Question: My
doctor recently diagnosed me with depression and wants me to
take medication. I’ve heard that the medications have a lot
of side effects. Are they safe enough for me to take? Will
they help me to feel better?
Answer: We are
very fortunate these days to have a large number of options
for the treatment of depression. There are over 25
antidepressant medications from eight different classes
currently on the market!
Your physician will use your age, medical history, prior
medications and depressive symptoms to determine which
medication is right for you. I’ll discuss some of the more
common antidepressants.
First of all, it is important to realize that depression is
not the same in everyone. There is a tremendous range of
signs and symptoms that a person may experience when
suffering from depression. Some people become more agitated,
some more lethargic. Some people lose weight, others want to
eat everything in sight. Many factors determine a person’s
individual expression of a depression episode. That is why
no ONE medication can treat depression in all people.
The various medications all have sets of symptoms that they
treat most effectively. That is why it is so important to
tell your doctor what you are feeling when you are
depressed. This will help your doctor pick the right
medication for YOUR depression.
The first class of antidepressants to be widely used were
the tricyclic antidepressants, so named because they share a
similar chemical compound of three linked rings. The
tricyclic antidepressants currently on the market are listed
below:
These
drugs are ARE NOT widely used anymore in the treatment of
depression, especially in senior citizens, because they have
the potential for serious side effects, including:
With all
those potential side effects, you might wonder why we ever
used these medications, but the truth is, they were very
effective at treating depression. Unfortunately, elderly
people often had such trouble tolerating even small doses of
the medications that they didn’t manage to achieve the
benefits.
Therefore, tricyclic antidepressants are NOT recommended for
treatment of depression after age 65. If you are taking one
of these medications, even if you have been taking it for a
long time, consult your doctor about switching to a safer
drug.
The most common antidepressants used today are the selective
serotonin reuptake inhibitors (SSRI). These medications are
all of a similar chemical structure and work by preventing
the brain from breaking down serotonin, one of the brain’s
chemical messengers. The SSRI’s currently on the market are
listed below:
-
Fluoxetine (Prozac)
-
Paroxetine (Paxil)
-
Citalopram (Celexa)
-
Fluvoxamine (Luvox)
-
Sertraline (Zoloft)
-
Escitalopram (Lexapro)
SRRI’s
are the safest antidepressants in use today, but they DO
have side effects, including:
|
· Nausea
and
vomiting |
· Anxiety |
|
· Diarrhea |
· Sexual
dysfunction |
|
· Insomnia |
· Headache |
-
Nausea and vomiting
-
Anxiety
-
Diarrhea
-
Sexual dysfunction
-
Headache
-
Insomnia
SSRI’s
are extremely effective at treating depression in all age
groups. However there are some pluses and minuses:
Pluses:
|
· Nausea
and
vomiting |
· Anxiety |
|
· Diarrhea |
· Sexual
dysfunction |
|
· Insomnia |
· Headache |
Minuses:
-
Take
6-8 weeks to work
-
Can
suppress appetite
-
Can
precipitate seizures
-
Worsen sleep problems
Despite
the potential side effects and minuses, SSRI’s are the first
line therapy for depression after age 65. If you are
prescribed an SSRI, stick with it!
The side effects usually diminish or disappear in
two-to-three weeks, and you need to keep taking it for 8 -
12 weeks to really see improvement. Don’t get discouraged if
you don’t feel better right away, it is to be expected.
If you can’t tolerate the side effects of an SSRI, or your
depression isn’t responding after a trial of at least 16
weeks, don’t despair.
There are several other medications on the market that may
help. The medications listed in the table on page 16 are
second line therapies after age 65.
Finally, the last class of antidepressants is the monoamine
oxidase inhibitors (MAOI). These medications have the most
serious side effects of all. They definitely should not be
used after age 65, unless closely monitored by an
experienced psychiatrist. The MOAI’s currently on the market
are Tranylcypromine (Parnate); Phenelzine (Nardil);
Isocarboxazid (Marplan).
If you are taking one of these medications, even if you have
been taking it for a long time, consult your doctor about
switching to a safer drug. As you can see, there are many
choices when it comes to treating depression, even after age
65, when sensitivity to medication may increase. Don’t be
frightened by potential side effects!
Most of the side effects resolve after a few weeks and when
your depression is gone, you’ll feel so much better. Keep
talking to your doctor, and keep treating your depression.
If one medication fails, try another, and keep at it until
the depression is gone and you can get back to your life! |
