NRIs (Norepinephrine Reuptake Inhibitor): Selectively boosts norepinephrine
NaSSAs (Noradrenergic/Specific Serotonergic Antidepressants): Enhances the release of norepinephrine and serotonin while blocking certain serotonin receptors
SARIs (Serotonin-2 Antagonists Reuptake Inhibitors): Blocks the reuptake of serotonin while also blocking one specific type of serotonin receptor
Other older antidepressants also targeted multiple neurochemicals (see the section ‘Taking tricyclics’, later in this chapter). However, these newer versions appear to have fewer side effects and are more specific in their actions on the neurotransmitters than the older tricyclics.
Taking tricyclics
This class of antidepressant medication was the most widely used for many years. Tricyclic medications are thought to have more general effects on neurotransmitters than the newer, more targeted medications (the ones we cover in the ‘Selecting SSRIs’ and ‘Getting more for your money’ sections, earlier in the chapter). The name is based on their chemical structure rather than the way they exert their effects, which can vary from one type of tricyclic medication to another.
The main reason that tricyclics are now less popular is that an overdose can be fatal. The newer antidepressants are generally much safer. Tricyclics are also associated with a host of side effects. These medications can cause dizziness from orthostatic hypotension, a sudden drop in blood pressure upon standing. Therefore, tricyclics are usually not prescribed for people at risk of falling, such as the elderly. Other side effects include weight gain, dry mouth, blurred vision, constipation, sweating, and sexual dysfunction.
Nevertheless, tricyclics may be more effective in severe depression than other antidepressants, and doctors often prescribe tricyclics when other medications haven’t worked or when anxiety is mixed with depression. Lower doses are used when the patients is elderly. See Table 15-3 for more information.
Table 15-3 Tricyclic Antidepressants
Brand Name
Generic Name
Usual Dosage (In Milligrams)
Allegron
Nortriptyline
50–150
Anafranil
Clomipramine
10– 250
Lomont
Lofepramine
140-210
Prothiaden
Dosulepin/dothiepin
50-150
Sinepin
Doxepin
30–300
Surmontil
Trimipramine
75–300
Tofranil
Imipramine
75–300
Triptafen
Amitriptyline
75–200
Understanding MAO inhibitors
The first drug to treat depression was discovered in 1952, totally by accident. Scientists were experimenting with a new treatment for tuberculosis. Unfortunately, while the drug had no effect on TB, surprisingly, the patients taking the drug reported that their low mood lifted. Thus, the first antidepressant was born – a monoamine oxidase inhibitor (MAO inhibitor).
MAO inhibitors work by targeting a substance that destroys neurotransmitters. Because fewer neurotransmitters are destroyed, this then increases levels of serotonin, norepinephrine, and dopamine. MAO inhibitors are prescribed less often because of potentially serious side effects when combined with certain common foods or medications (although newer types of MAO inhibitors that may not have the same dangerous interactions are under development). Side effects can include dangerous spikes in blood pressure that can result in strokes or death.
People taking MAO inhibitors should avoid food containing tyramine (a natural substance found in the body that also forms as proteins breakdown as they age) such as sausages, beer, red wine, avocados, aged cheese, and smoked fish. Drug combinations to avoid include any other antidepressant medication, most drugs for colds and asthma, drugs for the treatment of diabetes, for high blood pressure, and some painkillers.
Despite all of the problems with MAO inhibitors, doctors still use them to treat some forms of resistant depression. When safer medications haven’t helped, these drugs can be effective. They’re especially useful for the treatment of atypical depression, which often involves overeating, sleeping too much, and irritability. Table 15-4 provides more information.
Table 15-4 MAO Inhibitors
Brand Name
Generic Name
Usual Dosage (In Milligrams)
Marplan
Isocarboxazid
10–40
Nardil
Phenelzine
45–90
Parnate
Tranylcypromine
30–60
Looking Beyond Antidepressants
For most people with depression, an antidepressant medication helps ease symptoms. You may have to go through a trial period, but usually one or more of the drugs we discuss in the ‘Exploring Medication’ section, earlier in the chapter eventually works. However, when several different classes of antidepressant medication haven’t worked, your doctor (usually a psychiatrist) may try other types of drugs.
Depression is a serious problem. If the first tablet prescribed doesn’t work, hang on in there. Your doctor is highly likely to suggest an alternative drug, or combination, that is more than likely to help Upping the downs: Smoothing out moods.
A group of drugs called mood stabilisers don’t directly impact on serotonin, dopamine, or norepinephrine – the neurotransmitters that antidepressant medications target (see the ‘Exploring Medication’ section, earlier in the chapter). Mood stabilisers have multiple and complex effects on neurons. Many of these drugs seem to mainly affect two other neurotransmitters, glutamate and gamma-aminobutyric acid (GABA). Mood stabilizers, usually the first choice in treating bipolar disorder (refer to Chapter 2), are also used in combinations with antidepressants for treating resistant depression.
When taking some mood stabilisers, you’re going to need to have periodic blood tests to find out the concentration of the medication in your system. These drugs can have serious side effects when levels get too high. Toxic levels can be fatal, so follow your doctor’s instructions.
Some of the drugs described in Table 15-5 haven’t yet been officially approved for the treatment of depressive disorders. However, specialists have safely and successfully used many of them in their practices.
Table 15-5 Mood Stabilisers
Brand Name
Generic Name
Comments
Depakote
Valporic Acid
An anticonvulsant, may be useful for treating persons with mood swings or mixed states. Toxicity or overdose are less common than with lithium.
Lamictal
Lamotrigine
Found to be useful for some with bipolar disorder. There are worries about skin reactions that can potentially be fatal.
Neurontin
Gabapentin
Fewer side effects, less toxic. Generally ineffective by itself for mania. Used for anxiety and peripheral nerve pain. Needs more study.
Priadel
Liskonum or others
Lithium
Used primarily for bipolar disorder but can be added in small doses to antidepressants to enhance treatment. Side effects can include weight gain and tremor. Increased tremor, disorientation, and slurred speech may indicate dangerously high levels of the drug that can result in seizures or death.
Tegretol
Carbagen
Carbamazepine
Also an anticonvulsant and used to treat those with mood swings. Can be fatal in overdose. Interferes with the effectiveness of contraceptive pills.
Topamax
Topiramate
Has been used both as an anticonvulsant and mood stabiliser. Unlike many other choices, this drug is associated with weight loss.
Getting extra help for severe depression
For people with severe symptoms, a new class of medication, called atypical antipsychotics may help
. They are also sometimes given to those people who get insufficient benefit from the other antidepressants that we discuss in this chapter. Antipsychotics may help when individuals suffer from psychosis, paranoia, or delusional thinking (refer to Chapter 2 for more information about these severe depressive symptoms). These drugs may also be used when people with depression have problems controlling their temper, overreacting to small frustrations, or swinging back and forth from depression to mania.
Antipsychotic medication may have disturbing side effects. The newer atypical antipsychotic medications have a significantly decreased risk of a long-term side effect known as tardive dyskinesia, which involves involuntary movements, often in the face. When tardive dyskinesia appears, it usually does so after long-term use of the medication. Other serious side effects may include an intense feeling of agitation or restlessness, muscle spasms, muscle stiffness, shuffling gait, sedation, dry mouth, blurred vision, and hypotension. Weight gain is also particularly common and problematic.
Table 15-6 gives you more information about antipsychotic drugs.
Table 15-6 Atypical Antipsychotics
Brand Name
Generic Name
Comments
Abilify
Aripiprazole
Has minimal tendency to cause sedation, weight gain, or movement disorders.
Risperdal
Risperidone
Helps decrease agitation and behavioral disturbances, can cause movement disorders in higher doses.
Seroquel
Quetiapine
Low risk of movement disorders, can cause weight gain and sedation.
Zyprexa
Olanzapine
Improves mood in bipolar disorder. Causes weight gain.
And there’s more!
Your doctor may prescribe other drugs for the treatment of depression, or to combat the side effects of antidepressant drugs. Here are a few examples:
Stimulant medications: These medications can be used to decrease fatigue, increase your sex drive, and improve attention.
Hormones: Sometimes doctors advise hormone therapy because of abnormalities or as an augmenting agent. Augmentation is adding a second drug to increase the effectiveness of the first one.
Sedating medications: These drugs can help calm agitation or help with sleep.
Chapter 16
Help and Hope: Exploring Complementary Therapies for Depression
In This Chapter
Looking at supplements and herbs
Thinking about your diet
Using light therapy to tackle the winter blues
Examining treatments for severe depression
When the darkness of depression closes in, cheerfulness fades into dark desperation, and hope sinks into despair. Depression is painful, and recovery seems almost impossible at times. Then you read an article offering a supplement, another pill, a completely new therapy or medical procedure, a change in diet, or a special light bulb to help banish your depression. With renewed hope comes a lightening of mood, a little relief, and a ray of optimism. Hope itself can be a powerful tonic for depression.
Wanting to see the light at the end of the tunnel and start leading a normal life again is a powerful incentive for searching for the most effective therapy to put you back on an even keel. But putting your faith into treatments that haven’t yet been proved to be effective, is unwise and even dangerous. Following a certain course of treatment may lead to some improvement, purely because of your belief that it is going to be helpful. There’s nothing wrong with that – if the treatment is indeed harmless. But, at the same time, we want you to be careful not to be taken in by false promises. That’s our purpose in writing this chapter.
In this chapter, we give you information about complementary therapies, helping you to decide whether the treatments are suitable for you. We think of treatments as complementary (or alternative) if they’re not widely accepted as being effective by conventional mental health and medical professionals, or if the professionals don’t use that treatment as their first choice when treating major depression.
How popular are complementary therapies?
A study published in 2008 in Current Opinion in Psychiatry looked at complementary therapies in the treatment of anxiety and depression. The study highlighted differences between the use of complementary therapies to treat anxiety and depression in the US compared with other countries.
In the US, people with anxiety and severe depression often use complementary therapies. In fact, more than half of those suffering from severe depression said they’d tried complementary therapies in the year before the survey. But people who were suffering from severe depression said that they were also using conventional mental health or medical treatments for their depression. That’s pretty sensible, because the conventional medicine approach has the support of a large body of research.
Surveys carried out in Europe and Australia also reveal positive public attitudes towards the use of complementary therapies. However, the UK lags behind: only 14 to 30 per cent of people in the UK use complementary therapies.
Doctors today are increasingly advising the use of complementary treatments for easing depression.But it’s vitally important that you discuss with your doctor any alternative therapies that you’re thinking of tryingt Your doctor can give advice on whether a particular therapy is known to work, or whether the therapy might interact harmfully with medication you’re already taking.
If you or someone you love suffers from severe depression or has thoughts of suicide, you need to get professional help, at once. Remember, it’s extremely rare for staff of health food shops to be qualified mental health professionals.
Sampling Supplements and Herbs
A lot of people suffering from depression head for the health food shop seeking what they hope is a ‘natural solution’ to their problems. Many have researched complementary therapy options on the Internet first, others just ask the sales staff for advice. The Internet can disgorge a variable feast of choices, with page upon page, product upon product of herbs, supplements, and vitamins promising relief from your depression. Some therapies may indeed be helpful, while others may not. And beware, some of the advertised therapies are potentially harmful.
You may believe that taking herbs and supplements for depression is a relatively harmless, natural alternative. However, it’s very important that you only take these powerful substances under medical supervision. Some substances can significantly interact with other medication you’re taking and prove harmful. So, if you’re considering trying any complementary therapies, including the ones we discuss in this section, please consult your doctor first.
St John’s wort
Hypericum perforatum, better known as St John’s wort, is a small woody perennial used since the time of ancient Greece for a variety of medicinal purposes, from curing stomach problems to healing wounds. In recent years, people have been using St John’s wort extensively as a treatment for depression. St. John’s wort is thought to work by increasing chemicals in the brain – such as serotonin, norepinephrine, and dopamine – that affect mood. (Refer to Chapter 15 for more information about how these brain chemicals work.)
Overcoming Depression For Dummies Page 35