Dr. Timothy J. Legg, PhD, CRNP
Dr. Timothy J. Legg is a board-certified psychiatric/mental health nurse practitioner, specializing in providing care to individuals with mental health issues including depression, anxiety, and addictive disorders. He is also a certified gerontological nurse practitioner and has worked extensively with individuals struggling with psychiatric disorders in later life. He holds graduate degrees in nursing, clinical psychology, and health sciences research. Dr. Legg maintains an active clinical practice at Binghamton General Hospital in Binghamton, New York, and is a faculty member of the department of psychiatry at SUNY Upstate Medical University in Syracuse, New York.
Q: Is it true that antidepressants can be addictive and should be avoided?
No, antidepressants are not addictive. Sometimes, when people are on antidepressants for a while and they stop taking the medication, they may experience what is known as “discontinuation syndrome.” Some symptoms of discontinuation syndrome include feelings of nervousness or restlessness, gastrointestinal symptoms such as nausea, stomach cramps, or diarrhea, dizziness, and tingling sensations in the fingers or toes. People sometimes mistake these symptoms as withdrawal symptoms, believing that they became “addicted” to the antidepressant. In fact, this is a normal phenomenon that occurs in some people.
Many people believe antidepressants are addictive because their depression may return when they stop taking the medication. Some argue that they need the medication, which is a “mood altering substance.” I like to remind people that those who take blood pressure medications will have a normal blood pressure so long as they are taking the medication. However, once they stop taking their blood pressure medication, their blood pressure increases. This does not mean that they are “addicted” to their high blood pressure medication. Rather, it means that the medication has exerted the therapeutic effect that it was designed to create.
Q: What are some of the common side effects of antidepressants?
It’s important to know that not all antidepressants will cause side effects. Also, certain side effects occur across drug classes. It’s also important to know that most side effects occur almost immediately (within the first weeks of taking the new medication), but they often will go away with time. Unfortunately, the therapeutic effects of antidepressants are often delayed by several weeks, which can be quite distressing to people taking these medications. It can be frustrating for people to take medications and get side effects almost immediately, but have no relief for their depressive symptoms for several weeks.
Some of the more common side effects associated with selective serotonin reuptake inhibitors (SSRIs) include:
- Sexual side effects: Men may experience problems with delayed ejaculation or erectile dysfunction. Both men and women may experience decreased sexual desire or the inability to achieve an orgasm.
- Gastrointestinal: Some people may experience a dry mouth, decreased appetite, weight gain, or even weight loss. Others may experience nausea, diarrhea, or even constipation.
- Central nervous system: Some people may experience insomnia, but other people may experience sedation from their medication. Some people may experience transient agitation, or the feeling of being annoyed by others. Others will experience headache, dizziness, or tremors.
Other side effects include sweating, an increase in bruising, and in some rare cases, bleeding problems. Another side effect that sometimes occurs is a decrease in your blood levels of sodium. This happens more often in older patients, however.
In rare cases, seizures can occur. Additionally, suicidal thoughts and behaviors may occur in some people after starting an antidepressant. If this happens to you, it’s important to tell your doctor immediately.
Q: I’ve just switched my depression medications. How long should I expect it to take for my body to adjust to this new medication?
If you have any side effects from your new medication, you should see them occurring within the first week or two after the switch. Granted, side effects can technically happen at any time, but they are more likely to occur early in therapy. Generally, side effects will lessen with the passage of time. But if you are having persistent side effects extending beyond two weeks, you should discuss this with your doctor.
Q: I’m overwhelmed by the number of treatments and therapies that come up when you search for “depression remedies” online. Where do I start?
The Internet is truly a mixed blessing in that it can be a wealth of information, but it can also be a wealth of misinformation. Your primary care provider is the place to start your search. They can discuss the evidence behind online “remedies” and help you to sort between fact and fiction.
Q: I’ve read that sunlight can help with depression. Is that really true?
Some people notice that they only develop depressive symptoms, or their depressive symptoms get worse, during the winter months. This season is traditionally marked by shorter days with fewer hours of sunlight. People who had experienced this type of depression used to be diagnosed with a condition known as “seasonal affective disorder.” However, the American Psychiatric Association, in their 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), did away with “seasonal affective disorder.” Instead, the person who experiences depression that coincides with the changes in the seasons must meet the criteria for a major depressive disorder. If it’s determined that there is a seasonal pattern, the diagnosis would be “Major Depressive Disorder, with Seasonal Pattern.”
For people who experience this variant of major depressive disorder, natural sunlight can help. But in situations where natural sunlight is lacking, they can use light box therapy. Many people do report an improvement in their depressive symptoms when exposed to natural sunlight or light box therapy.
Q: How do I find a therapist that’s right for me?
The most important aspect of finding a therapist that is “right” for you is finding a therapist that you trust. In fact, what’s most important is finding a therapist with whom you can form a positive, strong therapeutic relationship. Over the course of many years, a multitude of studies have sought to determine which type of therapy is “best” for patients with a wide variety of disorders. Findings keep pointing to the therapeutic relationship as opposed to a specific therapeutic approach. In other words, the way in which the patient and the therapist relates to one another appears to be one of the strongest predictors of the effectiveness of therapy.
You can start with your doctor’s office. They may know therapists to whom they have referred other patients, and they may have received feedback on them. Additionally, if you had a friend who has undergone therapy, ask them for a recommendation. The important thing with therapy is that if after the first few sessions you feel that you don’t gel with the therapist, then find another therapist. Do not give up!
Q: What kinds of funding or financial help are available for seeing a therapist?
Many insurance companies do cover psychotherapy. If you have insurance, then the best place to start would be with a phone call to your insurance company, or by going online and perusing their webpage to find approved providers in your area. Many times, insurance companies do place limits on the number of visits that you can see a therapist for, so this is important to find out. If you have no insurance, you can inquire as to whether or not the therapy provider offers a sliding-scale payment system. Under these types of payment arrangements, you are billed based on your income.
Q: My friends think that I’m just bored and should find a new hobby. How can I tell them that my MDD is more than that?
Major depressive disorder is a difficult disease for others to conceptualize, especially if they have never experienced it themselves. Unfortunately, the person who suffers from major depressive disorder is often given lots of well-meaning, but ultimately useless advice. People with major depressive disorder have probably heard everything from “just pick yourself up by the bootstraps” to “you just need to find something fun to do.” It should be kept in mind that these comments are usually not being made out of an attempt by your family or friends to be mean-spirited. Rather, they represent frustration from your loved ones, who have no idea how to help you.
There are support groups out there for families and friends of people who have depression. These groups provide education to loved ones to help them understand that depression is not a choice and doesn’t happen because the person with the disorder is in need of a new hobby. People with depression may also consider asking their doctor to explain the disorder to their family members.
However, at the end of the day, people will believe what they want to believe. Therefore, people with depression should realize that they may be powerless to educate some people in their personal lives about the nature of their depressive disorder.
Q: I can’t sleep at night. Is this a common symptom for depression?
Yes, sleep disturbances occur in depressive disorders. Some people report that they sleep entirely too much, while others report that they can’t sleep at all. Sleep disturbances are quite common in depression and will probably be one of the areas of focus of your doctor’s attention.
Q: Are there any new treatments or research on depression?
With each passing year, our understanding of a wide range of psychiatric disorders continues to grow — depression included. New antidepressants continue to be developed. Most recently, the advent of transcranial magnetic stimulation (TMS) has received quite a bit of attention in terms of its efficacy in treating depression. It is an exciting time in psychiatry, as we are curious to see what new developments will occur in the next few years.
Q: I experience extreme fatigue. My neurologist told me to reduce the time I spend working. Is this normal?
Your neurologist is probably encouraging you to decrease time working to help you conserve energy. This would give you more energy for home-related tasks, as opposed to coming home from work and collapsing into bed. I’m not certain what the underlying neurological condition is, but balancing work and home life is essential to your overall physical and mental health.
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