Antidepressants: Therapeutic use

Last modified: Thursday, 25. December 2008 - 5:49 am

The antidepressants are used to relieve the symptoms of depression, which may include feelings of sadness, helplessness, loss of interest in usual activities, insomnia, loss of energy, problems concentrating, weight loss or gain, and decreased desire to socialize or communicate with others.

The three most common types of depression are major depression, dysthymia, and bipolar disorder. Major depression, which may occur once but usually occurs several times in a person’s life, will interfere with the ability to work, eat, sleep, study, and take pleasure in formerly enjoyed activities. Dysthymia is less severe than major depression but will interfere with feeling good and functioning well. Bipolar disorder (formerly called manic-depression) can be more serious than the other forms of depression. In this illness the person’s mood swings from symptoms of depression to extreme excitement with over-activity and feelings of elation. This type of depression can progress to serious mental illness if not treated.

Depression is twice as common in women than men and may occur with premenstrual syndrome or after childbirth as postpartum depression. Studies have not found any negative effects on the unborn child when the mother takes an antidepressant during the pregnancy, but this is a serious question that needs to be discussed with the physician. Antidepressants are very effective in the treatment of postpartum depression, but because they are secreted in the mother’s milk, the option of breastfeeding is another essential area for discussion and decision. Usually, women are recommended to avoid drug use during pregnancy, including the use of St. John’s wort.

Although less common than in women, about three to four million men have depression, and their rate of suicide is four times that of women. Men’s symptoms of depression may be anger and irritability and be masked by alcohol and drug use.

In addition to the treatment of depression, the Food and Drug Administration (FDA) has approved the (on-label) use of the antidepressants for treatment of panic disorders, obsessive-compulsive disorders, bulimia nervosa, social phobia, and generalized anxiety disorder. And although not the treatment of choice, the tricyclics are sometimes used for enuresis — bed wetting.

A physician may prescribe an antidepressant for an off-label use. These are a variety of problems not specifically mentioned on the drug label. Among these are pain, anxiety, attention deficit hyperactivity disorder, post traumatic stress disorder, premenstrual exaggerated feelings of depression, social phobia, and obsessive-compulsive-related disorders such as compulsive hair pulling, compulsive gambling, compulsive buying, sexual addictions, and kleptomania (compulsive stealing).

Studies show that the SSRIs may help alcoholics reduce the amount of alcohol they consume and also increase the number of days they can abstain from alcohol. Patients with anorexia nervosa may also be helped by antidepressants. No other treatment has been approved by the FDA for this eating disorder, but the antidepressants are helping patients maintain their weight and avoid relapse.

Because each patient will respond differently to the various antidepressants, the physician may try several — or even combine them — in the search for the most effective treatment for a particular patient.

Although the tricyclic and MAOI antidepressants cause an immediate pharmacologic action (drug reaction in the body), their clinical action (observable reaction) is delayed. This delay can last weeks or even months. This makes it difficult to use these antidepressants to treat severe depression when an immediate response is desired. The more severe cases of depression and other psychiatric and emotional problems may require other treatments in addition to the drug therapy.

The antidepressants have been found effective in post-stroke patients when a positive attitude is needed for recovery. Treating post-stroke depression improves the chances of the patient regaining mental acuity.

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