Depression: How Medicine Can Help

What is depression?

Depression is a medical illness, like diabetes or high blood pressure. People don't choose to be depressed. It's not because they're weak or "crazy." Depression affects more than 17 million people in the United States each year. It's twice as common in women as in men. Symptoms of depression include the following:

• Feeling sad most of the day, nearly every day, for 2 weeks or longer
• Loss of interest in things you used to enjoy
• Lack of energy
• Sleep and appetite disturbances
• Weight changes
• Feelings of hopelessness, helplessness and worthlessness
• Not being able to make decisions
• Thoughts of death and suicide

What causes depression?

The exact cause of depression is not known. Doctors think it may be caused by a chemical imbalance in the brain. The imbalance could be caused by your genes or by events in your life. Sometimes there aren't enough chemical messengers (called neurotransmitters) in the brain. These neurotransmitters carry messages from one nerve cell to another. When there aren't enough of these messengers, certain messages don't get carried to some areas of the brain. Two primary messengers, called serotonin (say "seer-o-tone-in") and norepinephrine (say "nor-ep-in-nef-rin"), are responsible for your moods (how you feel).

How will my doctor treat my depression?

Depression can be treated with medicine, counseling or both. The combination of medicine with counseling helps most people. Counseling can help you change a negative view of yourself, your past and your future. Regular exercise and avoiding alcohol, illegal drugs and too much caffeine can also help.

More than 20 medicines treat depression. These medicines are called antidepressants. They help increase the number of chemical messengers (serotonin and norepinephrine) in your brain.

How will my doctor choose an antidepressant for me?

Your doctor will probably think about the following 10 points when choosing an antidepressant medicine for you:

1. If you had depression before and a certain antidepressant worked well, that antidepressant might be the right choice of medicine for you again.
2. If any of your brothers and sisters, parents, uncles or aunts had depression and a certain antidepressant worked well for them, that medicine might work for you too.
3. The choice of an antidepressant depends on your health. If a certain antidepressant would have a bad effect on a health problem you have, that medicine wouldn't be the right choice for you.
4. Antidepressants may cause side effects. No antidepressant is totally free from side effects. The right medicine for you may be the one that gives you the fewest side effects.
5. The choice of an antidepressant depends on how often you have to take it. The less often you have to take the medicine, the easier it is for you to take all the doses you need to treat your depression.
6. Some antidepressants cost more than others. Your doctor will choose an antidepressant that works for you and that you can afford.
7. Your doctor will want to choose a medicine he or she has experience prescribing.
8. Your doctor will choose an antidepressant that will help you with symptoms like sleeplessness, anxiety and lack of energy.
9. If you're taking other medicines, your doctor will consider how an antidepressant will work with these other medicines.
10. Some antidepressants don't work well with certain foods. If your doctor gives you one of these antidepressants, he or she will let you know which foods you should stop eating.

Are antidepressants tranquilizers or "uppers"? Can I get addicted to them?

No. These drugs aren't tranquilizers. They don't give you a "high." They aren't addictive.

So antidepressants cause side effects?

Yes. All antidepressants have some side effects. However, not all people taking antidepressants get these side effects. Most of the side effects happen in the early weeks of therapy and lessen after a little while.

What are some of the common side effects of antidepressants?

You might have different side effects with different medicines. There are 2 main kinds of antidepressants: tricyclic antidepressants and selective serotonin reuptake inhibitors (called SSRIs).

Possible side effects of tricyclic antidepressants include the following:

• Dry mouth
• Blurred vision
• Increased sleepiness
• Excessive tiredness
• Hand tremors
• Feeling of weakness
• Constipation
• Bladder problems
• Weight gain
• Muscle twitching
• Increased heart rate
• Dizziness when standing up

You have to be careful if you get sleepy or dizzy when you take tricyclic antidepressants. It's not good to drive or operate machines when you take them, because they affect your reflexes and your attention span.

SSRIs might have the following side effects:

• Nausea
• Vomiting
• Tremor
• Dry mouth
• Sexual dysfunction (inability to ejaculate or to have an orgasm)
• Sleepiness
• Diarrhea
• Insomnia
• Anxiety

What if the side effects don't go away after a little while?

Talk to your doctor. He or she may change your dosage or you might try another medicine to get rid of the side effects.

How will I know if my antidepressant is working?

You will be able to sleep better. You'll be able to meet your day-to-day obligations and take care of yourself better (such as caring for your hair, dressing well, eating regularly). You will have more energy. Your weight problems will get better, and your appetite will be closer to "normal." You will have an increased desire to live. You and your family and friends will notice these changes. Be patient, though. It may take some time to get back to the way you felt before the depression.

How long will I take the antidepressant?

If this is the first time you have been treated for depression, you will probably continue to take this medicine for about 6 months after you begin to feel better. If this is the second time you've had depression, you might keep taking the medicine for at least a year. Depression that comes back a third time may require you to continue taking an antidepressant for a long time.

Can I drink alcohol when I'm taking antidepressants?

No. You should not drink alcohol because it might have a bad effect on you. You might be strongly affected by even a little bit of alcohol when you're taking antidepressants.

Where can I get more information about depression?

Your doctor is the first person you should talk to.