Depression
Drugs and Medication
Tricyclic
anti-depressants
These include imipramine, amitriptyline, nortriptyline, clomipramine,
protriptyline, doxepin, trimipramine, dothiepin and lofepramine. Each has
its own specific characteristics and differs in some ways from the
others. The TCAs were developed in 1958.
TCAs can take
anything from a week to several weeks to work and length of treatment
varies. They work by correcting a deficiency of monoamines in the brain.
These are chemical transmitters and their levels become reduced during
depression. Because they are cheap, TCAs are often the first drug
prescribed. However, they have some unpleasant side effects and so may
not be your doctor's first choice. But if you are one of the people who
does not respond to other drugs, they may prove effective. Side effects
may include difficulty urinating, constipation, rapid heartbeat, feeling
faint, drowsiness and confusion. If they are prescribed, your doctor will
supervise their use.
There are few withdrawal symptoms, although there may be a relapse into
depression a few weeks later.
Monoamine oxidase inhibitors
MAOIs include phenelzine, tranylcypromine and moclobemide. They are so
called because they slow down the removal of monoamines by the enzyme
monoamine oxidase. Each drug has its own specific characteristics and no
two are identical. They were developed in the late 1950s/early 1960s. The
first was actually a treatment for tuberculosis, which was then found to
improve mood - a happy, accidental discovery.
They can take a few weeks to work and the length of treatment varies.
There is no doubt that they work, but they have many side effects,
including lowered blood pressure leading to dizziness and fainting,
headaches and sleep problems. Some of this family of drugs may interact
adversely with foods such as mature cheese and pickled fish, so make sure
your doctor advises you about which foods to avoid.
Selective
serotonin reuptake inhibitors
The best-known SSRIs are fluoxetine (under the brand name Prozac) and
paroxetine (Seroxat in the UK and Paxil in the USA). Others are
citalopram, fluvoxamine, paroxetine (Seroxat) and sertraline. Each drug
in the SSRI family has its own characteristics and no two are identical.
For example, Seroxat is usually more effective than Prozac in treating
depression accompanied by an element of obsessive-compulsive disorder.
SSRIs are so called because they raise serotonin levels in the brain.
These levels are lower than normal in people with depression. The length
of treatment varies from person to person. Many people suffering from
depression have found them very helpful. They are just as effective as
the TCAs, but without the worrying side effects of the older drugs.
Nevertheless, you may be unlucky enough to experience nausea, insomnia
and general agitation or anxiety. Some people lose their sex drive.
Lithium
Lithium carbonate (often simply called lithium) is a mood regulator and
the drug your doctor will usually choose if you are suffering from mania
and manic depression. Other drugs he might prescribe include
carbamazepine and sodium valproate.
It may take several months before it is fully effective. Your doctor will
arrange regular tests to monitor the amount of lithium in your blood
because the level required for the treatment to work is not much below
the toxic level. Since you might experience some unpleasant side effects,
such as reduced thyroid function, thirst, trembling, nausea and diarrhea,
your doctor will supervise its use. Lithium is sometimes prescribed in
combination with TCAs. Carbamazepine and sodium valproate also may have
serious side effects.
Sleeping tablets
Insomnia and waking in the early hours of the morning, both common signs
of depression, can be treated with sleeping tablets. If you take them for
only a short time while you are completely exhausted, they can be very
helpful. However, most of these drugs are addictive, so you should not
take them for more than two weeks. Think of them as a short-term remedies
for depression.
Anti-anxiety drugs
Anxiety is a very common feature of depression and your doctor may
prescribe anti-anxiety drugs, or tranquillizers, to help you in the weeks
that it can take for anti-depressant medication to become effective. Some
anxiolytics are addictive, so, as with sleeping tablets, your doctor will
prescribe them for short-term use only.
