There are several types of antidepressant medications used to treat depressive disorders. These include newer medications, the selective serotonin reuptake inhibitors (SSRIs), the tricyclics, and the older monoamine oxidase inhibitors(MAOIs). Lately Saint John's wort has been particulary popular as an herbal treatment for depression (although it should be used under a doctor's supervision). The SSRIs - and other newer medications that affect neurotransmitters such as dopamine or norepinephrine - generally have fewer side effects than tricyclics. Sometimes your doctor will try a variety of antidepressants before finding the medication or combination of medications most effective for you.
"Major depression" is the type of depression that will most likely benefit from treatment with medications. It is a condition that lasts 2 weeks or more and gets in the way in your life. Major depression interferes with a person's ability to carry on daily tasks and enjoy activities that previously brought pleasure. Depression ican be caused by a number of factors, but the brain functions differently in people who are depressed. Depression runs in families, and genes appear to be involved. The environment and learning also play a role. Episodes of depression may be triggered by stress, difficult life events, side effects of medications, or medication/substance withdrawal, or even infections that can affect the brain.
Depressed people may seem sad, or "down," and they may be unable to enjoy their normal activities. Sometimes depressed people report feeling "numb" or emotionless rather than sad. They may have no appetite and lose weight (although some people eat more and gain weight when depressed). They may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. They may feel guilty, worthless, or hopeless. Some depressed people lack energy while others feel jumpy and agitated. They may think about killing themselves and may even make a suicide attempt. In severe depression people can have delusions (false fixed ideas) that they are unworthy, sinful, or terminally ill. Feelings of depression are sometimes worse at a particular time of day.
You don't need to have all of these symptons to be depressed. Depression can be mild or severe, and it can can occur with other medical disorders such as cancer, heart disease, stroke, Parkinson's disease, Alzheimer's disease, and diabetes. Depression may be overlooked while the more obvious life-threatening aspects of these diseases are treated.
The antidepressant medications that are used for serious depressions also help some people who have milder depressions. Antidepressants are not stimulants. They act by gradually reducing the symptoms of depression and helping depressed people feel the way they did before they became depressed.
Your doctor or health care provider will choose an antidepressant based on the your particular symptoms. You may notice improvement in the first couple of weeks, but usually the medication should be taken regularly for at least 6-8 weeks before the full therapeutic effect occurs. If there is little or no change in symptoms after 6 or 8 weeks, you may be switched to a different medication or a second medication may be added. There is no way of knowing beforehand which medication will be effective, so you may have to try first one and then another. Antidepressants are usually give for at least for 6 to 12 months. When a patient and the provider feel that medication can be discontinued, withdrawal should be discussed as to how best to taper off the medication gradually. Never discontinue medication without talking to the provider about it. For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing more episodes.
The dose of your antidepressant depends on the type of drug and your body chemistry, age, and weight. Antidepressant dosages are often started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects. Some of the newer antidepressants may be started at or near the target dose.
