DEPRESSION AND ANTI-DEPRESSANTS

Jagdish C. Dang, M.D.

 Know more about depression and ati-depressants from Dr. Jagdish Dang who is Board Certified in Psychiatry and Geriatric Psychiatry. He is also a former Chairman of Psychiatry at Barnert Hospital, and Distinguished Life Fellow, American Psychiatric Association.

Depression is a common disease.  More than one in 10 Americans are on prescription drugs, called anti-depressants.  Some people think depression is a weakness of mind.  It is not.  I want to emphasize that it is as much of a disease as diabetes or high blood pressure.  Nobody should feel guilty for being depressed.  Nobody should be ashamed of admitting that he or she is depressed.  Depression is treatable, like diabetes or high blood pressure.  It should not be ignored.

What is Depression?

When sadness or irritable mood are more intense or longer lasting than normal grief, accompanied with symptoms of sleep disturbances, appetite problems and poor interest in normal activities and sex, it may be an indication of depressive disorder.  In addition there may be crying spells, low energy, negative thoughts, body aches (and other physical symptoms), even suicidal ideation. In Bipolar and manic depression, a person may be thinking high, feeling extra energetic, may not need much sleep, and may have inappropriately high ideals

How Common is Depression

Depression is very common.  Almost 10 percent of adults are depressed at a certain time.  Children, teens and elderly are not immune to depression.  It crosses all ethnic, social and religious lines.

Causes of Depression

Sometimes depression is triggered by a loss, and the mourning period becomes inordinately prolonged or intense.  Any loss can do that, for example, loss of a family member, a job, physical abilities, social or functional humiliation, or retirement.  Sometimes an imaginary loss can be as harmful, especially neurological problems (Parkinson’s disease) or chronic problems, like arthritis can cause depression.  Depression in turn can increase the severity and disability of many medical illnesses, like heart disease and stroke. 

Some medications (Steroids) can also trigger depression.  Depression can happen after child birth (Postpartum Depression).  Long-term abuse of drugs and alcohol can lead to the disorder.  Hereditary and genetics have also been implicated as a cause of depression. But in most cases there is no obvious reason for depression, same as diabetes and high blood pressure.  Presently it is considered to be caused by a chemical imbalance, like many other diseases. 

Treatment of Depression

Psychotherapy, anti-depressant medication and E.C.T. (Electo-convulsive Treatment, or shock treatment) are used in various combinations to treat depression.  Sometimes, inpatient hospitalization is necessary. Medicaid, Medicare and other insurance companies pay for treatment of depression. Remember, antidepressants take two to 4 weeks to be effective.

Psychotherapy

Individual and group therapy are helpful.  Sometimes self-help groups are more acceptable to patients than seeing a psychiatrist or a psychologist.

Electro-Convulsive Therapy

E.C.T. can be very effective in selected cases of severe depression.

Anti-Depressants

I consider modern anti-depressants as the Eighth Wonder of the World. The older antidepressants, like Elavil, Tofranil, Sinequan, Norpramin, Pamelor, and MAO Inhibitors are not used much anymore mainly because of their side effects.  Sedation, common with those drugs, was unwelcome because it inhibited functioning of the person.

Newer anti-depressants, SSRI’s or Selective Serotonin Re-Uptake Inhibitors or other combinations, generally have very few side effects and are highly effective.  These drugs also help post-traumatic stress disorder, anxieties, panic disorder and phobias. They started with Prozac and then we had Paxil, Zoloft, Celexa and Lexapro.

Now we have Remeron, Wellbutrin, Effexor and Cymbalta, all wonderful products with their unique doses, effectiveness and side-effects. 

Mood Stabilizers like Lithium and Depakote help bipolar and manic patients. If you are interested in full discussion of any anti-depressant specifically, ask the Psychiatrist, and we can have a column just for that.

Take-Home Message

Depression is a common and treatable disease.