Why Antidepressants stop working

Q: I've taken different antidepressants over the years, and now my body seems to reject medications that helped before.  Any suggestions?

A:  We certainly know that antidepressant medications sometimes seem to stop working. Clinicians started to describe the “Prozac poop out” more than a decade ago, and it seems that the same thing can happen with any antidepressant. For some type of medications (like narcotic pain medication or benzodiazepine anxiety medications) we understand the chemistry of tolerance. For those drugs, long term use causes brain cells to adapt so that the same amount of medication has less and less effect over time. That tolerance and dependence process is pretty similar from person to person. Developing a “tolerance” to antidepressant drugs is very unpredictable from person to person, and we haven’t found any chemical change that explains it.

But the more we study this problem, the better we understand that we don’t really understand it. 

For example, we used to believe that whenever one antidepressant medication seemed to stop working, it was best to try switching to a medication of a different chemical type or class. 

We now know that the chemical type of class isn’t a useful guide. If one medication stops working, it’d definitely worth trying a different one—but the odds of success seem about equal if the new medication is similar to or different from the one that’s no longer helping.

Even if we don’t have a lot of science to guide us, we can still come up with some practical advice. If your antidepressant medication doesn’t seem to be helping:

• Consider whether other substances (alcohol, street drugs, or changes in prescription medication) might be making depression worse.
• Ask whether the dose of the medication is at the most effective level.
• If it’s time to try something different, changing to a different medication or adding a second “booster” medication seem about equally likely to help.
• How you respond to one medication doesn’t really predict how you will respond to a different one (even a different medication from the same family).
• When trying a different medication, it’s important to be patient enough (sticking with it long enough to know if it will really help) but not too patient (sticking with it past the point of futility). Be sure to ask your doctor how and when you will assess whether any new treatment is right for you.

By. Greg Simon, MD, MPH, is a psychiatrist and researcher at Group Health Cooperative at the Center for Health Studies in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.

Changing your perception

Change Perception and the Experience Changes:

You can easily change your perception when you recognise the fact that you made it up in the first instance based on your beliefs and past experiences. In a relaxed state with your eyes closed, create a mental image in your mind of a negative experience you wish to neutralize. Neutrally observe yourself experiencing the specific event, how it started, how you felt, where it took place, why it was negative for you and how you reacted. As you continue to neutrally observe the scene unfolding through to its end, see how your beliefs about life and yourself made you perceive the experience as negative.

Have Fun with Your Mental Image:

Have fun with the scenes in your mind as you change your perceptions. Keep it light. Allow yourself to sense how differently you would have felt or reacted had your beliefs about yourself and life been different. For instance, had you had more self-love, self-esteem and self-confidence when an important relationship ended; or had you had no attachment to money and no fear of failure when your business was in trouble; how would your perception of that experience be different? When you change your perception so does the experience.

Whatever the negative belief you had at the time, see yourself believing its opposite. Sense how your experience changes from one of disempowerment to one of empowerment as your beliefs change. Feel how the experience doesn't matter as much anymore or how you even feel stronger for it. From this place of strength, take a deep breath and as you exhale release the experience, seeing the image gently float away. Enjoy the lightness you feel as you mentally count upwards and slowly open your eyes. Knowing what you know now, what would you do differently?

Mind your Reality

Helping someone with Depression

About Depression

What can you do to help?
For people affected by depression, discussing their condition with family and friends, and asking them for their help, can be very daunting. They may feel too scared, ashamed or overwhelmed to admit how they are feeling. Tackling depression may seem an impossible challenge. This is when the encouragement and support of a friend is vital to help them feel less isolated and more motivated to actively work on overcoming depression.


By being a supportive friend, you can encourage someone affected by depression to seek help, receive a correct diagnosis and agree on a treatment with their doctor. But how do you approach this subject with them? You may feel that you need some advice to take the first step. Here are some top tips to start the communication:

Talking about depression with your friend
Some of the symptoms of depression (low mood, irritability and fatigue) can make it difficult for someone affected by depression to maintain friendships. Often someone affected by depression may withdraw from social contacts and may not actively seek to address their problem with their friends. And as mental health conditions are still often associated with a stigma in society, both parties may feel uncomfortable addressing the issue. This is why you as a friend may have to take the first step.

If you suspect your friend may be affected by depression, then you should seek positive ways to show your support and reassure them that you will take them seriously and that you will be there for them to lean on.

You could do this by saying:
You are important to me
You're not alone in this and I'm here for you
You don't have to feel guilty or ashamed, this isn't your fault
I can't really understand what you are feeling, but I can offer my compassion and be a friend to you
I'm going to be there for you to lean on. I'm not going to leave you or abandon you
When all this is over, I'll still be here for you
I'm sorry that you're in so much pain. I am going to take care of myself, so you don't need to worry that your pain might hurt me. You're not alone and neither am I
I love you (if you mean it)
Also consider offering them a hug if you feel comfortable with this.

Try to avoid saying negative things such as:

• Pull yourself together.
• No one ever said that life was easy.
• Stop feeling sorry for yourself. Get a grip.
• So, you're depressed. Aren't you always?
• There's always someone worse off than you are.
• Just try not to be so depressed.
• It's your own fault.

Believe me, I know how you feel. I feel depressed sometimes too.
Once you have approached the subject with your friend, encourage them to visit their doctor (if they haven't done this yet), and ensure that they take any prescribed medication as directed and follow any other therapies recommended by their doctor. Besides the professional support your friend will need, there are also ways in which you as a friend can help them get better.


Some lifestyle changes can help people cope with depression. You can help by encouraging your friend to:
Go outside for some fresh air and sunlight every day – why not invite them for a walk or do some gardening if they don't feel like facing the world?

Take regular moderate exercise – you can suggest you do the exercise together. Encourage them to participate in the exercise by reminding them how good they usually feel afterwards.
Avoid being self-critical – you can help by recognising their accomplishments, however small, and making positive comments whenever possible, e.g. remind them that last week they had three good days and the week before they had two – they're getting better all the time.
Eat a healthy, balanced diet – suggest cooking together or invite your friend over for a meal.
Be aware that your friend may just need to rest – offer practical support like shopping and cleaning the house. Try to balance motivating them without asking them to do more than they are ready for. If your friend has stopped taking care of themselves you could try bringing round some nice soap or bubble bath. It will help them relax and improve their self-esteem.


You can also help them by:
Staying in touch on the phone and/or by e-mail.
Avoiding activities where too much alcohol is consumed as drinking can make symptoms worse.
Making time for activities that you can enjoy together.
Generally, you should motivate your friend to learn about depression and depression treatments. This will encourage them to follow their course of treatment as instructed by their doctor and seek help if something doesn't work for them. They will also see that recovery is possible. You may find it useful to learn about depression together as your friend's concentration and memory might be affected. Audio books are a great way to absorb information if your friend finds it difficult to concentrate on written information.


If your friend is talking about or has attempted suicide
Thoughts of suicide and death can be a major symptom of depression, and should be taken very seriously. If a friend expresses suicidal ideas, reassure them that their life is important to you and many other people and that the appropriate treatment will help them to get better. No matter how hard it may seem to look after someone with suicidal thoughts, it is important to show that you care.


If your friend has suicidal thoughts, talk to other professionals (e.g. GP, emergency services, social services) for advice on how you can help them to stay safe, and encourage your friend to access help and support too. Keeping contact details for support helplines close to hand is also important e.g. Aware loCall Helpline 1890 303 302; Samaritans 1850 60 90 90; 1Life 1800 24 7 100.

Mental Health Awareness Week

^{Mental Health Ireland celebrates World Mental Health Day with local events for the whole community to enjoy}

^{Plan to Protect Your Mental Health & Wellbeing} 

^{World Mental Health Day is celebrated worldwide on the 10th of October. It is an opportunity to bring awareness to mental health on an international, national and local scale, informing and educating people about mental health and to work towards ending the stigma and create a non-judgemental space for people struggling with their mental health to open up and talk. If you would like to plan an event during Mental Health Week please download our Toolkit Here!}

^{Mental Health Ireland’s vision is for an Ireland where mental health is valued as being an essential part of personal wellbeing and the health of the nation.  Rather than focusing on mental and emotional pain as something to be eradicated, we need to promote the message that it is normal and indeed natural to feel down at times, and that feeling vulnerable is an inherent part of being human.} 

^{Mental Health Ireland will launch their ‘Plan to Protect your Mental Wellbeing’ campaign this Mental Health Week. It encourages everyone to become aware of their wellbeing by following five simple steps. These include Connecting with others, being Active on a daily basis, Taking Notice of what’s happening around you, to Keep Learning and to Give back to your community, friends or family. By monitoring our activities and actions in these areas of our daily lives we can see which areas we are doing well in and others we may need to concentrate on.} 

^{Mental Health Ireland have 103 Mental Health Associations in communities all over Ireland. Each Association has developed a number of activities and events to celebrate World Mental Health Week between the 5th-12th October. Some of these activities include:}

^{National Choral Singing Week in association with Mental Health Ireland. 
Laois Connects in association with Mental Health Ireland – full week of events can be found in this link 
Limerick Mental Health Association awareness week are compiling their events and information can be found on their facebook page
Mensana Fest with Carlow Mental Health Association will be revealing their events on their facebook page 
The Longford Mental Health Association are hosting a musical evening in the Longford Arms Hotel on the 9th October} 

^{More information and events will be uploaded so please keep an eye on this page for events taking place in your locality and please support Mental Health Ireland. If you would like to organise your own event please see this link for our World Mental Health Week Toolkit}  

^{Text MHI to 50300 to donate €4 to Mental Health Ireland}

^{100% of text goes to MHI across most network providers. Some providers apply vat which means that a minimum of €3.26 will go to MHI. Service provider: likecharity. Helpline 01 4433890}

Anxiety and relaxation techniques

Everyone gets anxious from time to time: there's public speaking, job interviews, the dentist and all the rest. For about one in six of us this will cross over into what psychologists term a disorder at some point in our lives. This is when people are almost continuously anxious and find it difficult to concentrate, have trouble sleeping and become irritable and restless. Women are roughly twice as likely as men to suffer from an anxiety disorder.

For the rest of us anxiety will come and go as part of the normal human condition. Whether it's a constant or occasional affliction, dealing with anxiety effectively is important. People are often prescribed drugs for anxiety but these are less effective in the long-term and have side-effects so relaxation training is often preferred. Relaxation training comes in a variety of flavours, but the five methods which have much in common and the most evidence to support them are (Manzoni et al., 2005):

1. Progressive relaxation The most commonly studied type of relaxation therapy may be familiar to you. It involves mentally going around the muscle groups in your body, first tensing then relaxing each one. It's as simple as that. And with practice it becomes easier to spot when you are becoming anxious and muscles are becoming tense as, oddly, people often don't notice the first physical signs of anxiety. This is based on the idea that the mind follows body. When you relax your body, the mind also clears.

2. Applied relaxation Applied relaxation builds on progressive relaxation. First you learn to relax you muscle groups one after the other. The next stage is to cut out the tensing phase and move straight to relaxing each muscle. Next you learn to associate a certain cue, say thinking 'serenity now!' (hello Seinfeld fans!) with a relaxed state. You then learn to relax really quickly. Finally you practise your relaxation technique in real-world anxiety-provoking situations. Once again, mostly this is about mind following the body.

3. Autogenic training Goes back to the 1930s and is another technique for progressively relaxing the muscles. To help you do this it has a mantra which you repeat to yourself as you go around major muscle groups: "my right arm is very heavy" and so on. A second stage involves inducing a feeling of warmth in the muscles. Once they feel 'heavy' from the first stage, you follow another mantra about warmth: "my right arm is very warm" and so on.

Further stages involve calming the heart and the abdomen and cooling the brow in much the same way. Once again, you'll notice that this is all about the mind following a calm body. As before practitioners recommend daily practice so that you can relax more and more quickly. With practice the simple intention to start the training will be enough to cause the body to become relaxed and warm.

4. Meditation Here's our old friend meditation which has so many different benefits.
If you've been reading PsyBlog for a while you'll have seen this come up in numerous contexts. There is certainly evidence that it can work for people who experience anxiety as well. I describe the basics of mindfulness meditation in this article about attention and meditation. Be aware that meditation is quite difficult and the drop-out rates are high from studies which investigate it (Krisanaprakornkit et al., 2006). This suggests some people don't find it particularly acceptable. For people who can manage it, though, the results are often better than the other techniques (Manzoni et al., 2005). Notice that this technique is much more actively related to the mind than the first three methods. It doesn't just target the body and wait for the mind to follow, instead it's about the way attention is focused. This may be partly why people find it harder. Still, it probably won't do any harm to try.

5. Cognitive behaviour therapy
Finally cognitive behaviour therapy, or CBT, targets both mind and body. As it's primarily a talking therapy you normally have to go to a psychologist who will help you target unhelpful thinking patterns. But there are books available that explain how it works (I mention a few here:

6 Self-Help Books for Depression Recommended by Experts). However these don't specifically target anxiety, they're mostly for mild depression. All together now And there's no reason why you should stick to only one approach. When Manzoni et al. looked at studies which used multi-modal techniques, they found these were effective as well.

If you need to relax—for whatever reason and at whatever time—then try one or more of these different methods. As you'll have noticed the effective techniques share a lot in common. Regular practice is the key and, if you give it a chance, the mind really will follow the body.

Seven Signs That You Need to See a Mental Health Professional

Seven Signs That You Need to See a Mental Health Professional

By LAURA L. SMITH, PH.D.

Everyone has bad days. And many have bad weeks. But when feeling depressed, stressed, or anxious stretches out over a period of several weeks and begins to interfere with daily life, then mental health professionals may need to be involved. Here are some signs that you or someone you care about need evaluation and possibly treatment:

1. Suicidal thoughts or plans. If you start thinking that life is not worth living, help is available. You can call your national suicide hotline (see important links thread) or a local mental health center. If you are aware of someone else who has thoughts of suicide, the hotline can advise you of what action you should take.

2. Feeling defeated and hopeless. Life can be tough. But if you feel that there is nothing to look forward to and hopeless, a mental health professional may be able to help you see other possibilities.

3. Unable to work or play because of overwhelming emotional distress. Again, bad times and bad things happen and when they do, people need time to grieve or regroup. But if you seem unable to adjust or adapt, a mental health professional may be able to give you a different perspective.

4. Changes in sleep. Everyone has occasional problems with sleep. But if you experience a significant change in your patterns, check it out with your medical provider who may refer you to a therapist experienced with sleep disorders (be sure to ask).

5. Changes in appetite. Again, first check with your medical provider. But many times, experienced mental health professionals work with clients who have problems with eating.

6. Changes in mood that last for longer than a few weeks. If you struggle with feelings of sadness, anger, or anxiety, help is available. You might first check with your physician to rule out physical reasons, then ask for a referral to a qualified mental health provider.

7. Lack of interest and withdrawal. If you find yourself losing interest in activities that were once pleasurable or withdrawing because of fears or worries, you may benefit from professional help. One final

tip: Not all mental health professionals have expertise in all types of problems. Therefore, be sure to state the nature of your problem as specifically and clearly as you can when you call. Ask if your problem is something the therapist works with regularly. Good luck and take care!

Acute Stress Disorder

The symptoms of PTSD may in fact be more appropriately called Accute Stress Disorder.

This diagnosis was brought around due to the amounts of people suffering many of the symptoms of PTSD but possibly not having met all of the criteria for such a diagnosis. As with all issues you're not alone

Acute Stress Disorder SYMPTOMS Acute Stress Disorder is characterized by the development of severe anxiety, dissociative, and other symptoms that occurs within one month after exposure to an extreme traumatic stressor (e.g., witnessing a death or serious accident).

As a response to the traumatic event, the individual develops dissociative symptoms. Individuals with Acute Stress Disorder have a decrease in emotional responsiveness, often finding it difficult or impossible to experience pleasure in previously enjoyable activities, and frequently feel guilty about pursuing usual life tasks.

A person with Acute Stress Disorder may experience difficulty concentrating, feel detached from their bodies, experience the world as unreal or dreamlike, or have increasing difficulty recalling specific details of the traumatic event (dissociative amnesia).

In addition, at least one symptom from each of the symptom clusters required for Posttraumatic Stress Disorder is present. First, the traumatic event is persistently reexperienced (e.g., recurrent recollections, images, thoughts, dreams, illusions, flashback episodes, a sense of reliving the event, or distress on exposure to reminders of the event). Second, reminders of the trauma (e.g., places, people, activities) are avoided.

Finally, hyperarousal in response to stimuli reminiscent of the trauma is present (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, an exaggerated startle response, and motor restlessness).

Specific Symptoms of Acute Stress Disorder:

Acute stress disorder is most often diagnosed when an individual has been exposed to a traumatic event in which both of the following were present:

The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others

The person's response involved intense fear, helplessness, or horror Either while experiencing or after experiencing the distressing event, the individual has 3 or more of the following dissociative symptoms:

A subjective sense of numbing, detachment, or absence of emotional responsiveness A reduction in awareness of his or her surroundings (e.g., "being in a daze") Derealization Depersonalization Dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

The traumatic event is persistently re-experienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.

Acute stress disorder is also characterized by significant avoidance of stimuli that arouse recollections of the trauma (e.g., avoiding thoughts, feelings, conversations, activities, places, people).

The person experiencing acute stress disorder also has significant symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).

For acute stress disorder to be diagnosed, the problems noted above must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.

The disturbance in an acute stress disorder must last for a minimum of 2 days and a maximum of 4 weeks, and must occur within 4 weeks of the traumatic event. Symptoms also can not be the result of substance use or abuse (e.g., alcohol, drugs, medications), caused by or an exacerbation of a general or preexisting medical condition, and can not be better explained by a a Brief Psychotic Disorder.

Criteria summarized from: American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

Stress and Stomach Problems

Posted by a member of our Voluntary Emergency Services:

It may not be known to you, but your recent stomach ache may be because you are under a lot of stress. Butterflies in your stomach may not be just a figure of speech any more. If you have been under a lot of stress, chances are that you might also suffer from some stomach problems caused by stress.

But one can't help asking the question: How does stress cause stomach problems?

Stress Stomach Problems

The various stomach problems caused due to stress are given below. Irritable Bowel Syndrome (IBS) One of the most common stomach problems caused by stress is the irritable bowel syndrome. Irritable bowel syndrome is an umbrella condition which comprises a variety of illnesses under its purview. Scientists say that when a person is stressed, the brain is programmed to release some hormones and chemicals. When these hormones enter the digestive tract of a person, they cause trouble. Irritable bowel syndrome maybe characterized by either an increase or decrease in the contractions of the intestines.

In case there is an increase in the contractions of the intestine, you might suffer from diarrhea or cramping. On the other hand, if there is a decrease in the contractions of the intestines, it may lead to constipation. The increase or decrease in the motility of the intestines affect the digestive system causing stomach trouble. Thus we see that IBS may cause an increase in the speed of passage of waste matter along the intestines or a decrease in the speed of passage of waste matter.

Read on to know more about symptoms and treatment of irritable bowel syndrome and irritable bowel syndrome medication.

Nervous Stomach
Normally when diagnostic tests fail to identify a particular cause for a stomach related illness, the condition is known as a nervous stomach. When there is no plausible cause for a stomach-related illness, it is generally assumed that the cause for it is a nervous stomach. Nervous stomach is the source of stomach problems from stress. A nervous stomach, like irritable bowel syndrome, is caused due to stress. It may be caused because the brain releases a lot more acids into the stomach when you are stressed.

A nervous stomach may be the cause of any stomach-related illnesses such as abdominal fullness, bloating, belching and flatulence, acid reflux, nausea and heartburn. More on stomach pain and bloating. Read on for more about: Nervous Stomach Ache Nervous Stomach in Children Other Stomach Problems Due to Stress

Along with irritable bowel syndrome and nervous stomach, there may also be a number of other stomach-related illnesses that are caused due to anxiety. One of the most common conditions caused due to stress include stomach ulcers.

Stomach ulcers are inflammation of the stomach due to excessive release of hydrochloric acid in the body. While hydrochloric acid is otherwise present in the body in very small amounts, even the slightest increase can cause trouble.

It is said that although inflammatory bowel disease (IBD) is not directly caused by stress, a preexisting case of IBD may be worsened due to stress.

How to Prevent Stomach Problems Caused by Stress
If your stomach problems are indeed caused by stress, I guess the most logical thing to do would be to reduce stress. So how does one reduce stress? Stress can be effectively managed in several ways. The most common way is to participate in some de-stressing activities which will make you feel less stressed. Find some hobbies which will help you reduce stress.

Other things you can do is to get corrective cognitive therapy that will help you deal with the stress better. You should also learn to prioritize your responsibilities and take up only so much work that you can handle. If nothing worse, try to get counseling, which will surely help you deal with your problems better. Read on for stress relief activities and stress relief techniques.

So now you know about the stomach problems caused by stress and how to cure them. After reading this article you probably know that there may be something else causing your stomach upset rather than a bit of extra pizza!

Antidepressants

The issue of Depression/Depressive Symptoms is debated often, the treatment for such disorders with medication is also hotly debated. This article gives a very general insight into the subject of Antidepressants. It seems to be acknowledged that Medication should also include a talking therapy in order to be more effective.

The Drugs industry drives a lot of research and so it could be considered biased. All medications should be approved by a Clinical Professional and Monitored often, medication is not a long term solution IMO and therefore a lot of consideration should be given when deciding to go this route.
Antidepressants

What You Need to know About Depression Medication
If you’re suffering from major depression, antidepressant medication, used under the guidance of a mental health professional, may relieve some of your symptoms. But antidepressants aren’t a silver bullet for depression. Medication doesn’t cure the underlying problem and is rarely a long-term solution. Not only do antidepressants come with significant side effects and dangers, but recent studies have also raised questions about their effectiveness.

Learning the facts about antidepressants and weighing the benefits against the risks can help you make an informed and personal decision about whether medication is right for you.

Is depression caused by a chemical imbalance in the brain?
This information is not intended to be a substitute for medical advice. If you are taking an antidepressant, do not change your dosage without consulting your physician!
You’ve seen it in television ads, read it in newspaper articles, maybe even heard it from your doctor: depression is caused by a chemical imbalance in the brain that medication can correct. According to the chemical imbalance theory, low levels of the brain chemical serotonin lead to depression and depression medication works by bringing serotonin levels back to normal. However, the truth is that researchers know very little about how antidepressants work. There is no test that can measure the amount of serotonin in the living brain—no way to even know what a low or normal level of serotonin is, let alone show that depression medication fixes these levels.
While antidepressant drugs such as Prozac increase serotonin levels in the brain, this doesn’t mean that depression is caused by a serotonin shortage. After all, aspirin may cure a headache, but it doesn’t mean that headaches are caused by an aspirin deficiency. Furthermore, many studies contradict the chemical imbalance theory of depression. Experiments have shown that lowering people’s serotonin levels doesn’t always lower mood, nor does it worsen symptoms in people who are already depressed. And while antidepressants raise serotonin levels within hours, it takes weeks before medication is able to relieve depression. If low serotonin caused depression, there wouldn’t be this antidepressant medication lag.

When it comes to depression, serotonin doesn’t tell the whole story

Experts agree that depression involves much more than just “bad” brain chemistry. Serotonin is just one of many factors that may play a role in the disorder. New research points to other biological contributors to depression, including inflammation, elevated stress hormones, immune system suppression, abnormal activity in certain parts of the brain, nutritional deficiencies, and shrinking brain cells. And these are just the biological causes of depression. Social and psychological factors—such as loneliness, lack of exercise, poor diet, and low self-esteem—also play an enormous role in depression.

How effective are antidepressants?

Researchers agree that when depression is severe, medication can be helpful—even life–saving. However, research shows that antidepressants fall short for many people. A major government study released in 2006 showed that fewer than 50 percent of people become symptom-free on antidepressants, even after trying two different medications. Furthermore, many who do respond to medication slip back into major depression within a short while, despite sticking with drug treatment.

Other studies show that the benefits of depression medication have been exaggerated, with some researchers concluding that, when it comes to mild to moderate depression, antidepressants are only slightly more effective than placebos.

If you have severe depression that’s interfering with your ability to function, medication may be right for you. However, many people use antidepressants when therapy, exercise, or self-help strategies would work just as well or better—minus the side effects. Therapy can also help you get to the bottom of your underlying issues and develop the tools to beat depression for good.

Side effects of antidepressant medication

There are many different types of drugs used in the treatment of depression, including selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Side effects are common in all antidepressants. For many people, the side effects are serious enough to make them stop taking the medication.

Side effects of SSRIs (selective serotonin reuptake inhibitors)

The most widely prescribed antidepressants come from a class of medications known as selective serotonin reuptake inhibitors (SSRIs).

Common side effects of SSRI antidepressants:
Nausea

Insomnia

Anxiety

Restlessness

Decreased sex drive

Dizziness

Weight gain or loss

Tremors

Sweating

Sleepiness

Fatigue

Dry mouth

Diarrhea

Constipation

Headaches

The SSRIs include:

Fluoxetine (Prozac)

Fluvoxamine (Luvox)

Sertraline (Zoloft)

Paroxetine (Paxil)

Escitalopram (Lexapro)

Citalopram (Celexa)

The SSRIs act on a chemical in the brain called serotonin. Serotonin helps regulate mood, but it also plays a role in digestion, pain, sleep, mental clarity, and other bodily functions. As a result, the SSRI antidepressants cause a wide range of side effects.

Common side effects include sexual problems, drowsiness, sleep difficulties, and nausea. While some side effects go away after the first few weeks of drug treatment, others persist and may even get worse.

In adults over the age of 65, SSRIs pose an additional concern. Studies show that SSRI medications may increase the risk for falls, fractures, and bone loss in older adults. The SSRIs can also cause serious withdrawal symptoms if you stop taking them abruptly.

Other antidepressant drug risk factors

Anyone who takes antidepressants can experience unpleasant or dangerous side effects. But certain individuals are at a higher risk:

People over 65. Studies show that SSRI medications may increase the risk for falls, fractures, and bone loss in older adults.

Pregnant women. The use of SSRI's late in pregnancy may lead to short-term withdrawal symptoms in newborns after delivery. Typical symptoms include tremor, restlessness, mild respiratory problems, and weak cry.

Teens and adolescents. The U.S. Food and Drug Administration requires that all depression medications include a warning label about the increased risk of suicide in children and young adults.

Antidepressants and suicide risk

There is a danger that, in some people, antidepressant treatment will cause an increase, rather than a decrease, in depression and with it, an increased risk of suicide. While this is particularly true of children and young adults on antidepressant medication, anyone taking antidepressants should be closely watched for suicidal thoughts and behaviors. The suicide risk is particularly great during the first month to two months of antidepressant treatment.

Monitoring is especially important if this is the person’s first time on depression medication or if the dose has recently been changed. Signs that medication is making things worse include anxiety, insomnia, hostility, and extreme agitation—particularly if the symptoms appear suddenly or rapidly deteriorate. If you spot the warning signs in yourself or a loved one, contact your doctor or therapist immediately.

Antidepressant warning signs

Suicidal thoughts or attempts

New or worse depression

New or worse anxiety

New or worse irritability

Feeling agitated or restless

Difficulty sleeping

Aggression and anger

Acting on dangerous impulses

Extreme hyperactivity

Other unusual changes in behavior

If you are concerned that a friend or family member is contemplating suicide, see Understanding and Helping a Suicidal Person.

Side effects of atypical antidepressants

There are a variety of newer depression drugs, called atypical antidepressants, which target other neurotransmitters either alone or in addition to serotonin. Some of the brain chemicals they affect include norepinephrine and dopamine.

The side effects vary according to the specific drug. However, many of the atypical antidepressants can cause nausea, fatigue, weight gain, sleepiness, nervousness, dry mouth, and blurred vision.

The atypical antidepressants include:

Bupropion (Wellbutrin)

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Mirtazapine (Remeron)

Trazodone (Desyrel)

Nefazodone (Serzone)

Side effects of older depression drugs

Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are older classes of antidepressants. Their side effects are more severe than those of the newer antidepressants, so they are only prescribed as a last resort after other treatments and medications have failed.

Antidepressant withdrawal

Once you’ve started taking antidepressants, stopping can be tough; many people have withdrawal symptoms that make it difficult to get off of the medication.

If you decide to stop taking antidepressants, it’s essential to consult a doctor and taper off slowly. If you stop abruptly, you may experience a number of unpleasant withdrawal symptoms such as crying spells, extreme restlessness, dizziness, fatigue, and aches and pains. These withdrawal symptoms are known as “antidepressant discontinuation syndrome." Antidepressant discontinuation syndrome is especially common when you stop taking Paxil or Zoloft. However, all medications for depression can cause withdrawal symptoms.

Antidepressant withdrawal symptoms

Anxiety, agitation

Depression, mood swings

Flu-like symptoms

Irritability and aggression

Insomnia, nightmares

Nausea and vomiting

Dizziness, loss of coordination

Stomach cramping and pain

Electric shock sensations

Tremor, muscle spasms

Depression and anxiety are also common symptoms when withdrawing from antidepressants. When depression is a withdrawal symptom, it’s often worse than the original depression that led to drug treatment in the first place. Unfortunately, many people mistake this withdrawal symptom for a return of their depressive illness and resume medication, creating a vicious circle.

In order to avoid antidepressant withdrawal symptoms, never stop your medication “cold turkey.” Instead, gradually taper your dose, allowing for at least 1-2 weeks between each dosage reduction. This tapering process may take up to several months, and should only be attempted under a doctor's supervision.

Exploring your depression treatment options

Antidepressants aren’t a cure. Medication may treat some symptoms of depression, but can’t change underlying contributions to depression in your life. Antidepressants won’t solve your problems if you’re depressed because of a dead-end job, a pessimistic outlook, or an unhealthy relationship. That’s where therapy and other lifestyle changes come in.

Studies show that therapy works just as well as antidepressants in treating depression, and it’s better at preventing relapse once treatment ends. While depression medication only helps as long as you’re taking it, the emotional insights and coping skills acquired during therapy can have a more lasting effect on depression. However, if your depression is so severe that you don't have the energy to pursue treatment, a brief trial of antidepressants may boost your mood to a level where you can focus on therapy.

In addition to therapy, other effective treatments for depression include exercise, meditation, relaxation techniques, stress management, support groups, and self-help steps. While these treatments require more time and effort initially, their advantage over depression medication is that they boost mood without any adverse effects

Self-help for depression

Depression recovery begins with positive daily lifestyle choices. If you cultivate supportive relationships, challenge negative thoughts, and nurture your physical health, you can help yourself, slowly but surely, overcome your depression.

Read Self-help for depression

Other depression treatment options

It sometimes takes time to find the depression treatment that’s right for you. Don’t be fooled into thinking that antidepressants are the best choice, just because they're sometimes the easiest choice. Alternate treatment options include:

Psychotherapy. Therapy has proven to be extremely effective in the long-term treatment of depression. It can also provide you with the tools to help prevent depression from coming back. There are many types of therapy available. For help finding the right therapist see: Psychotherapy and Counseling

Acupuncture. Acupuncture, the technique of using fine needles on specific points on the body, is increasingly being investigated as a treatment for depression, with some research studies showing promising results. If you decide to try acupuncture, make sure that you find a licensed qualified professional.

Light therapy. Not all people with depression have a seasonal worsening of mood, but those who do may benefit from light therapy. Exposure to bright light from a light therapy box causes biochemical changes in the brain that can help control symptoms of seasonal affective disorder (SAD) and certain kinds of depression. As with any treatment, always consult a mental health professional before using.

Deciding if depression medication is right for you

Self-prescription risk

Self-prescribing antidepressant medication is extremely dangerous. It can even be fatal. At the very least you should consult a primary care doctor. Unfortunately, studies have shown that many primary care physicians lack the specialist training necessary to provide the highest quality mental health care. Therefore, the best case scenario is to confer with a psychiatrist or other mental health professional before taking antidepressants.

Source: American Psychosomatic Society

If you’re considering antidepressants as a treatment option, make sure you carefully consider all of your treatment options. The following questions may help you make your decision.

Questions to ask yourself and a mental health professional

Is my depression severe enough to justify drug treatment?

Is medication the best option for treating my depression?

Am I willing to tolerate unwanted side effects?

What non-drug treatments might help my depression?

Do I have the time and motivation to pursue other treatments such as therapy and exercise?

What self-help strategies might reduce my depression?

If I decide to take medication, should I pursue therapy as well?

Questions to ask your doctor


How much mental health care training have you had?


Are there any medical conditions that could be causing my depression?

What are the side effects and risks of the antidepressant you are recommending?

Are there any foods or other substances I will need to avoid?

How will this drug interact with other prescriptions I’m taking?

How long will I have to take this medication?

Will withdrawing from the drug be difficult?

Will my depression return when I stop taking medication?

Guidelines for taking antidepressants

If you decide to take depression medication, it’s prudent to learn all you can about your prescription. The more you know about your antidepressant, the better equipped you’ll be to deal with side effects, avoid dangerous drug interactions, and minimize other safety concerns.

Some suggestions:

See a psychiatrist, not a family physician. Your family physician might help you or your loved one first realize that you may need depression treatment. But although any medical doctor can prescribe medications, psychiatrists are doctors who specialize in mental health treatment. They are more likely to be familiar with the newest research on antidepressants and any safety concerns. Your health depends on your doctor's expertise, so it's important to choose the physician who is best qualified.

Be patient. Finding the right drug and dosage is a trial and error process. It takes approximately 4 to 6 weeks for antidepressant medications to reach their full therapeutic effect. Many people try several medications before finding one that helps.

Monitor side effects – Keep track of any physical and emotional changes you’re experiencing and talk to your doctor about them. Contact your doctor or therapist immediately if your depression gets worse or you experience an increase in suicidal thoughts.

Don’t stop medication without talking to your doctor – Be sure to take your antidepressant according to the doctor's instructions. Don't skip or alter your dose, and don't stop taking your pills as soon as you begin to feel better. Stopping treatment prematurely is associated with high relapse rates. It can also cause serious withdrawal symptoms.

Go to therapy – Medication can reduce the symptoms of depression, but it doesn’t treat the underlying problem. Psychotherapy can help you get to the root of your depression, change negative thinking patterns, and learn new ways of coping.

Tips On Managing Stress.

Stress is a part of life, a normal response to demands either emotional, intellectual, or physical. It can be positive if it keeps us alert, motivated, and ready to avoid danger. It can be negative if it becomes chronic, increasing the risk of diseases like depression, heart disease and a variety of other problems. 

Managing stress is key to your health. And it isn't so very difficult to do. How Does Stress Affect Health? The body's autonomic nervous system has a built-in stress response that causes physiological changes to allow the body to combat stressful situations. This stress response, also known as the "fight or flight response," is activated in case of an emergency.

However, this response can become chronically activated during prolonged periods of stress, which can cause wear and tear on the body -- both physical and emotional. Stress that continues without relief can lead to a condition called distress -- a negative stress reaction.

Distress can disturb the body's internal balance or equilibrium, leading to physical symptoms such as headaches, an upset stomach, elevated blood pressure, chest pain, sexual dysfunction, and problems sleeping.

Emotional problems can also result from distress. These problems include depression, panic attacks, or other forms of anxiety and worry. Research suggests that stress also can bring on or worsen certain symptoms or diseases. Stress is linked to six of the leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide. Stress also becomes harmful when people engage in the compulsive use of substances or behaviors to try to relieve their stress.

These substances or behaviors may include food, alcohol, tobacco, drugs, gambling, sex, shopping, and the Internet. Rather than relieving the stress and returning the body to a relaxed state, these substances and compulsive behaviors tend to keep the body in a stressed state causing more problems. The distressed person becomes trapped in a vicious circle. What Are the Warning Signs of Stress?

Chronic stress can wear down the body's natural defenses, leading to a variety of physical symptoms, including: Dizziness or a general feeling of "being out of it" General aches and pains Grinding teeth, clenched jaw Headaches Indigestion or acid reflux symptoms Increase in or loss of appetite Muscle tension in neck, face or shoulders Problems sleeping Racing heart Cold and sweaty palms Tiredness, exhaustion Trembling/shaking Weight gain or loss Upset stomach, diarrhea Sexual difficulties Irritability, impatience, forgetfulness  

Tips for Reducing Stress

People can learn to manage stress and lead happier, healthier lives. Here are some tips to help you keep stress at bay:

Keep a positive attitude. Accept that there are events that you cannot control. Be assertive instead of aggressive.

Assert your feelings, opinions, or beliefs instead of becoming angry, defensive, or passive.

Learn and practice relaxation techniques; try meditation, yoga, or tai-chi. Exercise regularly. Your body can fight stress better when it is fit. Eat healthy, well-balanced meals.

Learn to manage your time more effectively. Set limits appropriately and say no to requests that would create excessive stress in your life. Make time for hobbies and interests.

Get enough rest and sleep. Your body needs time to recover from stressful events.

Don't rely on alcohol, drugs, or food to reduce stress. Ease up on caffeine, too. Seek out social support.

Spend enough time with those you love.

Seek treatment with a psychologist or other mental health professional trained in stress management or biofeedback techniques to learn more healthy ways of dealing with the stress in your life

9 Steps to Managing Depression

9 STEPS TO MANAGING YOUR ILLNESS

1. TAKE CHARGE OF YOUR LIFE.
Manage your illness; adopt and maintain a positive belief system; allow time for love, wonderment and serenity; don't do it alone; and forgive yourself for past mistakes. Steps 2 through 9 which follow provide the basis for Managing Your Illness. Put as many of these positive steps as possible to work for you each day. New Directions' four+ meetings per month will help to focus on the skills that you require to take charge of your life.

Develop a Positive Mental Attitude (PMA) and use it to attain success. Believe strongly in your ability to achieve and sustain a functional, productive, and happy life and use the resources and experience of New Directions and other support group members to aid you in this objective.

Don't fight the enemy -- depression or mania -- alone. It is cunning, recurrent and exhausting.Provide time each day for fun, relaxation, mindfulness and love. Remember that depression thrives on your stress, aloneness and despair. Expect miracles each day and allow time to wonder at the world's beauty and diversity.

2. FIND A GOOD PSYCHIATRIST.
Find the very best psychiatrist you can to work with you. Don't settle for anyone less. Your choice of psychiatrist is one of the most important decisions you will make in the management of your illness.Choose someone you intuitively like and feel comfortable with, someone who treats you with respect and is comfortable answering your questions.Your psychiatrist should be an expert in prescribing medication. He or she should be up to date on the latest medications and latest medical developments. In addition, he should schedule you for necessary blood work if you're on medications such as Lithium or Tegretol.

Today it's quite common for some psychiatrists to specialize in medication only, while others do both traditional "talk therapy" plus medication. Many people see two kinds of mental health professionals: a psychiatrist who dispenses medication and a psychotherapist for "talk therapy. " (More about talk therapy in Step No. 6).It's important to have that good psychiatrist NOW, while you're well, instead of waiting until you're in the midst of a crisis. Check with group members or your family doctor for a referral. Referrals are preferable to picking out someone at random from the phone book.

3. TAKE THE RIGHT MEDICATION.
Once you've found a doctor to put your trust in, the two of you can work on getting just the right medication(s) -- if necessary -- to keep you healthy. Sometimes it takes patience and diligent trial and error effort to hit upon the right combination of drugs for you. Remember that the medical arsenal has greatly expanded over the years and chances are extremely good that you can be helped.Take an active part in learning about your medication. Ask questions: What exactly is the medication supposed to do? What category does it fall under? Antidepressant? Antianxiety? Antipsychotic? How soon will it work? What side effects might you expect? How long should you stay on a medication before you and your doctor conclude it doesn't help you? Are there other meds you can try instead?While the doctor is the undisputed expert, it's in your very best interests to be an informed consumer. (See New Directions "Guide to the Most Commonly Used Psychiatric Drugs.")

4. EDUCATE YOURSELF ABOUT YOUR ILLNESS.
Most illnesses have a frightening ring to them. Shed light on the facts about depression and manic depression. Don't rely on hearsay reports, much of which contain half truths or distorted myths. Find out the truth. The more you know about your illness, the less intimidated and the more in charge you will feel.Knowledge is power. Many feelings of helplessness are reduced as people take bold steps to gain knowledge and learn the "good news" -- that highly effective treatments are available, that medical progress has been made in the past years and continues to be made, and the fact that so many people share your illness and you are not alone.

Information on mood disorders is available from numerous sources: the public library, bookstores, group members, your psychiatrist, psychotherapist, videos, lectures at local hospitals and New Direction's library. New Directions has established a psychoeducation program providing professionals to speak to our members on topics pertinent to diagnosis and treatment of the illness.

5. LEARN TO PREVENT EPISODES.
Both depression and mania can often be caught in their earliest stages and, with appropriate treatment, brought under early control.Learn what your early warning signals are. Then take action to combat them. Call your doctor when your earliest symptoms appear. You and he can then plan a strategy which hopefully can nip the illness in the bud. This can range from using medication ... to having therapy sessions ... to making changes in your personal life that may cause you distress.The ability to take action when we feel an episode coming on puts us in a powerful position to prevent a full-blown episode. (See "Catching a Manic Episode Before it Gets Started/How to Stop a Hypomanic Episode.")

6. GET "TALK THERAPY" IF NEEDED. In addition to medication, many people benefit greatly from one-on-one therapy.While medication is invaluable in alleviating symptoms of depression or mania or in stabilizing the mood, some people are still left with a residue of unresolved personal issues that may interfere with living well. These issues may include relationships with others, job success, personal growth and fulfillment, negative thinking, etc.One especially common problem is the lack of self-esteem people feel after having been diagnosed with a mood disorder -- or after suffering a major episode of the illness.In this and other cases, therapy with a skilled psychotherapist can prove of tremendous value. In therapy, we gain an understanding into our inner selves: our strengths, our conflicts, our patterns of behavior. Through this understanding comes the ability to change and to grow.

7. GET INVOLVED WITH WORK OR OTHER MEANINGFUL ACTIVITIES.
Staying healthy begins with having something meaningful to do each day. People who work at jobs they enjoy feel productive, needed and important. They feel a sense of belonging, a part of society. The pride they feel in their jobs is reflected in their self-esteem and self-confidence.

Work comes in many varieties. Some people find satisfaction in a relatively low-stress job, while others enjoy the challenge of having lots of responsibility. What matters is that your job fits your emotional needs -- which may change from time to time -- and that your job bring you that vital sense of satisfaction.Not everyone is able to work. Fortunately there are several options to keep people stimulated and to take them out of their homes. Volunteer work offers a cornucopia of opportunities in almost every field imaginable. Volunteer work can be a prelude to entering the work force or it can be a valuable end in itself.Another option is the "Day Program", also called "Partial Hospitalization program". Like volunteer work, it may be temporary or on a more permanent basis. Day programs offer structured days of activities, therapy groups and fellowship with others.But no matter what you choose to do each day, staying healthy means leaving home, getting out into the world and making a contribution.

8. JOIN A SUPPORT GROUP.
Support groups are unique. They offer an all-important sense of validation, a feeling that, "Hey, I'm not the only person with this condition, I'm in good company."Groups offer role modeling, practical information on how to cope, education on the illness and medication, doctor referrals, friendship and camaraderie, and a safe place to unburden yourself about things you may not be able to share anywhere else.

9. REACH OUT. There is a magic in being able to help someone else. Put your unique experiences to work. You are in a privileged position to help out others who share your same illness ... to lend an understanding ear or to offer a message of hope.No one can understand like someone who's been through it. Your experiences can make a difference in someone else's life.

Anxiety Treatment Strategies

When anxiety or stress threatens to throw you off kilter, it's time to come to your own emotional rescue.

Step 1:
Accept that stress and anxiety are a natural part of life. If you give yourself permission to experience and accept uncomfortable feelings, you'll be able to tolerate them better, explains Washington, D.C.-based psychotherapist Jerilyn Ross, M.A., president and CEO of the Anxiety Disorders Association of America and author of One Less Thing to Worry About: Uncommon Wisdom for Coping With Common Anxieties.

Step 2:
Consider what's really bothering you. When you begin to feel tense or anxious, take a deep breath and ask yourself, "What am I really anxious about?" That's when a journal can really come in handy. "To help you see patterns between your thoughts, your activities and your anxiety, it can help to write down what's making you anxious in a diary," Ross says.

Step 3:
Seize control over what you can. Consider what actions you can take to ease your anxiety level. "If you constantly worry about being late to work, get up 15 minutes earlier so you're not rushing so much in the morning," Ross suggests. "Focus on what you can do, rather than on what you can't do."

Step 4:
Change your negative thoughts. If you catch yourself thinking, "I can't meet this deadline," Ross recommends removing the "T" and restating the thought more positively: "I can meet this deadline. I just need to organize my time." This makes the task ahead of you seem possible and less daunting.

Step 5:
Be present-minded. "Stay rooted in the here and now," says Ross, "and focus on the information you have rather than on the 'What-ifs?' that often accompany anxiety." If you have trouble stopping the "What-if" habit, pinch yourself and say "Stop!" or visualize a stop sign, then consciously turn your attention in a more constructive direction.

These strategies may not solve all your problems, but they can help you change the way you interact with anxiety, worry and stress-and they can be remarkably effective at helping to