Drug Therapy, antidepressants, tricyclic antidepressants, SSRI, MAOI, combination therapy, combining antidepressants, switching from one antidepressant to another, washout period, Depression, Alternative therapies, mind-body medicine, integrative therapies

Drug therapy is used in the treatment of depression to moderate or correct neurochemical imbalances that affect moods. The most popular type of medication prescribed for depression is antidepressant. Antidepressants are medications that prevent or relieve depression. It helps the brains of people who are depressed to produce neurochemicals they may be missing. A different type of medication is prescribed for people with manic depression. There had been a substantial increase in the number of people taking antidepressants, since the introduction of Prozac.

Generally speaking, you will benefit from antidepressant medication if any of the following applies to you.

If you are out of touch with reality and have delusions or bizarre hallucinations. In this case psychotherapy is usually not powerful enough for the psychotic symptoms.
If you are so severely depressed or anxious that you cannot function or do anything to help yourself.
Your depression is persistent and/or severe.
If your depression is characterized by many physical symptoms such as agitation, apathy and lethargy, insomnia, extreme gloominess, sadness, pessimism, severe changes in appetite, retardation; a loss of interest in sex; a worsening of symptoms in the morning; and an inability to feel cheered up by positive events.
Your depression disrupts your normal everyday activities.
If you feel suicidal. In this case, you should be treated with the best of everything available, including a good antidepressant medication and intensive psychotherapy.
If you have been pursuing psychotherapy for a couple of months and do not see any improvement in your condition. The right antidepressant can give you a fresh start.
If you have a strong desire to get better.
If you do not abuse alcohol or other drugs.
Your depression has an identifiable beginning with symptoms that are different from your normal state.
You have been treated successfully for depression with medication in the past.

The drug treatment is enhanced by psychotherapy, which explores the inner conflicts that contribute to your condition, helps you to understand your moods, and teaches you ways in which you can alter your thinking and behavior to prevent episodes from recurring.

Types of antidepressants

There are several categories of antidepressants

There are other antidepressants that are chemically unrelated to these groups. An example is lithium that is not an antidepressant but is used to treat people with manic depression and other disorders.

Evolution of Antidepressants

There are currently over 20 antidepressants available worldwide. The early antidepressants include the monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). The TCAs, which all have a similar chemical structure, interact nonspecifically at a number of receptor sites. The newer antidepressants are uptake inhibitors. Examples are: SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), and receptorblockers such as mianserin and trazodone. The most recent class of antidepressants is called the selective NRIs.

TCAs have been the mainstay of the treatment of depression. The TCAs, while effective, are also associated with a range of unwanted side effects such as dry mouth and constipation that limit their use in important patient groups, including the elderly and those with preexisting cardiac conditions. An overdose of TCAs can prove fatal.

The development of SSRIs was a major breakthrough. They provide a safer option in comparison with the TCAs, but also have their shortcomings. They are very effective; but they also have several adverse side effects such as gastrointestinal events, sexual dysfunction, headache, and anxiety.

The most significant advance in treating depression since the advent of the SSRls has been the development of reboxetine, the first selective NRI. Reboxetine selectively and potently inhibits norepinephrine reuptake. This results in much less side effects. It was also found to be safe to use with elderly, while being as effective as SSRI as an antidepressant.

Selecting an Antidepressant

There are several antidepressants available to the doctor. How do they decide which on is right for you? Actually, there's no sure way of knowing before hand which medication will be effective for you. Of course, if you had used an anti depressant before and it had been effective, the doctor will start you back on it. Other than that, antidepressant therapy is partly a matter of trial and error.

Certain depressive conditions generally respond better to particular antidepressants, and surprisingly, some people react to some antidepressants better than others. When determining the type of medication for you, the doctor will take into consideration the type of disorder you have, and the side effects of the drugs. The doctor will start you at a low dosage level to determine how you react to the drug. The dosage will be gradually increased to the therapeutic dosage that is appropriate for you.
Only 50 to 60 percent of patients respond to the first drug they try. Your doctor may have to prescribe a few antidepressants before finding the most effective one for you and the dosage.

Combination Therapy

Some patients whose depression is particularly resistant to treatment may benefit from combination therapy. Combination therapy is when your doctor recommend you take more than one type of medication at one time such as a TCA plus MAOI, lithium plus MAOI or an antidepressant plus a thyroid supplement.

Combining antidepressants have to be done very carefully. Certain antidepressants have dangerous interactions when taken together. For example, TCAs can interact with MAOIs to produce fever, agitation, convulsions and even death.

So, do not attempt to mix any antidepressants without the knowledge and approval of your doctor.

Switching from one antidepressant to another

There is a protocol that needs to be followed when switching from one antidepressant to another. This has to do with the interaction of the different antidepressants. So, when switching form one medication to another, you will have to go through a "washout" period; this time will allow the antidepressant to clear your system so that the new one can be introduced safely. The wash out period depends on the types you are trying to switch. For example, switching from a TCA to paroxetine can be done almost immediately. In case of the other switches, your doctor will advice you.

Usually a two-week wait is adequate when switching from an MAOI to a TCA or SSRI, vice versa, or from one MAOI to another, or from one SSRI to another. When switching from fluoxetine to an MAOI, or from an MAOI to the tricyclic clomipramine a washout period of five to six weeks may be recommended.

Terminating Antidepressant Usage

Don't just stop taking antidepressants as soon as you feel fine. It can be dangerous. Premature discontinuation can cause a relapse (return of the depression). Your body has become accustomed to a certain dosage. Discontinuing the medication should be done just as you have started it - under the guidance of your doctor.

Antidepressants and thyroid hormones

Thyroid-hormone levels can have an impact on the effectiveness of an antidepressant. A depressed person whose thyroid gland is even slightest underactive will respond poorly to antidepressants. Adding a small dose of thyroid medication seems to boost the effect of the antidepressants and turn an incomplete response into a complete remission of symptoms. So, it is used by psychiatrists in developing a combination therapy for you.

Note About Drug Therapy

The antidepressant medications are extremely powerful, and each person requires different dosages and reacts differently to them. Doctors will start the dosage at a minimal dose and gradually increase it to attain the therapeutic level. It usually takes three to six weeks for your body to respond to the drugs and for you to notice an improvement in your symptoms. If your condition does not improve, or if you experience severe side effects with a particular medication, ask your doctor to switch to another one.
Common side effects of antidepressants include dry mouth, constipation, headache, blurry vision, sedation or agitation, memory loss, insomnia, excessive appetite, and heart palpitations. The side effects are usually mild and subside over time. Report all adverse effects to your doctor.