depression

What is depression? — Depression is a brain disease that makes you sad, but it is different than normal sadness (figure 1). Depression can make it hard for you to work, study, or do everyday tasks. How do I know if I am depressed? — Depressed people feel down most of the time for at least 2 weeks. They also have at least 1 of these 2 symptoms: They no longer enjoy or care about doing the things they used to like to do. They feel sad, down, hopeless, or cranky most of the day, almost every day. Depression can also make you: Lose or gain weight Sleep too much or too little Feel tired or like you have no energy Feel guilty or like you are worth nothing Forget things or feel confused Think about death or suicide If you think you might be depressed, see your doctor or nurse. Only someone trained in mental health can tell for sure if you are depressed. See someone right away if you want to hurt or kill yourself! — If you ever feel like you might hurt yourself or someone else, do one of these things: Call your doctor or nurse and tell them it is urgent Call 9-1-1 Go to the emergency room at your local hospital Call the National Suicide Prevention Lifeline: 1-800-273-8255 www.suicidepreventionlifeline.org What are the treatments for depression? — People who have depression can: Take medicines that relieve depression See a counselor (such as a psychiatrist, psychologist, nurse, or social worker) Do both People with depression that is not too severe can get better by taking medicines or talking with a counselor. People with severe depression usually need medicines to get better, and may also need to see a counselor. When will I feel better? — Both treatment options take a little while to start working. Many people who take medicines start to feel better within 2 weeks, but it might be 4 to 8 weeks before the medicine has its full effect. Many people who see a counselor start to feel better within a few weeks, but it might take 8 to 10 weeks to get the greatest benefit. If the first treatment you try does not help you, tell your doctor or nurse, but do not give up. Some people need to try different treatments or combinations of treatments before they find an approach that works. Your doctor, nurse, or counselor can work with you to find the treatment that is right for you. He or she can also help you figure out how to cope while you search for the right treatment or are waiting for your treatment to start working. How do I decide which treatment to have? — You and your doctor or nurse will need to work together to choose a treatment for you. Medicines may work a little faster than counseling. But medicines can also cause side effects. Plus, some people do not like the idea of taking medicine. On the other hand, seeing a counselor involves talking about your feelings with a stranger. That is hard for some people. Is depression the same for teenagers? — No. The symptoms of depression are a little different for teenagers than they are for adults. Some teenagers are moody or sad a lot of the time. That makes it hard to tell when they are really depressed. Teenagers who are depressed often seem cranky. They get easily “annoyed” or “bothered.” They may even pick fights with people. Also, when treating a teenager, doctors and nurses usually suggest trying counseling first, before trying medicine. That's because there is a small chance that depression medicines can cause problems for some teenagers. Even so, some depressed teenagers need medicine. And most experts agree that depression medicine is safe and appropriate to use in teenagers who really need it. What if I take medicine for depression and I want to get pregnant? — Some depression medicines can cause problems for unborn babies. But having untreated depression during pregnancy can also cause problems. If you want to get pregnant, tell your doctor but do not stop taking your medicines. The two of you can plan the safest way for you to have your baby. What do medicines for depression do? — Medicines for depression, also called antidepressants, can: Help you feel better and more able to do everyday tasks Reduce the symptoms of depression Relieve anxiety Each of the antidepressants works in a different way. But in general, they all change the chemistry of the brain (figure 1). Which medicine might I need? — Your doctor will decide which medicine is best for you. He or she might ask if any of your family members have had good luck with a particular antidepressant. If so, that might be a good place for you to start. The section at the end lists the most common antidepressant choices. Most people take just 1 antidepressant, but some people take 2 or 3 of the medicines together. The first medicine you try might not help enough. If that happens, tell your doctor or nurse, and don’t give up. People sometimes need to try a few different medicines or combinations of medicines before they find the treatment that works for them How long before I feel better? — Most antidepressants start to help within 2 weeks of when you start taking them. But it usually takes 4 to 6 weeks before you get the full effect. If you don’t feel any better after 2 to 4 weeks, ask your doctor or nurse what you can do. He or she might increase your dose, prescribe a second medicine, or offer another solution. What if I have side effects? — If you have minor side effects when you start taking an antidepressant, try staying on the medicine for a few weeks. Minor side effects often go away after your body gets used to the new medicine. If side effects do not go away or worry you, mention your problems to your doctor or nurse. He or she might have suggestions for how to reduce or deal with your side effects. Each of the medicines is different, but in general, side effects from antidepressants can include: Feeling jittery or restless Having trouble sleeping Feeling tired Headaches Nausea or diarrhea Problems with sex Weight gain This table lists the generic and US brand names of several antidepressants and how likely each medicine is to cause certain side effects (table 1). How long do I keep taking the medicines? — Most people stay on antidepressants for at least 6 to 9 months. If you have severe depression, it might make sense to stay on your antidepressant for a year or more. People with severe depression who recover and then go off their medicines often get depressed again. If and when you do go off your medicine, do it with the help of your doctor or nurse. You will need to slowly decrease your dose over a few weeks. Stopping antidepressants all of a sudden can cause uncomfortable symptoms. Medicines to treat depression: SSRIs (selective serotonin reuptake inhibitors) — SSRIs are usually the first medicines doctors prescribe when they are treating someone with depression. SSRIs often work well, are safe, and have fewer side effects than many of the other medicines. Some examples of SSRIs include citalopram (brand name: Celexa®), fluoxetine (brand name: Prozac®), and sertraline (brand name: Zoloft®). SNRIs (selective norepinephrine reuptake inhibitors) — SNRIs work in a similar way to SSRIs, but they also have other effects. Doctors sometimes suggest these medicines when SSRIs do not help enough. Some examples of SNRIs include duloxetine (brand name: Cymbalta®) and venlafaxine (brand name: Effexor®). Other antidepressants — Other antidepressants include bupropion (brand name: Wellbutrin®) and mirtazapine (brand name: Remeron®). These medicines do not tend to cause sex-related side effects, so doctors sometimes give them to people who have those side effects with other antidepressants. Bupropion does not cause weight gain, and it can be especially helpful to people who lack energy, but it can cause jitteriness. Mirtazapine increases appetite and can cause weight gain, so doctors sometimes give it to people with low appetite. TCAs (tricyclic and tetracyclic antidepressants) — TCAs are not used as much as SSRIs and SNRIs, because TCAs can cause more side effects, such as constipation and drowsiness. In addition, TCAs can disrupt the heart’s rhythm and cause other serious problems. In elderly people, these medicines can also cause confusion and memory problems. Even so, TCAs can help some people with depression, especially if they do not get better with SSRIs or SNRIs. Some examples of TCAs include nortriptyline (brand name: Pamelor®) and desipramine (brand name: Norpramin®). MAOIs (monoamine oxidase inhibitors) — MAOIs are not used very often because they can cause a lot of side effects, and because people who take them must avoid certain foods and medicines. Still, MAOIs can help people who have depression along with other problems or who do not get better with other medicines. Some examples of MAOIs include tranylcypromine (brand name: Parnate®) and phenelzine (brand name: Nardil®).
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depression

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depression

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