BROS & DEPRESSION
MEDICAL TREATMENT
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So Bros, are antidepressants a good treatment option? What are the potential side effects and safety concerns? Which one is right for you? Here’s all you need to know about depression medication.
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Antidepressants are medications that can help relieve symptoms of depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and dysthymia, or mild chronic depression, as well as other conditions.
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They aim to correct chemical imbalances of neurotransmitters in the brain that are believed to be responsible for changes in mood and behaviour. Antidepressants were first developed in the 1950s. Their use has become progressively more common in the last 20 years.
Finding the right antidepressant
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There are a number of antidepressants available that work in slightly different ways and have different side effects. When prescribing an antidepressant that's likely to work well for you, your doctor may consider:
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Your particular symptoms. Symptoms of depression can vary, and one antidepressant may relieve certain symptoms better than another. For example, if you have trouble sleeping, an antidepressant that's slightly sedating may be a good option.
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Possible side effects. Side effects of antidepressants vary from one medication to another and from person to person. Bothersome side effects, such as dry mouth, weight gain or sexual side effects, can make it difficult to stick with treatment. Discuss possible major side effects with your doctor or pharmacist.
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Interaction with other medications. Some antidepressants can cause dangerous reactions when taken with other medication
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Other health conditions. Some antidepressants may cause problems if you have certain mental or physical health conditions. On the other hand, certain antidepressants may help treat other physical or mental health conditions along with depression. Your doctor will be able to advise you after you consult with them with your medical history.
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Cost and health insurance coverage. Some antidepressants can be expensive, so it's important to ask if there's a generic version available and discuss its effectiveness. Also find out whether your health insurance covers antidepressants and if there are any limitations on which ones are covered.
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Types of antidepressants
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Certain brain chemicals called neurotransmitters are associated with depression — particularly serotonin,norepinephrine/norandrenaline and dopamine. Most antidepressants relieve depression by affecting these neurotransmitters, sometimes called chemical messengers, which aid in communication between brain cells. Each type (class) of antidepressant affects these neurotransmitters in slightly different ways.
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Many types of antidepressant medications are available to treat depression around the world (although this may vary country to country). These include the 3 most common antidepressants:
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Selective serotonin re-uptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These medications generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants are. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).
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Serotonin and norepinephrine re-uptake inhibitors (SNRIs). Examples of SNRI medications include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq) and levomilnacipran (Fetzima).
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Tricyclic antidepressants. Tricyclic antidepressants — such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin and desipramine (Norpramin) — tend to cause more side effects than newer antidepressants. So tricyclic antidepressants generally aren't prescribed unless you've tried other antidepressants first without improvement.
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Side effects of antidepressants
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The side effects of antidepressants can cause problems at first, but then generally improve with time. It's important to continue treatment, even if you're affected by side effects, as it will take several weeks before you begin to benefit from treatment. With time, you should find that the benefits of treatment outweigh any problems from side effects.
During the first few months of treatment, you'll usually see your doctor or a specialist nurse at least once every 2 to 4 weeks to see how well the medicine is working. For more information about your specific medicine, see the patient information leaflet that comes with it.
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Common side effects of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) can include:
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feeling agitated, shaky or anxious
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feeling and being sick
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loss of appetite
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not sleeping well (insomnia), or feeling very sleepy
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difficulties achieving orgasm during sex or masturbation
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in men, difficulties obtaining or maintaining an erection (erectile dysfunction)
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These side effects should improve within a few weeks, although some can occasionally persist. See your doctor if this continues to affect you.
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Common side effects of tricyclic antidepressants can include:
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slight blurring of vision
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constipation
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problems passing urine
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drowsiness
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dizziness
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weight gain
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excessive sweating (especially at night)
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heart rhythm problems, such as noticeable palpitations or a fast heartbeat (tachycardia)
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The side effects should ease after a couple of weeks as your body begins to get used to the medicine. See your doctor if this continues to affect you.
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Antidepressants and risk of suicide
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Most antidepressants are generally safe, but most countries' regulator of therapeutic goods including prescription medicines (such as the Therapeutic Goods Administration of Australia, the Food and Drug Administration in the USA and Medicines and Healthcare products Regulatory Agency (MHRA) of the UK may require antidepressants carry warnings. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behaviour when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.
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Anyone taking an antidepressant should be watched closely for worsening depression or unusual behaviour. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
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Making antidepressants work for you
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To get the best results from an antidepressant:
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Be patient. Once you and your doctor have selected an antidepressant, you may start to see improvement in a few weeks, but it may take six or more weeks for it to be fully effective. With some antidepressants, you can take the full dosage immediately. With others, you may need to gradually increase your dose. Talk to your doctor or therapist about coping with depression symptoms as you wait for the antidepressant to take effect.
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Take your antidepressant consistently and at the correct dose. If your medication doesn't seem to be working or is causing bothersome side effects, call your doctor before making any changes.
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See if the side effects improve. Many antidepressants cause side effects that improve with time. For example, initial side effects when starting an SSRI can include dry mouth, nausea, loose bowel movements, headache and insomnia, but these symptoms usually go away as your body adjusts to the antidepressant.
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Explore options if it doesn't work well. If you have bothersome side effects or no significant improvement in your symptoms after several weeks, talk to your doctor about changing the dose, trying a different antidepressant (switching), or adding a second antidepressant or another medication (augmentation). A medication combination may work better for you than a single antidepressant.
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Try psychotherapy. In many cases, combining an antidepressant with talk therapy (psychotherapy) is more effective than taking an antidepressant alone. It can also help prevent your depression from returning once you're feeling better.
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Don't stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause significant withdrawal-like symptoms unless you slowly taper off your dose. Quitting suddenly may cause a sudden worsening of depression.
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Avoid alcohol and recreational drugs. It may seem as if alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat. Talk with your doctor or therapist if you need help with alcohol or drug problems.
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