Depression Health Article

Drugs

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), reduce depression by increasing levels of serotonin, a neurotransmitter. Some clinicians prefer SSRIs for treatment of dysthymic disorder. Anxiety, diarrhea, drowsiness, headache, sweating, nausea, poor sexual functioning, and insomnia all are possible side effects of SSRIs. A recent study shows this generation of drugs increases patients' risk of gastrointestinal bleeding.

Tricyclic antidepressants (TCAs) are less expensive than SSRIs, but have more severe side effects including persistent dry mouth, sedation, dizziness, and cardiac arrhythmias. Because of these side effects, caution is taken when prescribing TCAs to elderly patients. TCAs include amitriptyline (Elavil), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor). A 10-day supply of TCAs can be lethal if ingested all at once, so these drugs may not be a preferred treatment option for patients at risk for suicide.

Monoamine oxidase inhibitors (MAO inhibitors), such as tranylcypromine (Parnate) and phenelzine (Nardil), block the action of monoamine oxidase (MAO), an enzyme in the central nervous system. Patients taking MAOIs must avoid foods high in tyramine (found in aged cheeses and meats) to avoid potentially serious hypertensive side effects.

Heterocyclics include bupropion (Wellbutrin) and trazodone (Desyrel). Bupropion is prescribed to patients with a seizure disorder. Side effects include agitation, anxiety, confusion, tremor, dry mouth, fast or irregular heartbeat, headache, low blood pressure, and insomnia. Because trazodone has a sedative effect, it is useful in treating depressed patients with insomnia. Other possible side effects of trazodone include dry mouth, gastrointestinal distress, dizziness, and headache. In 2003, Well-butrin's manufacturer released a once-daily version of the drug that offered low risk of sexual side effects or weight gain.

Electroconvulsive therapy

ECT, or electroconvulsive therapy, usually is employed after all therapy and pharmaceutical treatment options have been explored and exhausted. However, it is sometimes used early in treatment when severe depression is present and the patient refuses oral medication, or when the patient is becoming dehydrated, extremely suicidal, or psychotic.

The treatment consists of a series of electrical pulses that move into the brain through electrodes on the patient's head. ECT is given under general anesthesia and patients are administered a muscle relaxant to prevent convulsions. Although the exact mechanisms behind the success of ECT therapy are not known, it is believed that the electrical current modifies the electrochemical processes of the brain, consequently relieving depression. Headaches, muscle soreness, nausea, and confusion are possible side effects immediately following an ECT procedure. Memory loss, typically transient, has also been reported in ECT patients. ECT causes severe memory problems for months or years in one out of every 200 patients treated.

Late in 2001, a study reported on a pacemaker-like device used to treat epilepsy adapted for patients with depression. An implanted electronic device sends intermittent signals to the vagus nerve, which in turn carries the signals to the brain, connecting in areas known to regulate mood. Although still experimental at this time, early results in treating depression have been encouraging.

Expected results

Untreated or improperly treated depression is the number one cause of suicide in the United States. Proper treatment relieves symptoms in 80–90% of depressed patients. After each major depressive episode, the risk of recurrence climbs significantly—50% after one episode, 70% after two episodes, and 90% after three episodes. For this reason, patients need to be aware of the symptoms of recurring depression and may require long-term maintenance treatment.

Overall, recent recommendations from mental health clinicians suggest that the recovery process for patients with depression works best when mental health professionals focus on the whole person behind the disorder. In addition to prescribing medications, they also should address a patient's self-esteem, feeling of control, and determination. They emphasize that patients with depression need a sense of optimism and should be encouraged to seek the support of family members and friends.

Prevention

Patient education in the form of therapy or self-help groups is crucial for training patients with depressive disorders to recognize early symptoms of depression and to take an active part in their treatment program. Extended maintenance treatment with antidepressants may be required in some patients to prevent relapse. Early intervention with children with depression is effective in halting development of more severe problems.

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.

Peightel, James A., Thomas L. Hardie, and David A. Baron. "Complementary/Alternative Therapies in the Treatment of Psychiatric Illnesses." In Complementary/Alternative Medicine: An Evidence Based Approach. John W. Spencer and Joseph J. Jacobs, eds. St. Louis: Mosby, 1999.

Thompson, Tracy. The Beast: A Reckoning with Depression. New York: G. P. Putnam, 1995.

Ying, Zhou Zhong and Jin Hui De. "Psychiatry and Neurology." In Clinical Manual of Chinese Herbal Medicine and Acupuncture. New York: Churchill Livingston, 1997.