Depression Considerations

Depression Considerations:

❑ Finding the right treatment for depression can be as difficult as convincing someone that he or she needs help. Even so, according to the National Institute of Mental Health. Clinical depression is one of the most treatable of all medical illnesses. Depression Considerations. Today, most people with depression can be treated with antidepressant medications, “talk” therapy (psychotherapy), or a combination of the two. Experts agree that successful treatment also hinges on early intervention.

Early treatment increases the likelihood of preventing serious recurrences. Medications, such as the selective serotonin reuptake inhibitors, or SSRIs, are helpful. SSRIs generally produce fewer side effects than the older drugs (tricyclics), making it easier for people, including older adults, to adhere to treatment. Both generations of medication are effective in relieving depression. Although any given individual may respond to one type of drug and not another. It is difficult to predict which people will respond to which drug, or who will experience what side effects.

❑ Despite the relative safety and popularity of SSRIs and other antidepressants, some studies have suggested that they may have unintended effects on some people, especially adolescents and young adults.

In 2004, the Food and Drug Administration (FDA) conducted a thorough review of published and unpublished controlled clinical trials of antidepressants that involved nearly 4,400 children and adolescents. The review revealed that 4 percent of those taking antidepressants thought about or attempted suicide (although no suicides occurred), compared to 2 percent of those receiving placebos. Depression Considerations.

This information prompted the FDA, in 2005, to adopt a “black box” warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age twenty-four. A “black box” warning is the most serious type of warning on prescription drug labeling. Results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders. The study was funded in part by the National Institute of Mental Health.

❑ The FDA issued a warning that combining an SSRI or SNRI antidepressant with one of the commonly used triptan medications for migraine headache could cause a life-threatening serotonin syndrome, marked by agitation, hallucinations, elevated body temperature, and rapid changes in blood pressure.

Although most dramatic in the case of the MAOIs. Newer antidepressants may also be associated with potentially dangerous interactions with other medications.

❑ Seasonal affective disorder can be treated using light therapy, which involves exposing yourself to light of a certain frequency from a special light box for fifteen minutes to two hours per day. The reason this therapy works is that more melatonin, a hormone produced by the pineal gland in the brain, is produced in the dark, or on dark days, than in the light or on longer, brighter summer days. At certain levels, melatonin appears to trigger the onset of depression in some people. Most insurance companies now honor claims for these special light boxes.

❑ Atypical depression is a common but often undiagnosed disorder.

Nearly fifty years ago, two English psychiatrists first described atypical depression as a type of depression that seemed to differ from classic forms of depression in both its symptoms and treatment. Experts in the field of psychiatric research continue to debate the finer points of this diagnosis. However, atypical depression is usually characterized by onset of symptoms at an early age, overeating, oversleeping, and mood reactivity. Mood reactivity refers to the observation that although people with atypical depression experience pervasive sadness, mood may improve or worsen in direct response to specific events.

This is different from classically depressed individuals who experience persistent sadness. In addition, some research suggests that an older class of drugs, monoamine oxidase inhibitors (MAOIs), may be more effective in treating atypical depression than are newer drugs, including tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). However, research continues to try to define this more clearly. Atypical depression is more common in women than in men. Its exact cause isn’t clear, but genetics and environmental factors play roles. If you’re concerned that you or someone you know has atypical depression, seek help from a mental health professional.

❑ Pregnenolone is a naturally occurring hormone that may improve brain function, enhancing mood, memory, and thinking ability.

❑ Depression is not a natural part of aging, but it is frequently linked to age-related nutritional problems, such as B-vitamin deficiencies and poor eating habits. Older people who suffer from depression are as likely to benefit from treatment as a person in any other age bracket.

❑ Tyrosine is needed for brain function. This amino acid is directly involved in the production of norepinephrine and dopamine, two vital neurotransmitters that are synthesized in the brain and the adrenal medulla. A lack of tyrosine can result in a deficiency of norepinephrine in certain sites in the brain, resulting in mood disorders such as depression. The effects of stress may be prevented or reversed if this essential amino acid is obtained in the diet or by means of supplements. Mustard greens, beans, and spinach are good sources of tyrosine.

Caution: If you are taking an MAO inhibitor drug for depression, do not take tyrosine supplements, and avoid foods containing tyrosine, as drug and dietary interactions can cause a sudden, dangerous rise in blood pressure. Discuss food and medicine limitations thoroughly with your health care provider or a qualified dietitian.

❑ Some preliminary studies show promise in using dehydroepiandrosterone (DHEA)—a hormone naturally produced by the body—in the treatment of depression. In one study, nearly all patients taking DHEA for six weeks significantly improved. And about half of those were no longer considered clinically depressed.

Selenium has been shown to elevate mood and decrease anxiety. These effects were more noticeable in people who had lower levels of selenium in their diets to begin with.

❑ Vigorous exercise can be an effective antidote to bouts of depression. During exercise, the brain produces painkilling chemicals called endorphins and enkephalins. Depression Considerations. Certain endorphins and other brain chemicals released in response to exercise also produce a natural “high”. Most of those who exercise regularly say that they feel really good afterward. This may explain why exercise is the best way to get rid of depression.

❑ Music can have powerful effects on mood and may be useful in alleviating depression. Depression Considerations

❑ In one study, people suffering from depression were found to have lower than normal levels of folic acid in their blood than nondepressed individuals. Other studies have shown that zinc levels tend to be significantly lower than normal when people suffer from depression.

❑ It may be possible to diagnose depression by using a computerized tomography (CAT) scan to measure a person’s adrenal glands. Researchers at Duke University found that people suffering from clinical depression have larger adrenal glands than non-depressed people.

❑ A variety of different drugs are commonly prescribed to treat. Antidepressant drugs fight depression by changing the balance of neurotransmitters in the body. These medications include the following:

• Selective serotonin reuptake inhibitors (SSR1s). A popular class of drugs known as “second-generation” antidepressants that have become available in recent years. These new drugs have not been shown to be more effective than the others. But they tend to have fewer serious side effects. They include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), which specifically block the uptake of the neurotransmitter serotonin.

• Tricyclics. These drugs work by inhibiting the uptake of the neurotransmitters serotonin, norepinephrine, and dopamine, making more of the mood-enhancing chemical messengers available to nerve cells. Examples include amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), amoxapine (Asendin), and nortriptyline (Aventyl, Pamelor). Depression Considerations. Possible side effects include blurred vision, constipation, dry mouth, irregular heartbeat, urine retention, and orthostatic hypotension, a severe drop in blood pressure upon sitting up or standing, which can lead to dizziness, falls, and fractures.

• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These drugs increase the levels of both serotonin and norepinephrine by inhibiting their reabsorption (reuptake) into cells in the brain. Although the precise mechanism of action isn’t clear, it’s thought that these higher levels enhance neurotransmission—the sending of nerve impulses—and so improve and elevate mood. Medications in this group of antidepressants are sometimes called dual reuptake inhibitors. Examples include venlafaxine (Effexor) and duloxetine (Cymbalta).

• Tetracyclics. These drugs have an action similar to that of the tricyclics, but have a slightly different chemical structure and appear to cause fewer side effects. Maprotiline (Ludiomil) and mirtazapine (Remeron) are in this category.

• Monoamine oxidase (MAO) inhibitors. These drugs increase the amounts of mood-enhancing neurotransmitters in the brain by blocking the action of the enzyme monoamine oxidase, which normally breaks them, down. Examples of MAO inhibitors include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate). Possible side effects include agitation, elevated blood pressure, overstimulation, and changes in heart rate and rhythm. MAO inhibitors also have a high potential for dangerous interactions with other substances, including drugs and foods. Depression Considerations. Persons taking these drugs must adhere strictly to a diet that includes no foods containing the amino acid tyrosine. Refer to the detailed insert given out with the drug for details of the possible interactions. Over-the-counter cold and allergy remedies must also be avoided.

• Another drug, buproprion (Wellbutrin), is believed to act by inhibiting the uptake of dopamine but not serotonin or norepinephrine.

❑ Paxil (paroxetine) has been approved by the FDA for treatment of generalized anxiety disorders (GAD). The drug is already approved for treating social anxiety disorder, depression, panic disorder, and obsessive-compulsive disorder. GAD affects about 6.8 million adult Americans, and about twice as many women as men, according to the National Institute of Mental Health. People with GAD experience exaggerated, worrisome thoughts and tension about routine life events, lasting a minimum of six months. GAD is often accompanied by physical symptoms such as fatigue, trembling, muscle tension, headache, and nausea. The effectiveness of Paxil in long-term treatment of GAD (greater than eight weeks) was not evaluated, nor was Paxil studied in children and adolescents with GAD.

Caution: Paxil should not be used in children and adolescents for the treatment of major depressive disorder. Antidepressants in adults and children should be used with caution. Never discontinue use of antidepressants without first consulting a physician.

❑ Steroid drugs and oral contraceptives may cause serotonin levels in the brain to drop.

❑ Prozac and other “selective serotonin reuptake inhibitors” work to increase the activity of serotonin, while 5-hydroxy L-tryptophan (5-HTP) works to boost the body’s production of serotonin.

❑ A study published in the British Medical Journal indicates that extracts of St. John’s wort may be as effective as prescription antidepressants for mild and moderate depression. St. John’s wort is the most-prescribed antidepressant in Germany. But is treated as a dietary supplement in the United States. It is not approved as a safe and effective drug by the FDA. Many studies are under way to determine the effectiveness and safety of long-term use of St. John’s wort. Research published recently in the British Medical Journal indicates that, in a German study where St. John’s wort was matched against Paxil, the supplement proved to be just as effective and subjects had fewer side effects.

In some patients with HIV, using St. John’s wort and SSRIs may not be a good idea. It is expected that St John’s wort may significantly decrease blood concentrations of all of the currently marketed HIV protease inhibitors (PIs) and possibly other drugs (to varying degrees) that are similarly metabolized, including the nonnucleoside reverse transcriptase inhibitors (NNRTIs). Caution: St. John’s wort may cause increased sensitivity to sunlight. It may also produce anxiety, gastrointestinal symptoms, and headaches. Depression Considerations. It can interact with some drugs including antidepressants, birth control pills, and anticoagulants.

❑ People who smoke are more likely than nonsmokers to be depressed. Smokers and nonsmokers alike may benefit from Zyban (a sustained-release preparation of buproprion, also sold as Wellbutrin SR), an antidepressant also approved to help people quit smoking. Buproprion ele-vates levels of dopamine and norepinephrine, substances that are also elevated by nicotine in tobacco products. It allows patients to obtain the same feeling while weaning themselves off nicotine.

❑ Allergies, hypoglycemia, hypothyroidism, and/or malabsorption problems can cause or contribute to depression.

In people with these conditions, vitamin B12 and folic acid are blocked from entering the system, which can lead to depression. Depression Considerations.

❑ Individuals with depression are more likely than other people to have various disturbances in calcium metabolism.

❑ There is no doubt that attitude affects health. Study after study has shown that optimistic people are not only happier but also healthier. They suffer less illness, recover better from illness and surgery, and have stronger immune defenses.

❑ Many groups and organizations offer more information on depression. Depression Considerations.