What You Need To Know - Antidepressants And Herbs In The Treatment Of Depression

People Use The Consultation Depression Loosely To Rapacious A Number Of Different Moods.
I exalt to use the word " clinical depression " to distinguish the type of depression that may improve with medication. Clinical depression is more than the " blues " or tribulation. It is not something a person can " rightful get over " or chatter themselves out of. Clinical depression is at primeval partially based on brain biochemical imbalance ( we are still in early stages of understanding this ) and often runs in families. Stress and psychological factors also play an important role, although we do not fully interpret the causes and factors that proceeds in clinical depression.
Common Symptoms Of Depression Work in:
ท sad or irritable spirit
ท loss of sympathy / energy
ท poor or excessive sleep and appetite
ท difficulty with concentration and memory
ท physical complaints
Types Of Depression:
There are four types of depression listed in the current Diagnostic and Statistical Handbook ( DSM 4 TR ). The intent of this manual is to help those in the mental health field make accurate diagnoses. One of its goals is to make the diagnosis more consistent between providers. Unfortunately it is often used haphazardly.
1. Assimilation Disorder With Depressed Tenor: A reaction to a stressor. ( Loss of a loved one, work, veritable illness, maneuver etc. ) This type of disturbed humour is usually mild and self - limiting. When symptoms last longer than 6 months larger type of depression should be considered. Counseling, therapy and support may be yielding treatment. Medication is not usually necessary.
2. Dysthymia: A chronic low - level depression. It can be very debilitating and may be a part of the personality. It also can be laborious to treat with medication; therapy is recommended.
3. Exceeding depression: A severe form of depression with multiple symptoms as described considerable. Medication is necessary and usually very effective. Therapy may be helpful after acute symptoms have abated. Suicide implied duty be monitored. This can be severe enough to cause bananas ( loss of substantiality ) symptoms, such as delusions and hallucinations.
4. Bi - Polar 1 Disorder: A cycle of depression and elevation of temper ( hypomania or mania ). This can be very severe, with screwy symptoms. Antidepressants may be avoided due to risk of switching the vein to mania. This condition needs expert psychiatric treatment usually with humour stabilizing medication. ( By the way there is a valid amount of confusion and disagreement about this diagnosis especially between Bipolar 1 and Bipolar 2 disorders. Bipolar 2 disorder is less severe and medication is often not necessary. )
Differential Diagnosis ( problems that may be flummoxed with depression )
ท hypothyroidism ( low thyroid )
ท substance maltreat
ท chronic pain
ท side effects of medication
Target Symptoms Of Depression:
Identifying and describing specific target symptoms is crucial if treatment is to be monitored and its ' dynamism evaluated. It is easy to overlook how severe symptoms were when depression is resolved. The more specific the target symptoms are, the better to keep course of changes. Some examples of target symptoms are listed below.
ท sleep disturbance ( difficulty falling or staying flagging, awakening often during the nite, early morning awakening, oversleeping )
ท concentration / memory problems
ท low energy level
ท irritability
ท physical symptoms
ท change in appetite ( decreased or in addition )
ท lack of motivation / notice
ท mood changes ( torment, hatred despair )
Selective Serotonin Reuptake Inhibitors ( Ssris ) The Most Commonly Used Antidepressants.
SSRIs have been on the market for over 20 yrs. They increase levels of serotonin in the brain. Serotonin is a substance that allows chemical animation in the brain ( neurotransmitter ). Serotonin is known to play a role in depression and anxiety. SSRIs are used for treatment of depression, anxiety, Consuming - overdone disorder ( OCD ), and occasionally other illnesses. ( Fibromyalgia, chronic fatigue, pain ). SSRIs have much fewer side effects than the older antidepressants ( tricyclics such as Elavil ); they are not as lethal in overdose, and work well for most people. They are much more appreciated for tricyclics. All SSRI ' s are effective although side effects may differ reasonably. Considering mortals are different, some may cope more positively to one particular medication so to enhanced. Choosing between the SSRI ' S is usually dependent on the side development formation ( witness below ), and the prescriber ' s and patient ' s preference and proof. They are usually the first choice in depression and often the first choice in anxiety disorders. With anxious patients it is helpful to start low and increase the dose slowly in disposal to minimize the side side effect of activation. Anxious patients can be very sensitive to this side causatum. Higher doses of medications are often needed in Gripping Compulsive disorder and Panic disorder.
1. Prozac TM ( fluoxetine )
This may be more energetic initially. It has a deep half - life and inasmuch as stays in the system longer. Once a day dosing is usual; recently Prozac introduced a once a instance dose.
2. Paxil TM ( paroxetine )
May be more conciliatory initially, weight gain can be a problem. Once a day dosing is the criterion.
3. Zoloft TM ( sertaline )
May have fewer interactions with other medications. Weight gain may be a problem. May cause more innards low and diarrhea. Once a day dosing is the benchmark.
4. Luvox TM ( fluvoxamine )
Sometimes used for OCD, multiple dosing. Not used frequently in US. Needs higher doses that may cause drowsiness.
5. Celexa TM ( citalopram )
Said to be " more " selective for a particular type of serotonin and and so thinking to have less side effects and interactions. May have less weight gain. Once a day dosing is the gauge.
6. Lexapro TM ( escitalopram )
Similar to Celexa some feel it was manufactured considering the patent on Celexa was running out. Said to work quicker accordingly the other SSRIs.
Side Effects - SSRI ' s
Most SSRI ' s have comparable side effects. Some patients do better on one than on larger. This cannot be determined before a trial of the medication is given.
ท Nausea is a common problem. Taking the medication with food helps and this side issue. It usually passes in time.
ท Headache is usually mild and goes away with time ( about one epoch ) if it continues it may be necessary to change medication.
ท Activation or sedation: patient can feel either activated ( hyper, anxious ) or sedated. Patients with anxiety / panic are more likely to feel activated. To avoid this start with a low dose and increase as tolerated. Sedation will often disappear with time but occasionally a change in medication is necessary.
ท Sexual dysfunction can be a knowing problem with some antidepressants. Use may consummation in decreased sexual engrossment or endowment. Most common treatments for sexual dysfunction count: drug holidays ( haul the drug for one or two days once the patient is stable, ( cannot be done with Prozac due to staying in the body longer ), changing medication, or using an more medication. ( Some such drugs introduce: Periactin, Amantadine, Yohimbine, Ginkgo others. All have only limited happiness. ) Speak to your prescriber if this is an concern for you.
ท Weight Gain can be a problem that is often not taken seriously enough. Weight gain may start after you have been on the medication for a while. It may be necessary to change to a different antidepressant.
ท Agitation / Rush / There has been some anecdotal reports about patients becoming more influential on SSRIs. The research does not support this. However, that affair should be taken seriously, and attempts made to avoid a drug the patient is concerned about. The equivalent is true about the reports of heavier suicide.
Other Antidepressants
These drugs are knowing to disturb a number of neurotransmitters ( serotonin, dopamine, nor - epinephrine being the large-scale ones. )
1. Wellbutrin TM ( buproprion )
This should not be used in patients with a history of seizures. Verbal to cause less sexual dysfunction and weight gain. Now has a lingering release course but still is usually given twice a day. This is the equivalent drug as Zyban, which is used for calescent cessation. Obviously, they should not be used well-organized.
2. Trazodone
This is not a very effective antidepressant; it is however very helpful for sleep and may be used in low doses for anxiety. It should be used in caution with men due to
possible priaprism ( This is an involuntary erection that in the worst event may not go away ).
3. Effexor XR TM ( venlafaxine HCI ) Is realizing to have fewer interactions. Less weight gain and sexual dysfunction
4. Remeron TM ( mirtazapine )
Is vocal to have less sexual dysfunction and fewer interactions. Weight gain can be a problem. Used at lower doses ( 15 mg ) this is a good sleep aid, but is not powerful enough to be an antidepressant. At higher doses no longer specifically helpful with sleep.
5. Tricyclics
This is an older class of antidepressants that are no longer the first choice. They can have severe side effects including sedation, weight gain, effects on the heart, and drug interactions. These drugs are used in anxiety, depression and some pain syndromes. They are much less treasured than SSRI ' s. These drugs are lethal in overdose! ( IE.: amitriptyline, nortriptyline, desipramine )
6. MAOI ' S ( monoamine oxidase inhibitor )
These are other older class of antidepressants with many dietary restrictions and interactions. Not currently used very often. ( I. e.: Nardil TM, Parnate TM )
Herbs & Supplements For Depression
How herbs and supplements work is not fully unstated, but they have been used for thousands of years. They can be potent and should be used with care. They should not be mixed with other medications for anxiety or depression. You should let your health care provider know if you are considering taking supplements.
Research on supplements has been conducted in other countries for many years. In the US research has been slow due to the gospel that pharmaceutical companies ( who sponsor most research ) don ' t glom them as a moneymaker. This is changing however, and there is some research underway. Pharmaceutical companies are now primeval to father prescriptions forms of some supplements. Some of the outcomes of herbal research have been manifold, and more studies are principal. There are a number of supplements advertised for use in depression and anxiety, the attached are the most well studied and most commonly used.
ท Omega 3 Fatty Acids ( Fish Oil )
Some of the research on fish oil is truly exceptional. It indicates that it may be reliable as effective as antidepressants in treating depression. The research was done using 4000mg a day of fish oil.
S - Adenosylmethionine is a miscellaneous found in all living tissue, and is consolidated in the liver and brain. There have been a number of studies that have shown its potentiality in depression. It is also used in hepatitis and arthritis. There have been no side effects or interactions with other medications found. SAM - e uses B12 and folate in its lowering of homocysteine levels. It is for suggested that live levels of folate and B12 be buoyant when taking SAM - e. The dose of SAM - e is between 800 and 1600 mg a day to treat depression. It is important, and many pills may need to be moved to attain a wicked dose. Research in the US is required. Studies in other countries have been very good. ( Benjamin, 2000 )
ท St. John ' s Wort
Used for bitter to generous depression. The form of vim is concealed, some think it works like an SSRI or MAOI. The dose most commonly suggested is 300 mg, ( standardized to. 3 % hypercin ) three times a day. Side effects are usually lager but may insert photosensitivity, emotional vulnerability, itching, and exhaustion and weight increase. Alcohol, tyrosine, narcotics, amphetamines, and over the counter cold and flu remedies should counted on be avoided to be on the safe side. It interacts with drugs for HIV, and some other medications that are metabolized by the liver ( as many other drugs do also ). The research on St. John ' s Wort has been oftentimes salubrious ( Muskin, 2000 ) with one recent study green its power.
ท Ginkgo Biloba
Ginkgo is used for boxy depression in elderly, early Alzheimer ' s disease, impotence, logical vascular dearth and external circulatory disorders. Ginkgo should be standardized to 6 % terpene lactones, 24 % ginkgo flavones glycosides. The suggested dose for prevention is 120 - 160 mg a day in divided doses. Up to 240 mg a day may be used in Alzheimer ' s or conditioned depression. Side effects have not been reported. May be helpful for sexual dysfunction with SSRIs. This will thin your blood and increase blood flow, should be stopped a few days before surgery. There are over 400 published studies with Ginkgo in studies of circulation. ( Brown, 1998 )
Issues With Herbs & Supplements
Herbs have been used worldwide for many years. Although they are rationalization to be " natural ", remember, averse reactions, side effects and interactions with other drugs / herbs / supplements are possible.
There is a want of standards in manufacturing and often it is strenuous to know exactly what you are getting or how it has been distilled. Name brands you are known with should be used.
Some Herbs can be heavy ( as can some medications ). Read and take meaning labels, the active ingredient should be " standardized " although this is no guarantee.
Herbs may have interactions with other drugs, side effects and maybe treacherous effects on pregnancy. They should be considered seriously, and researched carefully before use. Under dosing is also a common problem, ( both with medication and herbs ) as is not giving herbs in a serving dose or enough time to work.
Cost is a aid as herbs can be precious and are not abstruse by insurance.
Combination herbs should be used with care and only if one is sure of the dosage of all ingredients.
Drug / Herb Interactions
Drug interactions can be a problem with any medication and some herbs. Herbs should not be mixed with drugs for the identical condition. Information is being discovered at a rapid rate about interactions. There is much we have to learn and caution is advised in the use of herbs. Discussion with health care providers who are knowledgeable or at rudimentary unfastened to these ideas can helpful. If your health care provider is not eager to consider and be unlatched to learning about herbs maybe you should consider a change of provider.
Some people may be slow metabolizes and need subordinate doses.
Over the counter drugs should be used with care when taking herbs.
Grapefruit Juice has been found to interact with many drugs, and characteristic herbs.
Caffeine may interact with some drugs and herbs.
Alcohol should not be mixed with most medications and some herbs.
Helpful Hints For Prescribers And Patients When Using Medications / Herbs
ท A full trial is crucial of medications, and supplements is important and often not done. This means a full dose should be prescribed for a wicked twist of time.
ท There is some information that indicates frequent commencing and stopping antidepressant medications may model to ineffectiveness.
ท Monitor target symptoms in scheme to finish talent.
ท Change one medication at a time in lineup to distinctly identify the outgrowth of each one.
ท Consider cost and the patient ' s insurance
ท There is less suicide risk by overdose when using SSRI ' s in consequence tricyclics.
ท In anxious patients start low; increase slowly ( but not too slowly, in plan to avoid discouragement due to roll of time needed for improvement )
ท Understand and consider side effects when choosing a medication. This will help to know what to foresee, reduce anxiety, and decrease early fence.
ท The first treatment for depression should be 8 - 12 months in skein, and there is a 50 % relapse standard after that. A second treatment regimen should last 18 months and has a 70 % relapse scale. After this medication may be needed for life.
ท Try to avoid utopian expectations about medications.
ท If you medical provider is not enthusiastic to gibber with you about these issues, feasibly you should seek a new one!
ท Always tell your health care provider when you are taking supplements of any charitable!
References:
Benjamin, S. ( 2000 ). Cam Spotlight SAM - e For Depression and More? Patient Care for the Cherish Practitioner Parade, 22 - 26.
Blumenthal, M. Goldberg, A. Brinckmann ( Eds ). ( 2000 ) Herbal Medicine, Expanded Commission E Monographs. Newton, MA: Integrative Medicine ommunications.
Brown, D. ( 1998 ) Phytotherapy, Herbal Medicine meets Clinical Science. Bothell, Washington: Bastyr University, Permanent Professional Education Program
Diagnostic and Statistical Instruction of Mental Disorders DSM - IV - TR ( Words Drill ) ( 2000 ) American Psychiatric Association
Physicians Desk Reference ( 2006 ) Thompson Healthcare.
Keegan, L ( 2001 ) Healing with Kin & Alternative Therapies. New York: Delmar.
Muskin, P. ( 2000 ) Coincident and Alternative Medicine in Psychiatry, Washington, DC: American Psychiatric Press.