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Medication

Therapists often prescribe medication during the course of therapy to help a patient cope with the debilitating symptoms of depression. The goal is to eliminate, or at least lessening the patient's feelings of anxiety and overwhelming sadness, enabling him or her to interact more productively with the therapist and cope with day to day activities. Yet many of these drugs have side effects, some more serious than others. And while they may relieve the symptoms experienced during a depression they don't address the actual cause. These medications fall into one ofseven general categories:

Selective serotonin reuptake inhibitors (SSRIs)

This group includes fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). They alleviate the lethargy and sadness of depression by increasing serotonin, a neurotransmitter that facilitates the function of nerve cells in the brain. People who are depressed have low levels of serotonin and when these are raised it seems to increase their energy and decrease their feelings of sadness. All of these medications have some side effects including upset stomach, jitteriness, insomnia, and can decrease sexual desire. SSRIs are among the newest treatments for depression and are reportedly safer than some prescriptions used in the past.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

These medications include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq). They are also relatively new and work by raising the levels of serotonin as well as norepinephrine, another neurotransmitter in the brain. Their side effects resemble those caused by SSRIs and, in large doses, can also cause dizziness and excessive sweating.

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

Bupropion (Wellbutrin) is an example of this category and works by increasing dopamine as well as norepinephrine in the brain. In contrast to SSRIs and SNRIs, Bupropion doesn't seem to lessen sexual desire or activity but if taken in high doses may increase the risk of seizures.

Tricyclic antidepressants (TCAs)

Used for years, TCAs are often as effective as the newer SSRIs and SRNIs in increasing the amount of serotonin and/or norepinephrine in the brain. However, they have more side effects including causing low blood pressure, dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. They can also trigger weight gain and, in older patients, may result in memory problems and even hallucinations.

Monoamine oxidase inhibitors (MAOIs)

MAOIs such as tranylcypromine (Parnate) and phenelzine (Nardil) also increase serotonin levels but are generally prescribed only if other medications haven't worked. This is because the side effects of MAOIs are more serious. These drugs also require a strict adherence to a limited diet in order to avoid potentially deadly interaction with certain foods and other medications. One of the newer MAOIs - Selegiline (Emsam) may have fewer of these complications and is designed to work as a skin patch instead of a pill.

Atypical antidepressants

Medications like trazodone (Desyrel) and mirtazapine (Remeron) are called atypical because they can't be put into any existing antidepressant category. Since they act as sedatives they are usually prescribed for night time use and may be given along with other antidepressants to relieve insomnia.

Medication Combinations

Treatment for depression is as individual as the patients who suffer from this illness and primary care physicians or therapists many prescribe a number of different medications to treat different symptoms. These prescriptions may include stimulants, mood-stabilizers, anti-anxiety medications, or antipsychotic drugs. In some cases, two or more antidepressants may be prescribed along with other medications to enhance the effectiveness of the treatment. This strategy is known as augmentation.

Finding the right medication

Treating depression is often a case of trial and error before the best medicines or combination of medicines can be found for the patient. Since anti-depressants often taken several weeks before they are fully effective and side effects begin to lessen, discovering the right treatment calls for patience. Furthermore, going off anti-depressants abruptly can cause withdrawal symptoms that could make the depression worse. But if a patient gives themselves a chance to get used to the medication or to switch over to one that is more effective they should find it well worth the effort.

Merln Hurd PhD; BCN, QEEGT

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PVKelsey, LICSW

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