People who take these medicines will start by taking them usually daily - your doctor will tell you if you should take it at night or in the morning. They'll take it for a while, so patients will often take it for a few days and say it's not doing anything. It's not helping at all. To which the doctor will usually encourage them: keep taking it, stick with it every day, and usually what will happen is that after a number of weeks of taking the medication (and that can vary from person to person), they'll come back to the doctor and say: You know, hey, come to think of it - I do feel a little bit more myself. I don't know when it happened. There was no light switch that went on, a sudden moment of feeling better. But kind of just gradually in the background, something has been kicking in and I feel a little bit more back to myself. I'm sleeping a little bit better. I'm eating a little bit better. I'm not as numb as I used to be. We usually recommend taking the medication between four and six weeks to gauge an appropriate response to the medicine. Some people may show a response earlier than that. Other people may take longer than that to show a response, but it is important to give it a significant amount of time to kick in before dismissing it as being ineffective.
Medical treatments for depression include medications as well as other procedures that may sometimes be helpful for people who are struggling with depression. Let's talk about medications: there are many different types of what we call antidepressants - medicines that seemed to help certain individuals who are struggling with depression that can provide a significant amount of relief. The most common type of antidepressant medicine that we encounter and that we prescribe is what's called an SSRI and that is short for Selective Serotonin Reuptake Inhibitor. These are medicines you may have heard of like Prozac (also known as fluoxetine) or Zoloft (also known as Sertraline.) They're prescribed for depression as well as for anxiety, and they seem to help a lot of people. Basically, they are thought to work by increasing the amount of Serotonin - one of the neurotransmitters or chemicals in the brain in the spaces between brain cells. That being said, the actual mechanism is probably a lot more complicated than that.
Another category of medication that is very similar to the SSRI is what's called the SNRI, which is Serotonin Norepinephrine Reuptake Inhibitors. These include medicines like Ephexor (also known as Venlafaxine) or Cymbalta (also known as Duloxetine.) These work in a manner very similar to the SSRI's, but there may be some subtle differences as well, both in terms of the effect that they have as well as some of the side effects that they have. Another antidepressant medicine of a different class (a different mechanism) that is sometimes prescribed for depression is called Welbutrin (otherwise known as Bupropion.) This is a medicine that doesn't really work as much with Serotonin as much as some of the other neurotransmitters in the brain. It usually works by giving people a boost of energy that people, for example, who were telling me that they can't get out of bed in the morning, that they have no energy to get through the day, that their depression is really sucking the life out of them - taking Welbutrin may sometimes endorse a little bit more pep during the day. Remeron (also known as Mirtazapine) may be helpful for depression as well. It works through a different mechanism relative to the other antidepressants and seems to help people not only with their depression, but also with sleeping and with appetite, in that it boosts appetite (makes people eat more). If that's a symptom of their depression, they benefit from that effect of the Mirtazepine.
Every medication in the field of medicine can potentially carry with it side effects. Some of the side effects are relatively minor nuisances, if you will, but things that people are fine tolerating and will continue taking the medicine despite that and others may be more significant and a reason to consider avoiding or switching a particular medicine in any given situation for any given patient. While it's impossible to get into every single potential side effect from every medication in this form, it's really important to talk with your doctor after he or she recommends a particular medicine about some of the side effects to anticipate. Broadly speaking, some of the common side effects to many of the antidepressant medications that we see are mostly mild ones at the beginning. So for example: nausea, upset stomach, some people may report a mild headache. These sorts of things usually get better with time. Most doctors will encourage patients to continue taking the medicine for a couple more days in the hope that some of those side effects will go away. Some of the antidepressants can affect a person's sleep, making it harder for them to sleep or affecting the quality of their sleep. If you notice that, it's very important to talk about it with your doctor. Some antidepressants can affect sexual function. If you notice that, it's also important to talk to your doctor as there may be ways to address that issue. Many of the antidepressants also carry a warning for individuals up to the age of 24 that some data seems to suggest that there may be an increase in suicidal thoughts in these individuals. This is something that is important to talk with your doctor about and to weigh the risks and benefits of the medication in that particular population.
One of the questions I get asked a lot about antidepressant medication is how long should someone stay on the antidepressant medication? Is it okay to discontinue it right after the symptoms get better? Should they stay on it for life? Or is there some in-between area that is really the ideal length of time? And the honest answer is that there is no clear consensus on this and it does depend on a variety of factors that you should discuss with your doctor. Some of the things that your doctor may consider are the number of depressive episodes that you've had in your life. For example, is this the first time that this is happening or is this the seventh time that this is happening? That might impact on that decision. The severity of the depressive episode might impact on the decision of how long to stay on the medicine. The side effects on the medicine might impact on whether you'd want to stay on it long-term or not. Whether you're involved in psychotherapy might affect that decision. And the level of support that a person has in his or her life. Family members, friends versus living a more isolated life without those sources of support and people who could encourage to come in if symptoms redeveloped, might also be a factor in considering the decision. It is really important to talk with your doctor about that.
A common question that's asked is: should a person start with therapy or with medication? As with so many things, there's no one-size-fits-all right answer, but there are some things to consider: therapy works well. Medications work well. The combination of the two seems to work better than either one by itself, and so oftentimes they will be combined. I often recommend it to patients if the clinical situation is appropriate to start with therapy. Therapy being a little bit more of a conservative option without the side effects that you necessarily could see from medication. If a course of therapy really doesn't seem to be helping, then consider adding on medication. That being said, every situation is unique and it has to be assessed individually, so there are no hard and fast rules, but that is one potential way to consider.