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The most common mental health diagnosis made today is that of depression. According to the National Institute of Mental Health, about 9.5 million Americans have had at least one diagnosed episode of depression. Fortunately, it is also one of the most treatable of all the mental health conditions. In addition to counseling and group therapies, many medications have been developed to assist in the treatment of depression.
Antidepressants are classified into various groups including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs). Essentially these drugs work on the chemicals in the brain that regulate moods such as depression.
TCAs work by increasing the levels of two neurotransmitters or chemicals in the brain--serotonin and norepinephrine. Neurotransmitters carry messages from one nerve cell to another. One theory as to the cause of depression is that these chemicals are being made in insufficient amounts. People usually take these medications for several months to allow the neurotransmitter levels to return to normal so that the depression may remain reversed. Examples of TCAs include Elavil, Sinequan, and Pamelor. Women who are pregnant or breastfeeding should not take these medications. In addition, people who are recovering from myocardial infarctions (heart attacks), or have severe kidney or liver disease should not take these medications. Common side effects that generally go away with use include dry mouth, blurred vision, urinary retention, and constipation. These medications should be taken as prescribed. Never attempt to alter the dosage from what your physician has prescribed. It may take two or three weeks after initially beginning the medication before therapeutic levels are reached in the bloodstream. Your physician may order various tests to monitor your blood levels. Avoid taking over the counter cold medications or other drugs without the physician’s knowledge. If you are seeking services from other professionals such as surgeons, dentists, etc., you need to make them aware of the medication and dosage that you are taking. Report any suspected side effects such as fever, sore throat or mouth, urinary retention, fainting, restlessness, or confusion to your doctor. Avoid excess exercise or extremely warm temperatures because these drugs may block perspiration. These medications are not addictive.
MAOIs treat depression by preventing the metabolism of neurotransmitters. They are used less frequently than the TCAs because they are less effective, it takes longer for them to become effective, and are more toxic. Usually they are administered for depression that is associated with anxiety attacks, or if the depression is not responding to treatment with TCAs. Side effects can be potentially serious and include abnormal heart rate, orthostatic hypotension, drowsiness or insomnia, headaches, dizziness, constipation, weakness, dry mouth, nausea, vomiting, or loss of appetite. In addition, while taking this medication, one must be very careful with diet. If foods that are considered to by tyramine-rich are consumed, hypertensive crises can result. These foods include aged cheeses, avocados, guacamole dip, bananas, chicken livers, canned figs, meat tenderizers, pickled herring, raisons, sour cream, soy sauce, and yogurt. The physician will provide you with a list of foods to avoid to prevent this potentially serious complication. Beer, red wines, and caffeine containing beverages should be avoided. In addition, you will need to avoid taking amphetamines, antihistamines, and antihypertensives. Symptoms that you would want to report immediately to your physician because they may indicate hypertensive crises include headaches or heart palpitations. It may take 12 hours or longer after ingesting the medication before toxic effects may be seen. Avoid overactivity when taking this medication. Sometimes this drug has suppressed anginal pain (chest pain), a possible warning of heart attack. If you are taking this medication over an extended period of time, have your vision checked periodically. A condition known as optic toxicity may result. Always wear a medic alert bracelet or card at all times to inform emergency room staff about the MAOIs.
The use of SSRIs has become very popular in the treatment of depression because their proven safety record in comparison to other drug therapies for depression. These prevent the neurotransmitter serotonin from being taken up at the nerve endings. Common side effects that have been reported include nausea, diarrhea, constipation, insomnia, dry mouth, headache, nervousness, anorexia, sweating and sexual dysfunction. Take these medications as ordered by your physician. Contact him before stopping the drug on your own. Avoid the use of antihistamines, Valium, alcohol or trytophan because of the potential reactions that may occur. Let the physician know if you are currently taking anticoagulants such as Coumadin or Heparin or theophylline. If you are experiencing drowsiness from this medication, avoid operating heavy equipment or driving.
In conclusion, the advent of the many new wonder drugs that have come onto the market can help those suffering from depressive disorders to resume normal lives. It is very important to follow your physician’s instructions and make him aware of your concerns. Together you can work as a team to overcome a potentially debilitating illness.
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