Key points about antidepressant therapy

One more thing before I start describing different kinds of antidepressants. Well actually here are 13 things - some key points about antidepressant therapy that can be useful for both those who take their medicine already and those who is about to start. These tips will help you to understand some basics and answer most of the frequently asked questions about antidepressants.

"- It takes from two to six weeks for an antidepressant to begin to work. You may feel worse before you feel better because side effects can occur almost immediately, whereas therapeutic benefits appear later. The good news is that most side effects dissipate within days or weeks.

- Antidepressants are not habit-forming and are not drugs of abuse.

- Do not despair if the first medication does not work. Finding the appropriate medication(s) and dosages may take time. The good news is that many different antidepressants are available.
- The most frequent reason for an antidepressant “failure” is that the dose was too low and the duration of treatment too short.

- Feeling better is not a good reason for discontinuing or reducing your medications. Individuals often are tempted to stop medication too soon, risking relapse or recurrence.

- For individuals with bipolar disorder or recurrent major depression, medication may have to become part of everyday life to avoid return of disabling symptoms.

- You should never mix medications of any kind—prescribed, over-the counter, herbs, or borrowed—without consulting a doctor.

- Some drugs, like alcohol, reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer and hard liquor.

- Some drugs, which are usually safe when taken alone, can cause severe and dangerous side effects if taken with other drugs. Always tell dentists, pharmacists and other medical specialists that you are taking antidepressants.

- If you have been prescribed an MAOI (such as Parnate or Nardil), you will have to avoid certain foods and over-the-counter medications. Be sure to get a complete list of disallowed foods and medications from your doctor and always carry it with you.

- Antianxiety drugs, such as diazepam (Valium) or alprazolam (Xanax), are not antidepressants. They are sometimes prescribed along with antidepressant therapy, but should not be taken alone for a depressive disorder.

- Scientific studies suggest that patients with three or more episodes of depression or two severe episodes may need to be maintained on antidepressants indefinitely. The maintenance dose should be the same as the dose required to achieve an initial therapeutic response.

- Antidepressants work best in most individuals when prescribed alongside a course of psychotherapy. People taking both medication and engaging in psychotherapy generally take less time to feel better and maintain their gains longer than those taking antidepressant medications alone."

Tips are taken from here

Take care!

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Special populations and depression therapy

Today I would like to start speaking about antidepressant therapy as the most common depression cure method. However, before listing different medications in-depth I'll begin with short advices for the below-mentioned groups:

"When deciding on therapy, some clinically depressed patients require special considerations:

Bipolar disorder -- these patients have extreme mood swings (periods of excessive high spirits followed by severe depressive episodes). Typically, the antidepressants are augmented with mood stabilizers.

Children/adolescents -- The SSRI fluoxetine is the only effective (and approved) antidepressant for this age group. There have been reports that children on antidepressants are more likely to commit suicide than those who are not on antidepressants; while some data suggest that this may be true, it has not been proven conclusively. Primary care providers need to weigh the risks of antidepressant therapy versus untreated depression. Most often, treatment carries fewer risks of suicide than non-treatment.

Pregnant/postpartum women -- Depression can be a common symptom during pregnancy and postpartum -- it usually corrects itself, but sometimes severe depression must be treated (in about 10 percent of pregnant/postpartum women). Antidepressants can pass to the fetus and through breast milk. The effects of antidepressants on the developing fetus and newborn are not well known. Therefore, doctors should carefully consider the risks and benefits of treatment.

Treatment for depression is not a short-term process but a long-term project with specific goals of remission and maintenance. Multiple approaches of medication, psychotherapy and patient education are most effective in the treatment of MDD. Close consultation with a physician and/or psychiatrist can provide the best treatment options".

Source

Now good luck and you can now proceed to:

- Noradrenergic and Specific Serotonin Antidepressants (NaSSA)
- Monoamine Oxidase Inhibitors (MAOI)
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)
- Tricyclic Antidepressants
- Selective Serotonin Reuptake Inhibitors (SSRI)

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10 tips on how to sleep better

In the previous post I provided an explanation of the link between depression and sleeping disorders. Here I am posting tips on how to get to bed easily and sleep well.

Try to follow instructions below to get asleep as soon as possible. If you treat your body a nice rest, it’s going to help you a lot if you want to cure depression.

As usually here are the key-points with my comments:


1. Keep the lights low before bedtime.

Remember: melatonin is a hormone of darkness. When it is produced you start felling sleepy. Thus keeping the lights low will help your body to lower daytime activity and prepare you for a sleep.

2. Follow a routine to help relax and wind down before sleep, such as reading a book, listening to music, or taking a bath.

When you are depressed it is hard to relax your body and calm down your thoughts about how everything is bad-bad-bad. However, shifting your activity into reading can make a great deal. Music and bath can also be good natural relaxants which will drive at least some of the worries away from you.

3. Try not to take naps during the day because naps may make you less sleepy at night.

And not only!
Usually human body needs about 8 hours of sleep for regeneration. Thus it will demand these hours either in night or daytime. However, taking naps during the day causes a hormonal misbalance in your body. Again: daylight prevents production of melatonin, which is associated with sleeping.

4. Avoid Caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality.

Try to awoid overexcitement before going to bed - be it chemical stimulants or physical excercises. Your body will need more time to restore to a calm state before it is relaxed enough for falling asleep.

5. Make your sleeping place comfortable. Be sure that it is dark, quiet, and not too warm or too cold.

If something disturbs your body, it will not be able to relax, but will work on reacting to the irritants. Thus you are more likely to fall asleep when your body is safe and comfortable as well as your thoughts are calm.

6. Try to go to sleep at the same time each night and get up at the same time each morning.

This one is simple. After plenty of repetition your body will get used to fit its rhythms to an everyday ‘schedule’.

7. Try not to exercise close to bedtime. Experts suggest not exercising for 3 hours before the time you go to sleep.

Just like in # 4: your bloodstream, breathing and internals will need time to get to normal state after excercises. Untill that you won't get asleep.

8. Don't eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.

Heavy meal for your stomack is just like heavy thoughts for your mind. When your belly is busy taking care for your food - your body is unable to stop the process and shut down imidiatelly.

9. Avoid using your bed for anything other than sleep or sex.

If you watch TV, eat or do whatever else in your bed, your body will fail to recognize it as a place intended for sleep.

10. If you have trouble lying awake worrying about things, try making a to-do list before you go to bed. This may help you to relieve of those worries for whole night.

Instead of thinking you need to do this and that - you unload your mind and write it down point by point. After that you can be easy knowing you have a list of what-to-does and will not miss or forget something during the day.

The list is taken from here.

Good night! Sleep tight! And I will appreciate any comments or questions.

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Alternative remedies for depression

I know I haven't posted in a while but lately I am finding it harder and harder to keep up with any of my writing. I just recently started writing more for AC and last night I wrote a post in my main blog. I have so much on my mind that I am having a hard time concentrating on anything. Anyway I recently write an article for Associated Content about alternative remedies for depression and thought I would post the link here for those who want to read it.

This article will help those who can't afford prescription drugs or don't want to take prescription drugs. Please read it and leave me a comment either here or on my AC page. Here is the link to my article:

Alternative Remedies for Depression

Take a look at my other articles as well if you like. Here is the link to my CP page where the rest of them are. Subscribe if you want because I have more articles on the way.

My CP page

I hope you enjoy them.

If you would like to sign up for Associated Content and get paid to write articles then go to the link below.

Join Associated Content

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Sleeping disorders and depression

Sleeping disorders are known to be one of the common symptoms of depression. However, the relationship between insomnia and depression is more complicated where one effects another and vise versa.

The key factor is Melatonin - "the hormone of darkness".

"What is Melatonin

Melatonin is a naturally occurring hormone secreted by the pineal gland, a pea-size structure at the center of the brain. As our eyes register the fall of darkness and the onset of night melatonin is produced. It signals to our body to prepare for sleep, our blood pressure dips, there is a decrease in body temperature and we start to feel sleepy

Melatonin & Depression

Melatonin is an important nighttime hormone associated with sleep and regeneration. However, excessive levels or daytime melatonin can cause depressive disorders. Medical research confirms the relationship between melatonin and mood disorders. The following paragraphs explain how melatonin works and why it causes depression.

Darkness & Melatonin

Melatonin is normally released by the pineal gland in the evening as sunlight is diminishing. Melatonin causes us to feel tired and withdraw. This helps us to sleep, but if we have to be awake when melatonin is in our system, we become lethargic, disoriented, irritable and moody. This explains why shift work and jet lag can be so debilitating, and why depression rates are highest in darker climates. Almost everyone with a mood disorder suffers worse in the winter because of excess melatonin in his or her system."

Source

Thus you are right to make a conclusion that sunlight is one of the tips on how to cure depression. It may sound simple yet be difficult to follow. When depressed we tend to seek for dark colors. Even subconsciously you will wear dark-colored clothes, sit at home with drawn curtains, place dark-colored furniture in your room and think that you feel comfortable, while your melatonin levels grow higher and worsen your state little by little. All you need to stop it is to go for a walk. Shopping can be a nice idea if you decide to buy some bright-colored clothes. Especially it will be useful to take some friends with you which is both fun and can help to improve your mood.

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Symptoms of depression

In the first post I quoted the article which explains the built-up of depression. Now let us look closely on its symptoms so that we know every bit about the sickness we face. Here I’m posting the list of the most common symptoms of depression with my comments.
Feedback is much appreciated.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)

This one is the most common symptom associated with depression and it is quite different from ‘feeling blues’. The main difference is that the feeling of sadness \ emptiness during depression is nearly constant. Moreover you keep thinking about it and pity yourself which makes it worse.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

No matter If you have to participate in some job-related or fun activities - you wake up in the morning tired and go on through the day feeling sad and unwilling to do anything but sit and think about how bad you feel today. Everything else seems worthless if not annoying.

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

e.g. you are sure that you are not physically hungry. However, you keep eating more and more. Be it intentional search for some food in your kitchen or unwitting constant picking of some snacks while reading or sitting at the computer.

4. Insomnia or hypersomnia nearly every day

Troubles with getting to sleep and waking up in the morning, sleepy feeling during the day, multiple awakenings during the night, a desire to sleep long hours – sleeping disorders and depression are tied closely and can influence each other in different ways.

5. Psychomotor agitation or retardation nearly every day

Swinging emotions as well as sudden changes from tiredness and lack of movement to agitation and rush.

6. Fatigue or loss of energy nearly every day

This one is close to the second point: every action either physical or cognitive causes energy loss, annoyance and tiredness.

7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day

Consequences from unwillingness to do anything lead to the thoughts like “I don’t want and can’t do anything, I do everything wrong, I am a burden to everyone” etc. These thoughts bore sense of guilt for everybody and lack of confidence which make original depressive feelings worse.

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day

Inability to concentrate or attempts to concentrate on too many things, being at the same time unable to finish all of them properly. Attempts to complete many tasks at the same time.

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

It can be not even a real suicide planning, but playing and experiencing a ‘movie’ in the mind of how will it be to commit suicide. However planning, attempting and committing suicide is a way for patients to free themselves from suffering on critical stage of depression.

The list is taken from here.

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Principles of depression

Low mood, Anxiety, Delusions, Memory and concentration problems, Loss of interest in things you used to enjoy - one may think these are no big deal but just a normal reaction to stress at work, overdue bills, taxes, family quarrels or whatever.

However, when these symptoms are followed by sleep problems (either insomnia or oversleeping), eating disorders (increase or decrease in appetite), constipation, period irregularities, decreased libido, constant feeling of tiredness - one of the most possible diagnosis’ is depression.

It is obvious that to get over negative symptoms of a sickness one should understand it's origin. In this post I would like to quote one of the clearest yet simple explanations on how depression occurs I've ever read:

"The stress system relies on two key hormones: adrenaline and cortisol. In short, adrenaline works in the short term, while cortisol has large momentum and works in the long term.

It is important to realize that the stress system can also be activated if your brain perceives danger or any kind of threat. In the first stage, this triggers the release of adrenaline into the bloodstream to prepare the body for action. As a result, your heart beats faster, you begin to sweat, your breath becomes shallower, and your senses become more acute. This is the so-called fight or flight response to the stressor event, and was quite adequate during most of our evolution, when these events were quite specific and usually short-term. Problems with chronic stress arise because in a modern society we cannot escape easily from the stressor, be it an overbearing boss, crowded cities, or traffic jams.

The effect of the stress hormones on the brain is curious and not what you might expect. The initial surge of adrenaline will make you feel good, though not quite in the same way as with serotonin. The difference is that adrenaline will make you feel euphoric and accelerated, whereas serotonin produces a state which could be described as that of quiet bliss. However, as far as the communication between neurons is concerned, adrenaline can compensate for low levels of serotonin. There is, alas, a serious drawback of adrenaline: together with it comes cortisol, the yang of the stress hormones.

Just as your levels of adrenaline start coming down, so rises the amount of cortisol flowing through your veins. Moreover, cortisol has a much larger momentum than adrenaline, which means that even though it builds up slowly, it also takes a long time to go back to normal. And should you constantly be engaging in activities which require adrenaline, so will your levels of cortisol slowly increase. Together with the rise of cortisol and the decrease of adrenaline, come the nasty side-effects of the stress hormones. It is at this moment that you feel bad, anxious, and having lots of negative thoughts.

To complete the picture of how chronic stress causes depression, there remains one critical factor to be explained: high-levels of stress hormones will over time diminish your brain's ability to produce serotonin. The exact mechanism by which this happens is still subject to discussion, but the general consensus is that sleep is the key. The reason is that higher levels of stress hormones mean less sleep, which is fundamental for the brain to restore its ability to produce serotonin".

from: Demystifying Depression by Name of Feather

If you came this far, I hope you have understood the basics of how the depression build-up works: More stress hormones mean less happiness hormones which means depression. Now as we know the roots of evil we may proceed to cure methods.

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