DEPRESSION - THE UPS AND DOWNS OF PHARMACOLOGICAL TREATMENTS
Symptoms like fatigue, agitation, restlessness, lack of energy, weight gain or loss, sleep disturbances and feelings of sadness, guilt and hopelessness are signs of the serious, yet common, illness affecting millions of individuals each year. According to an American study conducted by the Analysis Group Inc. and The Massachusetts Institute of Technology Sloan School of Management, depression is more widespread than coronary heart disease, cancer and Aids combined.
There is strong evidence that depression is as debilitating as most other general medical conditions and that it results in increased general medical resource utilization. The economic costs of depression are extremely high, with approximately 200 million workdays being lost per year due to the illness. It is estimated that depression costs the United States approximately 53 billion dollars a year.
For the individual sufferer depression can also be very costly. It can cost them their job, their relationships, their self-esteem and in some cases, their life.
The good news though, is that the progress made in the study of the major affective disorders during the past decade is unmatched by that in any other area of psychiatric research. These advances are especially visible in the area of treatment, with current options resulting in an impressive response rate of 70 - 80%. The bad news though, is that fear, stigma and lack of knowledge prevents two-thirds of those people suffering from clinical depression from seeking treatment.
If you feel that you or any of your loved ones may be suffering from depression, it is important to seek help. Clinical depression can only be diagnosed by a medical or mental health professional, and from there various treatment options can be considered. For more information, counselling and referrals, the Depression and Anxiety Support Group can be contacted, Monday to Friday, between 8am and 7pm, and on Saturdays, between 8am and 5pm, on (011) 783 - 1474/6.
Depression is a real ailment that has real treatments, which fortunately are both effective and safe. Treatment usually consists of medication, psychotherapy or a combination of the two. There are a variety of anti-depressant medications to choose from, and it is important to find the particular one that works for you. The various types include the older Tricyclics (e.g. Tofranil, Anafranil, Wellbutrin), the MAO inhibitors (e.g. Parnate, Marplan), the SSRI's (e.g. Prozac, Zoloft), and the newer ones like Effexor and Serzone. All work in various ways on the neurotransmitters in the brain, especially on serotonin and norepinephrine.
Although these medications have a response rate of approximately 80%, they are not without some limitations. There are some common side effects, the first of which is sexual dysfunction. While loss of ejaculatory function in men and loss of libido and anorgasmia (inability to orgasm) in both sexes may be complications of virtually any anti-depressant, these side effects appear to be most common with the MAO Inhibitors and the SSRI's. Before taking action, it must be clarified whether the sexual dysfunction is a result of the anti-depressant or the underlying depression. There are a number of adjunctive medications that can be tried to improve SSRI-induced sexual dysfunction.
Other side effects include dizziness, sedation and "feeling medicated". Dizziness may be caused by low blood pressure secondary to anti-depressant medications. Some people who say that they feel "overly medicated" are actually overly sedated. Many anti-depressants are prone to this symptom. Prozac, Zoloft and Wellbutrin are a few that are experienced as least sedating. Sedation often diminishes in the first weeks of treatment, and if you are only experiencing minor difficulty from this side effect, you should allow some time to pass before changing your anti-depressant. Sometimes the solution is to take your medication as a single dose just before going to bed.
Then there are the anticholinergic side effects, such as a dry mouth, impaired ability to focus at close range, constipation and urinary hesitation. All Tricyclics have some degree of these symptoms. Weight gain is also a problem with the Tricyclics, the MAOI's and Lithium, although today there are also adjunctive medications to combat this.
Some of these side effects may discourage the use of anti-depressants, but the advantages of seeking treatment far outweigh the inconveniences some may cause. Early treatment may help to keep the depression from becoming more severe or chronic. Thoughts of suicide are common in depression, and the risk of suicide is increased when patients are not treated and the depression recurs. Treatment can prevent recurrences, which is especially important as the more episodes of depression that occur, the greater the chance of recurrence. About half the people who have one episode will have a second. Without treatment after two episodes, the chances of having a third are even greater. After three episodes, the chances of having a fourth are 90%.