Anyone can develop depression. But, treatment is effective in about 80% of identified cases, when treatment is provided. Psychotherapy and medication are the two primary treatment approaches. Antidepressant medications can make psychotherapy more effective, for some people. Someone who is too depressed to talk, for instance, can't get much benefit from psychotherapy or counseling; but often, the right medication will improve symptoms so that the person can respond better.
This page and the linked pages explain many issues related to the treatment of depression with medication. It is intended to help you understand how and why drugs can be used as part of the treatment of depression. It is important for you to be well informed about medications for depression, if you are taking any of these medications, but this is not a "do-it-yourself" manual.
Self-medication can be dangerous. Interpretation of both the signs and symptoms of depression, and identification of possible side effects, are jobs for the professional. The prescription and management of medication, in all cases, must be done by a responsible physician working closely with the patient, his/her psychologist, and sometimes the patient's family. This is the only way to ensure that the most effective use of medication is achieved with minimum risk of side effects or complications.
Symptom Relief, Not Cure
Just as aspirin can reduce a fever without clearing up the infection that causes it, psychotherapeutic medications act by controlling symptoms. Like most drugs used in medicine, they correct or compensate for some malfunction in the body. Psychotherapeutic medications do not cure depression. In many cases, these medications can help a person get on with life despite some continuing mental pain and difficulty coping with problems. For example, antidepressants can lift the dark, heavy moods of depression. The degree of response ranging from little relief of symptoms to complete remission depends on a variety of factors related to the individual and the particular disorder being treated.
How long someone must take a psychotherapeutic medication depends on the disorder. Many depressed and anxious people may need medication for a single period perhaps for several months and then never have to take it again. For some depressions, medication may have to be taken indefinitely or, perhaps, intermittently.
Like any medication, psychotherapeutic medications do not produce the same effect in everyone. Some people may respond better to one medication than another. Some may need larger dosages than others do. Some experience annoying side effects, while others do not. Age, sex, body size, body chemistry, physical illnesses and their treatments, diet, and habits such as smoking, are some of the factors that can influence a medication's effect.
The kind of depression that will most likely benefit from treatment with medications is more than just "the blues." It's a condition that's prolonged, lasting 2 weeks or more, and interferes with a person's ability to carry on daily tasks and to enjoy activities that previously brought pleasure.
The depressed person will seem sad, or "down," or may show a lack of interest in his surroundings. He may have trouble eating and lose weight (although some people eat more and gain weight when depressed). He may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. He may speak of feeling guilty, worthless, or hopeless. He may complain that his thinking is slowed down. He may lack energy, feeling "everything's too much," or he might be agitated and jumpy. A person who is depressed may cry. He may think and talk about killing himself and may even make a suicide attempt. Some people who are depressed have psychotic symptoms, such as delusions (false ideas) that are related to their depression. For instance, a psychotically depressed person might imagine that he is already dead, or "in hell," being punished.
Not everyone who is depressed has all these symptoms, but everyone who is depressed has at least some of them. A depression can range in intensity from mild to severe.
Antidepressants are used most widely for serious depressions, but they can also be helpful for some milder depressions. Antidepressants, although they are not "uppers" or stimulants, take away or reduce the symptoms of depression and help the depressed person feel the way he did before he became depressed.
Antidepressants are also used for disorders characterized principally by anxiety. They can block the symptoms of panic, including rapid heartbeat, terror, dizziness, chest pains, nausea, and breathing problems. They can also be used to treat some phobias.
Your physician will choose a particular antidepressant based on your symptoms. When you begin taking an antidepressant, improvement generally will not begin to show immediately. With most of these medications, it will take from 1 to 3 weeks before changes begin to occur. Some symptoms diminish early in treatment; others, later. For instance, energy level, or sleeping and eating patterns may improve before the depressed mood lifts. If there is little or no change in symptoms after 5 to 6 weeks, a different medication may be indicated, and you should discuss this with your physician. Some people respond better to one medication than to another. There is no certain way to determine which medication will be effective, so your doctor may have to prescribe first one, then another, until an effective one is found. Treatment with medication is continued for a minimum of several months and may last up to a year or more.
While some people have one episode of depression and then never have another, or remain symptom-free for years, others have more frequent episodes or very long-lasting depressions that may go on for years. Some people find that their depressions become more frequent and severe as they get older. For these people, continuing (maintenance) treatment with antidepressants can be an effective way of reducing the frequency and severity of depressions. Those that are commonly used have no known long-term side effects and may be continued indefinitely. The prescribed dosage of the medication may be lowered if side effects become troublesome. Lithium may also be used for maintenance treatment of repeated depressions whether or not there is evidence of a manic or manic-like episode in the past.
The dosage of antidepressants varies, depending on the type of drug, the person's body chemistry, age, and, sometimes, body weight. Dosages are generally started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects.
Questions for Your Doctor
To increase the likelihood that a medication will work well, you and your family must actively participate with the doctor prescribing it. Tell the doctor about your past medical history, other medications being taken, anticipated life changes such as planning to have a baby and, after some experience with a medication, whether it is causing side effects. When a medication is prescribed, you should ask the following questions, recommended by the US Food and Drug Administration (FDA):
- What is the name of the medication, and what is it supposed to do?
- How and when do I take it, and when do I stop taking it?
- What foods, drinks, other medications, or activities should I avoid while taking the prescribed medication?
- What are the side effects, and what should I do if they occur?
- Is there any written information available about the medication?
Follow the links below for information about types of antidepressant medications, side effects for each type, an important FDA warning about antidepressants, and a list of medications. The list has the generic (chemical) names matched with the trade names (brand names used by drug companies). If you cannot find additional information using the trade name, search for information using the generic name.