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Should I take an antidepressant

Dr Henriette Smith October 2017

· Mind
What's Stopping You From Seeing a Doctor About Depression?

Are you struggling with depression?? Are you getting treatment for it? If not, you’re not alone. About two-thirds of people with major depression never seek appropriate treatment, and the consequences can be devastating: personal suffering, missed work, broken marriages, health problems and, in the worst cases, death.

The World Health Organization ranks depression as one of the world’s most disabling diseases. Yet with treatment, 70% of people with clinical depression can improve, often in a matter of weeks.

So what keeps us from seeking help?

  1. If I give it time, I’ll snap out of it.

Clinical depression is a biochemical disease, something you can’t just snap out of. And like other medical conditions, it requires treatment to control or heal it. Waiting for depression to simply pass can be harmful for a number of reasons. For one, depression that goes untreated may become more severe. The longer the delay in treatment, the more difficult it may be to control, and the more likely it is to recur when treatment is stopped. There also is growing evidence that untreated depression can contribute to or worsen other medical problems. Heart disease is the one that has been most linked to depression, but research also suggests a link between depression and metabolic issues such as obesity, diabetes, and diseases such as Alzheimer’s and cancer.

  1. I don’t want to take antidepressants.

Here are eight common fears about antidepressants, as well as facts that can help you and your doctor decide if an antidepressant is right for you.

  • Fear: Antidepressants make you forget your problems rather than deal with them.
  • Fact: Antidepressants can’t make you forget your problems, but they may make it easier for you to deal with them. Being depressed can distort your perception of your problems and sap you of the energy to address difficult issues. Many therapists report that when their patients take antidepressants, it helps them make more progress in psychotherapy.
  • Fear: Antidepressants change your personality or turn you into a zombie.
  • Fact: When taken correctly, antidepressants will not change your personality. They will help you feel like yourself again and return to your previous level of functioning. (If a person who isn’t depressed takes antidepressants, they do not improve that person’s mood or functioning.) Rarely, people experience apathy or loss of emotions while on certain antidepressants. When this happens, lowering the dose or switching to a different antidepressant may help.
  • Fear: Taking an antidepressant will make me gain weight.
  • Fact: Like all drugs, antidepressants have side effects, and weight gain can be a common one of many of them. Some antidepressants may be more likely than others to cause weight gain; others may actually cause you to lose some weight. If this is a concern, talk with your doctor.
  • Fear: If I start taking antidepressants, I’ll have to take them for the rest of my life.
  • Fact: Most people who take antidepressants for a first-time episode of depression need to take them continuously for six to nine months, not necessarily a lifetime. Once an antidepressant get depression under control, you should work with your doctor to decide when to stop your medication and then decrease your dose gradually. Discontinuing them suddenly may cause problems such as headachesdizziness, and nausea.
  • Fear: Antidepressants will destroy my sex life.
  • Fact: Some antidepressants can have an effect on sex. The problem is usually in having an orgasm rather than a lack of desire. But because depression itself decreases libido, a medication that eases depression may improve your sex life. As with other side effects, certain antidepressants may be more likely than others to cause sexual problems.
  • Fear: Antidepressants are expensive and aren’t covered by my medical aid.
  • Fact: Antidepressants are usually covered by medical aid, especially the higher options. The cost of antidepressants varies widely, depending on the dosage, the drug you are taking, and whether it is available as a generic. Even without medical aid coverage, it is possible to purchase a generic antidepressant for as little as R50 per month.
  • Fear: Taking an antidepressant is a sign of weakness.
  • Fact: Like medical conditions such as diabetes or high cholesterolmajor depression is a condition that often responds to medication. When depression interferes with your ability to function normally, seeking treatment is not a sign of weakness. It’s a sign of good self-care.
  • Fear: Antidepressants increase the risk of suicide.
  • Fact: Studies in recent years have raised concerns that antidepressants may raise the risk of suicidal thoughts or behaviors (but not deaths) among children, adolescents, and young adults. For example, a 2009 review in the British Medical Journal (BMJ) looked at 372 studies involving nearly 100,000 people who were taking antidepressants. It found that compared to placebo, antidepressants were associated with a slightly higher risk for suicidal thoughts in some children and young adults, have no effect on suicide risk among those 25 to 64, and reduce the risk in those 65 and older.

In October 2004, the FDA directed the manufacturers of all antidepressant drugs to put a strong warning on antidepressant drug labels. The boxed warning says that antidepressants have been shown to increase suicidal thinking and behavior (not attempts) in children and adolescents and should be used with caution.

Before the FDA released its first advisory in March 2004, antidepressant use in children and teens had been rising steadily for years. By the end of June 2005, there was a 20% drop in antidepressant prescriptions for kids aged 18 and younger. But in September 2007, Florida researchers reported an unprecedented spike in child and teen suicides. One possible explanation is that frightened parents and doctors might be withholding needed medication from depressed youth, leading to an increase in suicide deaths.

If your child has depression, be sure to talk to your doctor to determine if psychotherapy, depression medications, or both are right for your child.

Other studies paint a different picture. A 2006 study published in PLoS Medicine suggests that antidepressants have saved thousands of lives. Data show that the U.S. suicide rate held fairly steady for 15 years before the popular antidepressant fluoxetine (Prozac) was sold and then dropped steadily over 14 years while sales of Prozac rose. The strongest effect was among women.

The bottom line: Regardless of your age or sex, it’s important to see a doctor immediately if you have suicidal thoughts or other significant symptoms of clinical depression.

  1. I don't feel sad all the time. Why do I need treatment for depression? 

As mentioned in our article “What is the difference between sadness and depression”, you don’t need to feel sad or cry all day to be clinically depressed. Often people with depression see their primary care doctors for problems such as muscle pain, sleeping problems, or fatigue, not knowing those are signs of depression. Sometimes these symptoms accompany sadness; other times they don’t.

There is also so-called ‘masked depression’ -- when, for whatever reason, people don’t feel in touch with a sense of sadness or abnormal mood. They may be more likely to report something like apathy, blunted mood, or not feeling like themselves.”

In these cases, a doctor may diagnose depression based on other symptoms, particularly decreased interest in or loss of pleasure from favorite activities. If you are having symptoms such as fatigue, muscle pain, or loss of interest in activities you love, don’t rule out depression as a cause. See your doctor.

  1. I’m embarrassed to talk to my doctor about it. 

The shame of having a mental health problem keeps folks from seeking help or even talking about suffering from depression. But depression is nothing to be ashamed of. It is a medical condition, much like diabetes or high cholesterol, which requires treatment.

It is also a very common condition. Depressive disorders affect nearly 19 million people in the U.S. every year -- regardless of gender, age, race, religion, sexuality, income, or education. So there’s a good chance your doctor won’t hear anything from you that she hasn’t heard many times before.

Remember that virtually everyone experiences depression at some point, and your doctor will not repeat anything that you share during an office visit. Still, if speaking to your own doctor is embarrassing, find out if your medical aid has someone you can speak with first by phone. If you don’t have a medical aid, check out mental health services in your community.

If you think you need immediate assistance, call your local doctor/psychologist or psychiatrist or the SADAG Mental Health Line on 011 234 4837. If necessary, please phone the Suicide Crisis Line on 0800 567 567 or sms 31393.

  1. I’m afraid of having to talk about painful subjects in therapy. Depressed people avoid treatment for fear of having to undergo a probing examination of their psychological pain. They have a fear of opening it all up -- ‘I don’t want to go there,’” Unfortunately, in some cases, getting into painful discussions is necessary for healing. But in other cases, it doesn’t have to be as deep or scary as you might think. A good therapist understands what is like for someone to open up to a stranger and will guide you through that process. He won’t push you to open up too quickly or at a level you are not comfortable with.

Find a therapist you feel comfortable with and ask him as many questions as he asks you. Find out what therapy will be like. Although painful discussions may be necessary in time, your therapist cannot force you. What you reveal is up to you.

10 Questions To Ask Yourself Before Starting Antidepressants

Depression is a serious medical condition, and the decision to take antidepressants can be just as big of a deal. Additionally, seeing a therapist, changing your behavior, establishing healthy eating, sleeping, and exercising habits, socializing and joining groups—doing all the things that will improve your mood—should be part of your long-term plan to fight depression.

But before you make a decision about antidepressants in your treatment plan, it's important to do some thinking. We talked to top doctors and psychiatrists to learn the 10 questions you should ask yourself before considering antidepressants.

1. Could my depression be the result of a medical condition?

Many health conditions affect mood and can contribute to feelings of depression. Thyroid conditions and heart disease, for example, can result in depressive symptoms. It is important to see your doctor first, to rule out medical conditions that may be the root cause of your depression.

2. Could my depression be a side effect of another medication?

Some prescription meds have side effects that can include depression. If you recently added a new prescription at the same time you noticed your mood has been affected, talk to your doctor about all the meds you're on to ensure there are no unintended depressive consequences.

3. Have I suffered a recent loss?

Remember that it's not unusual to feel intense emotions following a death, divorce, relocation, or retirement. It's important to remember that antidepressants treat symptoms and not root causes. Learning coping methods through cognitive behavioral therapy should be the first step when it comes to dealing with situational depression. Also, you should ask yourself how long you've been depressed.

4. Am I exercising enough?

Research indicates that regular exercise boosts the serotonin levels in our bodies, resulting in improved mood and energy levels. Try to increase your exercise regimen to see if you experience a decrease in your symptoms. Aerobic exercise in particular can be effective in both preventing and treating depression. It's a combination of the feel-good brain chemicals—like neurotransmitters and endorphins—and the reduction of immune system chemicals that can worsen depression.

5. Am I eating a healthy, well-balanced diet?

A sugar-heavy diet can cause a severe drop in blood sugar levels, which can lead to feelings of low energy and depression. Additionally, gastrointestinal issues can lead to mood problems including depression. Increasing your probiotic and veggie intake can be a step in the right direction." Other things to add to your diet: beneficial dietary factors associated with omega-3 fatty acids (from foods such as salmon, tuna, mackerel, dark green vegetables, flaxseed, nuts, and soybeans) as well as vitamin B12 (from foods such as seafood, low-fat dairy products, and fortified cereals). Complex carbs have been found to raise the level of serotonin in your brain, so a baked sweet potato or whole-wheat pasta are good choices.

6. Am I socializing on a regular basis?

The saying "No man is an island" has strong implications when dealing with depression. Those that isolate or have poor social support systems report greater feelings of sadness. Be sure to connect with friends and family; join a local group in your community or take a continuing education class to learn new skills and meet new people. Social support is strongly linked to improved mental health and decreased stress.

7. Am I getting enough sleep?

Research shows that normal, healthy adults who go without good sleep for just one month begin to show clinical signs of depression. And a lack of sleep can make even the most level-headed person become irritable and short-tempered. Sleep deprivation leads to changes in the brain, which include changes in neurochemicals and in hormones. But many adults don't get enough sleep. The cut-off for good health is getting at least six hours. If you have problems with sleeping, it's important to nip it in the bud because it can quickly lead to anxiety and depression. One simple step is to watch your caffeine intake. Not only will you sleep better, but you'll feel less cranky, jittery, and anxious.

8. Have I tried to reduce my stress or anxiety?

One of the best pieces of advice that can be given to treat depression is to fight it. It feels at times like the flu, but the treatment is the opposite. When you feel least like getting out of bed, that is the most important time to drag yourself out and get busy. When you least feel like exercising, that is the time to get some fresh air and go for a walk. And when you least feel like socializing, that is the time to call a friend and have a coffee and conversation. Medication like antidepressants may help with mood or even sleep and appetite, but it will not change your behavior. You have to purposefully change that part.

Some other positive ways to change your behavior are to engage in mindful practices such as meditation, yoga, tai chi and even going to church. These activities have been shown to reduce depressive symptoms and increase an overall sense of well-being. Also, look at your triggers. Are you in an unhealthy relationship or doing a job you hate? Often, tough decisions that we continue to avoid making contribute to our feelings of helplessness or depression. Talking to a trained therapist to come up with a plan to change your behavior, or aspects of your life, is a good first step.

9. Am I drinking too much?

Rather than helping you with your problems, an increase in alcohol use typically makes things worse. There's good science indicating the abuse of alcohol can actually lead to depression, and long-term alcohol use has also been linked with anxiety. Alcohol can also interfere with good sleep, further compounding the problems of anxiety and depression. Because alcohol makes us less inhibited and more impulsive, it also makes us more prone to anger, aggression and violence. Research shows that if you do drink, it's best for your health—both physical and mental—to limit it to two drinks a day.

10. Do I have a long-term plan for dealing with my depression?

Sometimes, no matter what you try—changing your diet, taking supplements, working with a therapist, or exercising—the darkness still looms; you may want to think about taking medication, especially if you find that the depression is inhibiting your daily functions. So if you're seriously considering going on antidepressants, you should also have a plan for going off the meds. Wean yourself off antidepressants in 6 to 9 months after new coping habits have been formed—under the supervision of your doctor. However, if it is your second episode of major depression, you need to stay on your medication for two years. If you have had more than two episodes op depression in your life, it is probably better to stay on long-term antidepressants.

This post is for informational purposes only. It should not be considered therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise provide any clinical opinions. If you think you need immediate assistance, call your local doctor/psychologist or psychiatrist or the SADAG Mental Health Line on 011 234 4837. If necessary, please phone the Suicide Crisis Line on 0800 567 567 or sms 31393.

This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise provide any clinical opinions. If you think you need immediate assistance, call your local doctor/psychologist or psychiatrist or the SADAG Mental health Line on 011 234 4837. If necessary, please phone the Suicide Crisis Line on 0800 567 567 or sms 31393.