Antidepressants and their side effects

[Susan]

I can add to those tips – thanks to my mom. It is necessary to get up from a lying or sitting position very slowly – since you may feel dizzy. If you develop the flu or some allergies, don’t go in for any over the counter remedies without first speaking to your doctor, as these seemingly harmless medicines can trigger side effects. Tell your doctor immediately if you have any side effects that you find intolerable. To avoid sleep problems, you might want to avoid caffeine and other stimulants that could keep you awake. And of course, no alcohol, no smoking, no recreational drugs. Understandably, it is difficult to handle people who are depressed, since you really have to watch what you say to them, lest they feel offended in their emotional state.

[David]

You know, we have been talking all along about depressed people. What about the caregiver? When a family member has a major problem it’s a big strain on the caregiver – and can be quite thankless too. Studies have proved the while the quality of life improves for the person who is sick, it becomes worse for the person who is taking care of them. The caregivers become depressed gradually, and creak under the weight of the work involved. Now if the caregiver is depressed, obviously their mental state is going to influence the mental condition of the person they are taking care of. So caregivers should also be taken care of. There should be interventions that can encourage good communication between patients and caregivers so both can benefit from this, and both can understand each other’s roles.

[Marie]

Somehow I feel that doctors – and generally the medical profession tends to ignore the self help methods available for depression, probably because very few professionals get involved in this sort of thing. There are so many depression oriented support groups, though, that are very effective. They give the depressed person the chance to interact and socialize with others who are also going through the same suffering. These support groups are devoted to helping people with depressive disorders so that they can share their problems and experiences. I don’t know how effective self-help books are – but they are definitely worth a try for someone who is keen on overcoming depression; after all they come from a lot of research. Some people may be cured with this sort of therapy and not need any thing else.

[Jeff]

Patients should be encouraged to work on developing skills to cope with and explore their emotions with the people they interact with at these support groups. Depends on the facilitators I guess. Some people can simply just close up, build a wall, and refuse to talk at all. Before getting involved with the group, some counseling as to how the group can help must be done, so that it is approached with a good understanding of the outcome, so that they can work towards it. They can then use the group to expand their skills and develop new healthy social contacts and relationships. New friendships are formed, things are viewed in a broader sense and with the help of a good counselor or facilitator things can be pushed comfortably in the right direction, getting the person to feel better.

[Kim Wilde]

The general practice of the doctor is to choose an antidepressant based on the person’s symptoms. The person could improve in two weeks. But the doctor advises the patient to continue the med for at least 6 weeks or even 8 weeks to experience the full therapeutic effects. Suppose there is no change even after 6—8 weeks, the medication could be changed or a second one like lithium added to that it can help the original antidepressant work. There is just no way to know which medication will be effective in the beginning – before any medication is prescribed. So the doc just prescribes one and then the other. And then, for the medication to be effective, it needs time. To avoid the risk of relapse, the medicine must be continued for 6 or 12 months or maybe longer, depending on what the doc says.

[Susan]

What about when the patient and doctor feel that the medication can be stopped? The patient obviously can’t suddenly stop. Both doctor and patient have to discuss the process of withdrawing from the medication and how best it can be tapered off. If there are several bouts of depression, antidepressants must necessarily be administered in the long term if future episodes are to be avoided. Actually when antidepressants are started, there is a tendency to feel worse before the medicine actually begins to work. Side effects are a possibility as soon as the medicines are begun – while the actual benefits take a little longer to manifest themselves. Side effects are often mild and disappear in a few days or weeks. When prescribed by the doctor, antidepressants are generally not habit forming.

[David]

The most important thing to remember is not to get upset if the first medication doesn’t seem to work. Getting and settling down with the right medication takes time, and so does deciding the right dosage. What is really encouraging is that there is a variety of antidepressants available to choose from, so your doctor will be aware of which ones work for your constitution and situation. An antidepressant usually seems like it has failed because the time for which it was taken was too short or the dosage was too low. That’s one side of it. Some people begin to feel better with antidepressants – and think they can discontinue or reduce their medications. This is very tempting, but there is always the risk of stopping too soon and facing relapse. If the person has major depression, they may need to take medication as a routine so that the symptoms don’t recur.

[Jeff]

One of the questions most docs face is the patient asking which antidepressant drug is the best for them. The neurotransmitters that control our moods have a lot more to do, being involved in other processes like sleep, eating, and pain. So drugs that affect the neurotransmitters can actually treat more than just the depression. The antidepressants can actually treat other related problems like headaches, eating disorders, etc. Even bed-wetting is being treated with antidepressants. Actually all antidepressants are effective – but some work better for certain types of depression. If you notice, people who are depressed and agitated tend to respond to an antidepressant drug that has a calming effect on them. For those who are depressed and sort of withdrawn, they may need an antidepressant drug that stimulates them – different choices are available.

[Leo]

Ultimately, antidepressants are not magic! They only help the depressed person feel better. They just can’t solve problems in people’s lives. So many mental health professionals are concerned that people who could benefit from psychotherapy – sometimes depend on antidepressant drugs for that immediate solution. But there are those that feel that the effect of antidepressant drugs is very gradual – and they cannot produce instant results. As was mentioned in an earlier post, probably the best combination is counseling and medicine – but the correct treatment for a particular patient can depend on so many other things. It is very tough to make the decision related to how to treat depressions, how other factors many respond to the antidepressant drugs and the way it will act on different people.

[Marie]

For some individuals depression becomes more frequent and severe with an increase in age. In these cases, continued treatment with antidepressants can effectively bring down the frequency and severity of these depressions – it’s a sort of maintenance treatment. Generally these medications are not known to have any long-term side effects – and can be continued almost indefinitely. If at all there are side effects that are difficult to tolerate, the doc may lower the dosage. Lithium is often prescribed for maintenance treatment for periodic occurrence of depression whether the person has experienced manic or manic-like depression. Dosage varies – depending on which drug, the individual’s body chemistry, age, body weight, etc. Most medicines are safely started at a low dosage and increased over time till the expected result is achieved without any severe side effects.

[Kim Wilde]

Sadly, some people with bipolar disorder who have mood swings between manic and depression don’t respond to lithium and there is no way to know who will respond and who will not respond before it is prescribed. Regular blood tests are routine before treatment with lithium. Lithium is not effective if the dosage is too low. Too much can trigger off a variety of side effects that may or may not be tolerated. A very small range separates an effective dose and a toxic one. The lithium levels in the blood are checked before starting the treatment with lithium to find the best level. When the person stabilizes on a maintenance dosage, the lithium levels need to be checked on a regular basis – say every few months. How much lithium needs to be taken can vary over a period of time – this depends on how ill the person is, body chemistry and physical condition.

[Susan]

Lithium is not without its problems. For people who take lithium for the first time, they experience side effects like drowsiness, weakness, nausea, fatigue, hand tremor, or increased thirst and urination. Some of these disappear or decrease gradually, but hand tremor doesn’t go away. Some people put on weight. While dieting can help, crash diets can be harmful as they lower or raise the lithium level. Water and other beverages that are low calorie can keep the weight down. Changes in the kidney happen – this can increase urination in adults and bed wetting in kids – and all this during treatment. However, these changes are not unmanageable and can be handled by lowering the dosage. Lithium makes the thyroid glad become under active or enlarged – so the thyroid must be monitored during treatment. Thyroid hormone may be given along with lithium.

[David]

Lithium is something doctors must be very careful about prescribing because of the complications that may occur, especially if the person has thyroid, kidney, or heart disorders, epilepsy, or brain damage. Women of childbearing age must know that lithium can increase the risk of congenital malformations in babies. If they are pregnant, special care must be taken during the first three months. Anything that brings down the sodium level in the body, reduced intake of table salt, a change to a low salt diet, too much sweating as a result of too much exercise or hot climate, fever, nausea, diarrhea can all cause a build up in lithium levels, making it toxic. So it is necessary to know that anything that lowers sodium levels or dehydrates a person must be reported to the doctor immediately, so that corrective action can be taken.

[Jeff]

Lithium can be a big problem – when it is combined with other medications it can result in many undesirable effects. Diuretics – which remove water from the body, can increase lithium levels and bring about toxicity too. Even coffee and tea can lower lithium levels in the body. The toxicity is what causes vomiting, a nauseous feeling, drowsiness, general feeling of lethargy, blurring of vision, dizziness, slurred speech, confusion, irregular heartbeats and finally seizures. Lithium overdoses can be fatal! If anyone is on lithium medication, they must tell the doctor who is treating them. Even if a dental problem develops, the dentist must be told about all the medications they are on, so that proper care can be taken to ensure that the patient does not develop major discomforts.