Anti-Depressant Medications

Many people will feel better with the help of counseling, and medication may not be necessary at all. However, if left untreated altogether, depression can last longer or even worsen. It can seriously interfere with your ability to study, work, and enjoy relationships. Depression also can be a life-threatening illness when there is a risk of suicide. Many people get better without medication, but sometimes medication is necessary to help lighten your mood and help you to function so that you can begin working through other problems.  

The diagnosis of depression is based on the recognition of certain characteristic signs and symptoms affecting your mood state, thinking patterns, and physical well-being. At present, no blood test can confirm or eliminate the diagnosis of depression.  

If you are a student at UC Berkeley, the first step in seeking help is to discuss your symptoms with a counselor. Stop by Mental Health Services, 3rd Floor, Tang Center, or call (510) 642-9494. Your counselor will evaluate your symptoms and recommend whether depression medication is likely to help you, given your unique symptoms and circumstances. If medication seems like a reasonable option, you will be referred to a nurse practitioner or primary care physician in the health service or to a psychiatrist (physician specializing in antidepressant medications) at UHS or in the community.   

Depression is an illness in which factors such as genetics, chemical changes in the body, and external events may play an important role. Research suggests that depression may be linked to changes in the functioning of brain chemicals called neurotransmitters. Current research focuses on the serotonin, norepinephrine, and dopamine systems. Certain genetic factors and changes in body hormones also have been implicated in some depressive conditions. These complex biological changes can produce profound changes in your mood and behavior. Antidepressants are thought to correct some of the chemical imbalances present in a depressive illness. 

The first step is usually an appointment with a psychiatrist to discuss your depressive symptoms. Your psychiatrist may ask the same questions another professional already has asked you. While you may find this repetition frustrating, keep in mind that questions are repeated so that your doctor can gain a thorough understanding of your symptoms, medical history, medication use, and drug or alcohol use. For female patients, it also will be important to discuss issues of pregnancy and birth control use since medication may be potentially harmful to a fetus or nursing infant. Since certain drugs, as well as some medical conditions, can produce depressive symptoms, you also may be referred to another physician for a complete physical exam and laboratory tests. 

There are approximately 20 antidepressants currently available and approved for the treatment of depression. Antidepressants generally are classified by the chemical properties of the drug and how they are thought to work. Groups of medications your doctor may refer to include: Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclic Antidepressants (TCAs), or Monamine Oxidase Inhibitors (MAOIs). Some clinicians may refer to medications discovered in the last 10 to 15 years as "new" medications and those medications that have been available in the last 30 years as "older" medications. There also are mood stabilizers for those with bipolar disorder.

Like shoe sizes, not every medication is the right fit for every individual; a medication that works well for a friend may not be the best match for you. Your doctor will consider your particular symptoms when selecting your medication. He/she also will consider the potential adverse effects of medication. The goal of treatment is to effectively eliminate depression with a medication that produces minimal problems or adverse effects. An "ideal" medication that does not pose some potential problem or risk is not yet available. Side effects generally are mild and decrease with time. Research is focusing on more selective medications for depression that produce fewer and less problematic side effects. You must ask your doctor about any concerns you might have about a medication or its potential side effects. 

Antidepressants are a relatively safe treatment option in otherwise healthy individuals being treated for depression. Like most prescribed (and some over-the-counter medications), antidepressants may cause mild, and usually temporary, side effects in some people. Most of the time, side effects are manageable and disappear over time. Common side effects include nausea, loose stools or constipation, dizziness, drowsiness, nervousness, sleep changes, dry mouth, headache, and blurred vision. Some people experience a change in sexual interest or functioning. While more severe problems are less common, they are possible.

Your doctor or pharmacist will have information sheets that outline a range of potential side effects. Each time you meet with your doctor for follow-up sessions, she or he will ask about your response to the medication and check for problematic effects. Unusual side effects or those that could interfere with your ability to work or study should be reported to your doctor immediately so that changes in the medication can be made. Most side effects are reversible and gradually disappear after a medication is stopped. Don't hesitate to talk to your doctor if you have questions or concerns.

All antidepressants take time to work. Don't be discouraged if you don't feel better right away. The therapeutic response typically occurs within two to four weeks after treatment is started, although some people feel better sooner. It is not unusual for your friends and family to notice signs of improvement before you do. When the medication begins to work, you may find yourself increasingly able to accomplish things and enjoy life in a way that is more "normal" for you. If you do not respond to one medication, your doctor may recommend a change of dosage or a change to other medication(s).

Each person is unique in his or her response to medication. Treatment of depression is an ongoing process, with your doctor monitoring and "fine-tuning" your medication, depending on how it is working for you. Each person is unique in his or her response to medication.

The currently prescribed medications that are approved for the treatment of depression are not considered addictive. Drug addiction implies that you would crave increasing amounts of a substance. While certain medications used in treating unusual forms of depression do have potentially addictive qualities, these medications are not considered standard antidepressants. Although antidepressants are not addictive, you may experience some symptoms that lead you to wonder whether you are getting "high." Early on in treatment, antidepressants may cause you to feel unusually energized, especially compared to your previous state. Feeling "high" or intoxicated suggests an unusual reaction to your medication, an interaction with another medication, complications from drug or alcohol use, or an unwanted side effect. In addition, some patients with bipolar disorder may experience an unwanted episode of euphoria. Should you experience any of these problems, contact your psychiatrist immediately. Antidepressants are not addictive.  

Medication will not change who you are as a person, your unique personal characteristics, or your life circumstances. The goal of antidepressant therapy is to allow you to work toward positive changes in your mood state and thinking patterns. Antidepressant medication assists people in experiencing the full range of human emotions without feeling overwhelmed. Although these positive changes may seem like personality changes, most often they are a sign that you are recovering your ability to react to people and situations in a non-depressed way. Sometimes antidepressant medication produces temporary side effects that feel like negative personality changes. In particular, you may feel less emotionally sensitive or less "intense" than you did before taking medication. If this occurs and is distressing for you, don't hesitate to discuss your concerns with your counselor or psychiatrist. 

An important question! Sometimes when antidepressants are taken in combination with other drugs, the chances of side effects or drug interactions increase. It is very important to consult with your prescribing physician, particularly about allergy medications. Be sure to tell your doctor about any medications you use, even over-the-counter or "natural" vitamins and herbal products. 

There is no evidence that antidepressants decrease contraceptive protection. However, like other medications, antidepressants are potentially harmful to the fetus if you are or become pregnant. 

You and your treatment professional(s) will meet regularly after the medication is prescribed to assess any changes and/or concerns and to evaluate how the medication is working for you. Typically, people take antidepressant medications for eight to twelve months or longer. While it often is tempting to stop taking the medication when you feel better, it is important to continue until you and your doctor agree your depression is treated. Stopping the medication early can result in the return of your original symptoms or adverse reactions. You may be asked to gradually decrease or "taper off" the medication. "Tapering off" is particularly important with some medications to give your body an adjustment period. 

In the majority of cases, depression is an illness that can be effectively treated with medication and counseling. However, there is always a chance that your depression may return once a medication is stopped. Continuing antidepressants and/or therapy for the recommended period minimizes this possibility. In a small number of cases, depression reoccurs after treatment is complete. Recognizing the signs of a new depressive episode and seeking treatment early is very important. You should also discuss this possibility with your doctor before ending treatment.  

There has been a great deal of publicity about herbal preparations, such as St. John’s Wort, for the treatment of depression. In the US, there are currently no adequate studies to prove that this or other herbal remedies are an effective treatment, especially when compared to standard antidepressants for certain forms of clinical depression. In addition, herbal preparations may not have any significant impact on severe forms of depression. Currently, it is not recommended that traditional antidepressants be mixed with herbal antidepressants. If you are curious about any new developments in the research on herbal preparations, talk with your psychiatrist before “self-medicating.” 

Although the cost of medication may be difficult for some students to budget, the costs of not treating depression also are high. You’ve invested considerable time and money to attend Cal. Your ability to function in school, relationships, and outside employment may be significantly affected by an untreated episode of depression. If you have the Student Health Insurance Plan (SHIP), call (510) 642-5700 for benefit information. If you do not have SHIP, you will need to check your insurance policy to find out what is covered.  

Alcohol itself is an extremely potent depressant. You certainly don’t want to feel more depressed! The use of alcohol and drugs can complicate the diagnosis and treatment of a depressive illness. Many depressive conditions are associated with the excessive use of alcohol and some drugs. Using drugs or alcohol can increase the risk of dangerous behaviors, including suicide; or cause complicated interactions with your prescribed medication. In summary, alcohol or drug use can reduce the effectiveness of your treatment, prolong your illness, and increase the risk of negative medication side effects. Alcohol and drugs can make your depression worse. 

This is something you should discuss with your doctor. In most cases, if you miss a dose, don’t take a double dose next time. Simply continue with the next scheduled dose and try not to miss again. If you miss several consecutive doses, you may experience problems such as headaches and nausea. Most importantly, if you often forget to take the medication, your recovery is likely to take longer.  

Often people who care about you already are aware of and concerned about the changes in your mood and energy levels. They may be very relieved you are getting help. Since depression can leave you feeling exhausted or helpless, getting support from others is important. However, many people have never experienced serious depression and may have trouble understanding how disabling it can be. They might not mean to be insensitive or unsupportive, but they may say or do things that hurt. It may help to share this information with those you care about so they can better understand and help you. 

For many people, the combination of medication and psychotherapy is the most effective way to treat depression. While medication can help improve depressive symptoms, it can’t change events, thoughts, or behaviors that are problematic or distressing for you. Even before becoming depressed, you may have been struggling with personal or family issues that affected how you felt about yourself and your relationships. Psychotherapy can help you explore and resolve these concerns. Individual and/or group psychotherapy also may be recommended to help you improve self-esteem, relationship skills, and strategies for managing stressful events. Good nutrition, quality sleep, and exercise also are important elements of your recovery. To feel better as quickly as possible, consider all the recommendations of your counselor and/or psychiatrist.