ASK THE DOCTOR; Medication, Counseling Can Help to Reduce Depression

Dr. Jim Mitterando

Editor’s note:

This is the second installment of a two-part series on depression.

A combination of medication and therapy is most effective to treat depression. Counseling

Counseling helps people gain insight into and resolve their problems. You learn how to better cope with stress, obtain more satisfaction in their life and “unlearn” behavioral patterns that contribute to unhappiness or stress. Counseling helps prevent depression from happening again. It is important to find a therapist you are comfortable with. If you don’t connect after a few visits, you might need to change therapists.

I believe licensed social workers and psychologists provide better therapy than many psychiatrists, who often focus on prescribing drugs. Medications

There is no single best antidepressant drug – many have similar effectiveness. However, a medication that works for one person may not work for another. Thirty percent of people require a change in the medication after it is prescribed. It is a “trial and error” approach. Most often prescribed are selective serotonin reuptake inhibitors, such as fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro), as first-line treatment for depression because they have fewer side effects. These drugs, called SSRIs, increase serotonin in the brain. Drugs similar to SSRIs include serotonin and norepinephrine reuptake inhibitors, SNRIs, such as nefazodone (Serzone), trazodone (Desyrel) and venlafaxine (Effexor), and dopamine reuptake inhibitors, such as bupropion (Wellbutrin). The older tricyclic antidepressants (Elavil, Norpramin and Pamelor) are used less frequently after other drugs do not work or to take advantage of their sedative side effects. Depression is not a sign of weakness or craziness. Antidepressants will not change your personality or make you a different person. The goal of treatment with antidepressants is to get you feeling back to the way you used to feel. They are not “pep” or “happy” drugs. Often the response to these medications is subtle. You will notice that things do not bother you as much. You will feel less negative, less anxious and enjoy the things you used to enjoy.

Treatment takes time Antidepressants are slow to work. You may see a response in two weeks, but many people don’t see a full benefit for six to eight weeks. If your response is not satisfactory, you might need a higher dose, or a different drug. Oftentimes, people are tempted to stop medication too soon. You may feel better and think you no longer need the medication, but it is important to continue the medication at least 6 to 9 months to prevent a recurrence of the depression. People with recurrent depression may require chronic usage of antidepressants to prevent relapses. Side effects

You may experience side effects at first, such as stomach cramps, diarrhea or fatigue, but they tend to lessen after a couple of weeks. Decreased sex drive or decreased ability to have orgasm can occur with SSRIs but resolve when the medication is stopped. Antidepressants are not addictive, but withdrawal symptoms can occur if discontinued abruptly. A gradual withdrawal is recommended. Lifestyle changes Antidepressants are helpful, though not a panacea. They help the underlying chemical cause of depression; but you need to make necessary lifestyle changes – exercise, stress reduction and counseling – to address underlying issues to fully treat depression. You can reduce stress through relaxation techniques (meditation, yoga, deep breathing) and developing coping strategies through counseling. Exercise helps with stress reduction and also releases chemicals in the brain that help reduce depression. During menopause, some women find estrogen helps with depression and mood swings. St. John’s wort may be helpful in mild depression but is not as effective as prescription medicine in treating more severe depression. As with many supplements, purity and dosage can be a concern since it is not regulated. Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.