor to take the approach of changing one medicine at a time to see how you feel after each change. It will be a slow process but it will help you determine how each medication affects your mood and whether or not the medication is needed to help you feel better.

If you haven't done so already, you may also want to try to find a support group—this may be an organized group specifically for people who have lost loved ones, or maybe a pain support group, or maybe some other group that organizes around an activity that interests you. There are many people that struggle with your conditions and it's often helpful to share your stories and know that you are not alone. The people in these groups may be able to recommend doctors and specialists if you are interested in finding a new doctor.

Medications used for depression are called antidepressants. Antidepressants work by helping to balance the chemicals in the brain. The goal of medication is remission of your depression, so you feel like yourself again. There are several different types of antidepressant medication. None are addictive.

Here are a few things to expect if you choose this type of treatment:

  • Medication takes time to work. Usually, depression symptoms don't begin to go away for 2 to 4 weeks, and it may take up to 8 to 12 weeks to see the full benefit of your medication.
  • You'll probably need to take medication for at least 6 months after you feel better. Sticking with treatment during this time greatly lowers the chance that your symptoms will return.
  • During the first few months of treatment, your doctor may schedule several follow-up visits to see how you're doing and adjust your medication if necessary.
  • Every person has unique chemistry, and it can take time to find the right medication for you. If the first medication you try doesn't relieve your symptoms, don't be discouraged. There are other alternatives.
  • Common side effects you might notice include dry mouth, mild nausea, sleepiness, or insomnia. Luckily, side effects often go away after the first few days or weeks of treatment. If you have side effects that are severe or that don't go away, call your doctor. Be sure to call your doctor if you have any new or sudden changes in mood, behavior, thoughts, or feelings.
Dr. Elizabeth Lombardo, PhD
Physical Therapy Specialist

There are many antidepressant medications. I recommend you speak with your doctor about the different options.

In addition, keep in mind that therapy is also a vital component of treatment for depression. In fact, research shows that cognitive behavioral therapy (CBT) is as effective as medications.

CBT is based on the premise that how you think affects how you feel and what you do.

You can find a CBT therapist near you at: http://therapists.psychologytoday.com

Dr. Lara Honos-Webb, PhD
Psychology Specialist

The dominant approach to treating depression is the medical model and its attendant treatment of choice—antidepressant medications. Most depressed people who go to the doctor for treatment are given prescriptions for medicine alone rather than pointed toward psychotherapy interventions that have been shown to be equally effective. In one study, 88 percent of patients reporting depression received a treatment recommendation of antidepressant medication in contrast to 39 percent who received a recommendation of psychotherapy. This practice is in contradiction to the existing scientific evidence that shows psychotherapy is an effective treatment for depression and that it has many benefits over medication.

Dr. John Preston, PsyD
Psychology Specialist

Almost every day there’s a story in the popular media about the dangers of antidepressants or a report of yet another research study that questions the efficacy of a particular antidepressant. And even though antidepressant use is soaring in the United States, there is still a stigma about admitting you’re taking them. In spite of the stigma, antidepressants can and do work for most people with depression. With proper treatment, antidepressants are effective for about 70% of those treated—even those with serious depressions. 

They can be a lifesaving first step in stabilizing mood, especially when your depression has affected your functioning to the extent that you are in danger of losing your job or an important relationship, or you are at risk of harming yourself. 

Depression 101: A Practical Guide to Treatments, Self-Help Strategies, and Preventing Relapse

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Depression 101: A Practical Guide to Treatments, Self-Help Strategies, and Preventing Relapse

When you have depression, it can feel like there's no way out. To begin changing the way you feel, you'll need an arsenal of proven techniques for lifting your mood and preventing relapse. The...

There are many different medications used for the treatment of depression. The most commonly used are the selective serotonin receptor inhibitors (SSRIs). Experts believe that depression is caused by a lack of serotonin in the brain. The SSRI class of medications stops receptors in the brain that would normally absorb the free serotonin. With these receptors blocked there is now more serotonin in the brain. Think of your brain as a lake full of fish, and the fish swim out of the lake via a stream (the receptors). If we were to stop access to the stream by building a dam (blocking the receptors), there would then be more fish in the lake because they cannot get out.

There are other medications with slightly different means of treating depression, including selective serotonin and norepinephrine inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs).

Dr. Tarique D. Perera, MD
Psychiatrist (Therapist)

Therapy and lifestyle changes alone often are enough to treat minor depression or seasonal affective disorder. In more severe cases, antidepressants may be needed, says Tarique Perera, MD, a psychiatrist with Contemporary Care of Connecticut.

Medicines used to treat depression regulate the levels of neurotransmitters in the brain. These neurotransmitters are dopamine, serotonin, and norepinepherine, and they are thought to be "happy" neurotransmitters that elevate mood. Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinepherine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) all increase the levels of those neurotransmitters by either inhibiting the chemistry that breaks them down or preventing nerve cells from reabsorbing them (reuptake). Some of these drugs, particularly MAOIs, can have serious side effects, and these should be taken into consideration as you and your doctor plan your treatment.

Continue Learning about Depression Treatment

Depression Treatment

Depression Treatment

Because it is a multi-faceted condition, treatment for depression is multi-faceted as well. Minor depression can often be treated with therapy and a few simple lifestyle changes, while chronic or major depression treatment can req...

uire medication in addition to therapy. In some severe cases, electroconvulsive therapy (ECT) may be used. It's important to work with your mental health professional to determine which course of treatment for your type of depression is most appropriate.
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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.