How effective are antidepressants in treating depression?

[David]

We know that antidepressants are medicines prescribed to treat people who suffer from depression. Most people recover gradually with the help of these antidepressants and lead a better quality of life. But can they treat completely? There must be the issue of so many side effects and interactions with other medication they might be taking. Because antidepressants are prescription-only drugs, they do carry many risks, along with the benefits. Antidepressants cannot be taken without doctor’s advice and monitoring. Fact is, they do help significantly and there is a lot of research to prove that they are effective. Factors to consider are severity of the person’s depression and past history of medical problems, how old they are, etc. Usually a combination of medication and therapy is recommended. Come, lets share information and views on this.

[Susan]

You know, David, apparently for adults who are suffering from severe depression, antidepressants are the answer since they are found to be the most effective compared to any other treatment. For mild depression, they suggest just psychotherapy to cure, but here also, often an antidepressant drug is prescribed. This is probably to get them into the frame of mind to actually go in for therapy and maybe get some physical exercise – which we know can bolster your moods. I don’t know, but it is not easy for someone who’s depressed to suddenly get up and go for therapy and all that positive thinking stuff. If they could do that, they wouldn’t need treatment in the first place. Which is why antidepressants could be helpful – to encourage them into thinking positively about getting better. So – I think antidepressants are good – they get you started on the actual non-medication treatment!

[Jeff]

Susan has a valid point, considering how antidepressants work. Antidepressants are supposed to slow down the removal of chemicals called serotonin and norepineprhine – or neurotransmitters. These are necessary for our brain to function normally and they also control our moods, and other things like eating, sleeping, thinking, feeling pain, etc. For people with depression, antidepressants make these chemicals available in the brain and bring back its balance, and therefore bring relief. They make the person less sad and hopeless. These antidepressants are prescribed for about six months - some people may need them longer or less. These drugs are also used for treating other problems like obsessive compulsive disorder, eating disorders, chronic pain, pre menstrual syndrome, etc. which might all be an outcome of depression.

[Marie]

But antidepressants also have side effects. There are different kinds of antidepressants – the SSRI – selective serotonin reuptake inhibitors, tricyclics, and others. The SSRIs are drugs like Prozac, Paxil, Zoloft – and these only act on the serotonin in the brain, while tricyclics and MAO inhibitors act on both serotonin and norepinephrine. Also there’s the chance of them interacting with other chemicals in the body. The consensus is that SSRIs have fewer side effects than tricyclics and MAO inhibitors. SSRI side effects are dry mouth, insomnia, headaches and sexual problems, restlessness, diarrhea and exhaustion. Tricyclics like Elavil, Tofranil, etc. cause constipation, blurred vision, tiredness and impaired thinking.

Thing is, the side effects are not same for all individuals – so you need to understand the medication and listen to your doc. Does anyone know what MAOs are?

[Leo]

MAOI – monoamine oxidase inhibitors – are antidepressants that are used less commonly that the SSRIs and tricyclics. You’ll come across Nardil, Parnate etc..they make you weak and dizzy and cause headaches and tremor. These MAOIs can cause severe adverse effects if you take them along with other antidepressants and other OTC meds for cold and flu. In fact, when you get a prescription from your doc for MAOI drugs, you’ll be informed about which foods and alcoholic drinks you need to avoid when you take the MAOIs – its very very important to get these facts straight. So even if your doc suggests that you take some other antidepressant, he or she will advise you to stop the MAOI for some time before the other medication is started, so that the MAOI can be flushed out of your body. Depression is no laughing matter!

[Kim Wilde]

Yeah – in any case, antidepressants interact with other medications. It can have an effect on all the other medications you are taking. So you’d better tell your doc if you are on medication for other problems, including all your herbal stuff as well. You never know what reactions might be there, because some medicines will cause serious problems in combination with others. There’s something called serotonin syndrome, which is a drug reaction when two antidepressants interact with each other, or when the patient is on recreational or other drugs, and sometimes scarily enough – from the one antidepressant alone. There’s hyperactivity, sweating, seizure, diarrhea, mental problems etc. So even if you are switching from one anti depressant to another, a gap of two weeks is a must so that you don’t suffer this serotonin syndrome.

[Marie]

All antidepressants are not a hundred percent effective though some work for specific types of depression. If a person who is depressed and all worked up, they would need an antidepressant that calms them down as well. For those who are depressed and kind of stick to themselves might need an antidepressant that cheers them up. In any case, it is always better to try psychotherapy before going for the antidepressant drug. Moreover, drugs take a while to show their effects. Also, it is generally recommended that therapy be combined with medicine though which one is right would depend on many criteria. Likely reactions based on patient history must be considered and then the decision must be made. I personally vote for the counseling method to make a depressed person better – more often than not, it’s a matter of not having someone to talk to.

[Susan]

A very unwelcome side effect of antidepressants is weight gain. It’s quite common with antidepressants, mood stabilizers and antipsychotic. Of curse we know that being overweight carries with it a slew of health problems, but it seems more important to get that mood under control, especially when it seems like all hope is lost. But once the mood is okay, how can you shed those extra pounds and stop yourself from feeling lousy about the way you look? You could probably change your medication to one that makes for less weight gain but there’s no surety that this will work. Reactions to medication differ from person to person. Actually there seems no information about the connection between antidepressants and weight gain – but practically everyone who’s on antidepressants seems to experience weight gain!

[Kim Wilde]

Some antidepressants cause more weight gain than others. In fact, the tricyclics and MAOIs cause more weight gain than the SSRI antidepressants. Even with SSRIs, continued use of Paxil leads to weight gain. But its not just the antidepressant that causes weight gain in a depressed person. So many other things have to be considered. Some people lose weight when they are depressed. And if they feel better when they take an antidepressant, then they might have better appetite and gain weight. Some people overeat when they are depressed – and become overweight. What about that? Hypothyroidism also makes a person put on weight. Whatever, its best to tell the doc who prescribed the antidepressants about any thing you feel because they might suggest something else in case the weight gain is because of the medication. Weight gain carries a whole lot of other problems with it - as Susan said earlier.

[Susan]

Yes, Kim, the weight gain-depression cycle is a vicious one. Eating out of boredom, feeling lonely or because of emotional upsets – all lead to becoming overweight. So that’s perhaps why depression and weight gain go hand in hand. Anyway… it’s not a shocking thing to hear. And once the person becomes overweight, they feel depressed about that – and just continue to eat! This doesn’t help at all because they just don’t realize that the more you eat, the more you weigh; and the more you weigh, the worse you feel. Stress also causes depression, which results in weight gain. Highly stressed people have a lot of cortisol releasing into their bloodstream and this makes them hungrier, in an unhealthy way – and they turn to food. Becomes a kind of comfort thing where they think food is the answer when they’re depressed, anxious or tired.

[David]

Turning to food when suffering from stress or anxiety is so common. When people are depressed and overweight, they suffer from insomnia as well. So, when sleep eludes them at night, they wake up often. If they don’t get enough sleep they will not lose weight. During cold weather, people’s depression and worry from weight gain just seems worse. Since it seems tough to go out to exercise, fewer calories are burnt. When there’s less sunlight for a long period of time, there’s something called seasonal affective discover which makes people sleep more, but in an exhausted way, yearn for carbohydrates and feel hungry all the time. The result? Fatter. The only way to conquer this is to exercise. A regular routine not only enlivens the mood, but also makes you lose weight.

[Marie]

It’s a proven fact that exercise helps to fight depression and weight gain. But it has to be a regular routine if there are to be consistent results both for the depression as well as the weight. A one off incidence of exercise will only make the problem worse – increase depression (and weight of course). Support from family and friends goes a long way in recovery from both. Apart from weight gain as a side effect, some antidepressants also boost moods – this could be advantageous if sets you off on the right path to make the necessary effort to exercise and feel better. Also, being in constant touch with the doctor is necessary so that dosage adjustments if any can be made. Above all, a good night’s sleep does more than anything else.

[Susan]

I’d like to add some to what Marie said – one of the things that really works for depression is relaxation techniques. This helps stress. Like Kim mentioned, the vicious cycle of stress-tension-reaching for food-weight gain-depression can be broken. When the mind is clear, its easier to focus on eating well balanced healthy meals for the right amount of energy. Stress reduction is very important. Equally important is to reach out for help when you feel you are out of balance. It will only make the situation better. In any case, weight loss cannot happen overnight. It takes positive effort. Since many factors influence weight gain or loss, you have to keep a track of what is triggering it off. And no matter how you are feeling, don’t ever adjust your dosage of medicines without talking to your physician.

[Marie]

Ok..here’s more information about the effect of antidepressants and putting on weight. What the doctors consider is the short term effects of the medication – which could be from 3-6 months and long term effect which is more than 6 months. If the patient gains more than 7% of their original weight, then there’s cause for concern. As far as SSRIs are concerned, weight gain in short term use is negligible. So the point is, it is necessary to know the effect of weight gain before the right medication is chosen. It’s the doctor’s responsibility to keep the patient informed about all sorts of side effects, including weight gain, and how they can prevent this weight gain through the right amount of exercise and proper diet.

[Kim Wilde]

I was browsing and read about use of antidepressants during pregnancy. It was interesting to know that while taking antidepressants during pregnancy can present risks for the baby, but stopping it can be risky for the mother. For most kinds of depression, antidepressants are supposed to relieve the symptoms and make the person feel better. But during pregnancy or while conceiving, a lot of women do experience depression and emotionally charged, which makes it difficult for them to deal with it. Many antidepressants are supposed to be safe for use during pregnancy but it is not free without risks. On going research does come up with some positive encouraging results – but many antidepressants have been linked to birth defects in the fetus especially when taken during the first trimester.