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| Depression Information |
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Depression Series (Part 2): My Antidepressant Doesn't Work - What Can My Psychiatrist Do?
Maria has been increasingly depressed for the past few years. She has tried at least four newer antidepressants but so far, she doesn't seem to respond. Unable to work, she's now feeling helpless and hopeless. Likewise, her family is discouraged. Frustrated and baffled by Maria's lack of progress, the family doctor refers her to a psychiatrist. What can the psychiatrist do to help Maria? The psychiatrist has several options in dealing with a treatment-resistant or refractory depression. First, Maria's psychiatrist can optimize the dose of her antidepressant. Maria has been taking low doses of antidepressants. In spite of her lack of response, the medication dosage has not been increased. To obtain a clinical response, her psychiatrist should increase the dose every two to three weeks. The antidepressant can be adjusted up to the maximum allowable dose if no or only partial response is observed. Second, her psychiatrist can choose to augment the effect of her antidepressant with another medication such as lithium, triiodothyronine (T3), or buspirone. Among augmenters, lithium and triiodothyronine have the best support from the literature. Despite lithium's efficacy, some doctors avoid this drug because it requires regular blood monitoring and has unfavorable side effect profile such as acne, tremors, and thyroid and renal dysfunction. Recently, studies have shown atypical neuroleptics such as olanzapine and risperidone to be good augmenters. In my opinion, further studies are necessary to establish these two drugs as standard augmenter. Indeed, research studies and clinical experience have found augmentation strategy to be effective. Third, combination strategy is worthwhile to try. Maria's psychiatrist can add another antidepressant to boost the effect of her current antidepressant. For instance, trazodone can be added to an SSRI (serotonin reuptake inhibitor e.g. citalopram). Literature suggests that combining two drugs with different mechanisms of action and drugs that involve several brain chemicals has resulted in clinical improvement. In this scenario, one antidepressant plus another antidepressant is equal to three, or four or even ten, not two. Fourth, the psychiatrist can switch from one antidepressant to another. Previous studies have shown that when making a switch, a drug should be replaced by a drug from a different class e.g. from SSRI to SNRI (serotonin and norepinephrine reuptake inhibitor e.g. venlafaxine), or from TCA (tricyclic agent e.g. nortriptyline) to SSRI. But recent studies show that switching drugs within the same class (e.g. SSRI to another SSRI) is just as effective. Fifth, Maria's psychiatrist can also treat other ongoing symptoms or drug-related problems that further complicate her depression. If she is anxious and agitated, then her psychiatrist should prescribe antianxiety drug (e.g. lorazepam) or if Maria is psychotic then adding an antipsychotic drug should help. Moreover, medication side effects (such as insomnia, dryness of mouth, constipation, etc.) that negatively affect Maria's compliance to the drug should be addressed promptly. Lastly, if despite above measures Maria doesn't respond to antidepressants, then electroconvulsive therapy should be entertained. Of course, this procedure should be done with her consent. In summary, Maria's psychiatrist can optimize the dose, augment or combine treatment, switch the medication, treat side effects and ongoing symptoms, or use electroconvulsive therapy for treatment-resistant or refractory depression. About The Author Copyright © 2003. All rights reserved. Dr. Michael G. Rayel author (First Aid to Mental Illness?Finalist, Reader's Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Dr. Rayel pioneers the CARE Approach as a first aid for mental health. To receive free newsletter, visit www.drrayel.com. His books are available at major online bookstores.
Depression - Google News |
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Alternative Medicine Eliminate The Belief That Your Illness Is Genetic Many illnesses, emotional and otherwise, are often said to be genetic in origin. When one is told that their particular problem is of a genetic nature it often leaves them feeling helpless since, to date, the idea of reversing something that is stored deep within one's structural DNA, which exists in every single cell of one's body, is considered an impossibility. New Treatment for Depression to be Presented at the American Psychiatric Association Annual Meeting Within the next few weeks, the FDA is expected to issue its final approval of a medical breakthrough treatment for chronic or treatment-resistant depression. This new therapy will be presented at the American Psychiatric Association's Annual Meeting in Atlanta from May 21st-May 25th. The Annual Meeting is the largest gathering of psychiatrists in the world. Over 25,000 psychiatrists are expected to attend this important medical meeting. 5 Surefire Tips to Beat Depression Now Being lonely is a normal part of our everyday lives... We get sad when we fail in our exams, when we're rejected by the person we love, or when someone very close to us passes away. How to Uncover the Reason You Cant Sleep Tonight If you are like me ...you love your sleep! Depression in Teenagers: Now What Can We Do? No doubt you have seen the recent news headlines about a federal panel that recommended to the FDA that anti-depressant medications carry the strongest possible warning label for use in children and teenagers. This recommendation to the FDA shook the medical community, especially those who work with depressed young people. The biggest problem from the treatment community's point of view was not the recommendation for the warning label, but the way that the media protrayed the panel's recommendation. Chronic Fatigue Syndrome And Depression Are Not The Same Thing! Chronic Fatigue Syndrome is a very misunderstood illness and this is perhaps why there are so many myths about it. Perhaps the most common myth about Chronic Fatigue Syndrome is that it is effectively a mental condition, and another name for depression. But these two conditions are very different! And when you label a condition incorrectly it can cause no end of problems when trying to diagnose and treat it. So it's extremely important to make the distinction between Chronic Fatigue Syndrome and depression - because they are completely different illnesses. For one, depression can be a symptom of Chronic Fatigue Syndrome, but there are many Chronic Fatigue Syndrome sufferers out there who do not suffer from depression at all. Second, research has shown that Chronic Fatigue Syndrome sufferers have an abnormality in their 'deep sleep' brainwave patterns. In contrast, depression sufferers do not have this abnormality. In addition, depression sufferers tend to feel tired all the time, whereas Chronic Fatigue Syndrome sufferers' exhaustion increases notably after mental or physical exertion. There are also symptoms of Chronic Fatigue Syndrome that are not shared by depression sufferers. Nasty flu-like symptoms, headaches, reversal of sleeping patterns, painful muscles and joints, Restless Legs Syndrome, and an increase in colds and viruses all are just a few symptoms that can play a part in Chronic Fatigue Syndrome. These are just a few of the differences between Chronic Fatigue Syndrome and depression! Another myth about Chronic Fatigue Syndrome is that all Chronic Fatigue Syndrome sufferers need to do is to 'pull themselves together' - and they'd be cured... ... if only it were that simple! Chronic Fatigue Syndrome is actually a bio-physical condition and was (finally) accepted as such by the UK government in 2001. But no cure has yet been found. Unfortunately there are still many people out there (including some medical professionals) who still think that the condition is 'all in the sufferer's head'. It is because of this misunderstanding that the Chronic Fatigue Syndrome community has fought so hard against Chronic Fatigue Syndrome being wrongly labelled as a mental illness. And it is perhaps because of this battle that depression amongst Chronic Fatigue Syndrome sufferers has often sadly been overlooked... Yet for many, depression can be a very real symptom of Chronic Fatigue Syndrome. If you suffer from depression as a Chronic Fatigue Syndrome sufferer, then it's vital that you take it very seriously and that you try to address it as soon as possible. If you don't deal with your depression, you are unlikely to be able to recover from any chronic illness... ...and recovering from Chronic Fatigue Syndrome is no exception. It is possible to recover from Chronic Fatigue Syndrome. So if you do experience depression as a symptom of your Chronic Fatigue Syndrome, make it a priority to deal with it. Only that way can you get yourself on the road to recovery. Being A Victim Is Always A Choice Do you blame your past, your family, your partner, your job, your circumstances or a host of other things for your unfortunate place in life. If so then, by definition, you are choosing to identify yourself as a victim. What's The Latest on Suicide Risk and Antidepressants For Children? FDA confirms some antidepressants increase suicide risk in some children. In February of 2004, two advisory committees of the U.S. Food and Drug Administration recommended that the FDA warn practitioners about the possible risk of suicide potential associated with antidepressant treatment in children. The information was obtained from clinical trials of medications with children, expert witnesses on suicide research, testimony from families of suicide victims, as well as from those whose children had benefited from antidepressant medication. Are the Benefits Worth the Costs? Schizophrenia suffers around the world have benefitted greatly with the discoveries of modern medicine. Certain medications have been found to regulate and balance brain chemistry giving an individual suffering from schizophrenia a seemingly normal life. If an individual is taking Zyprexa to control their schizophrenia, they should be alerted that many dangerous side effects are showing up with this drug. These Zyprexa side effects have caught the watchful eye of the FDA. In recent years the FDA asked the maker of Zyprexa to start issuing warnings about their medication. This was done in an attempt to alert all consumers of this drug to the potential dangerous Zyprexa side effects. These include but are not limited to the following: Hyperglycemia, Hyperglycemic Coma, Diabetes, Neuroleptic Malignant Syndrome, and Pancreatitis. Antidepressants: Control or Cure? What's curious is that most of them will be on these drugs for life. Equally curious is that over seventy percent of people who stop taking them, for any length of time, will relapse into another painful episode of their illness. Quick Steps To Improve Your Mood Looking to improve your mood? Depression is a Choice There is one very simple reason for all emotional depression. It Aint Easy Being Brave A zoo attendant entered a lion cage carrying only a broom. He casually swept with no concern for the wild animal. He even poked the big cat with his broom. The lion hissed at him and moved to another corner of the enclosure. An onlooker remarked "You certainly are brave." The sweeping man chuckled and said, "I ain't brave, that old cat ain't got no teeth." What's Causing My Depression and Fatigue? Chronic Fatigue and Chronic Depression are absolutely systemic in our society today. Recent studies done by the AMA and CMA purport one in four people in North America are suffering from some form of chronic fatigue or depression and it's expected eight out of ten of us will experience similar afflictions in our lifetime. But numbers like these don't speak to the cause and only tell half the story. Mental Health Stigma What Can We Do About It? What is Stigma? Depression is Underdiagnosed in College Students Everyone feels down or blue once in awhile. Especially during difficult times, it's normal to feel sad or discouraged. But when those feelings persist for two weeks or longer, it could be depression. It's a common illness that affects an estimated 19 million Americans-that's nearly one in ten! It's also one of the most under-diagnosed illnesses on college campuses. The symptoms can come on so slowly that one day, a person realizes that he can't remember the last time he felt good. Here are some warning signs for depression: Hurricane Recovery: Steps to Start Putting Your Life Back in Order It seems unreal, another major storm hitting Florida after experiencing four last year. The beginning of hurricane season, Floridians were just starting to get past the destructive events that caused many of people stress and even, depression. As Hurricane Dennis comes onshore, the upcoming hours, days, and months afterwards may be ones of disbelief and shock. There are ways to help get one?s life back in order after these type of predicaments. Depression: Bringing Yourself Down Sometimes it's hard to see the forest from the trees. Sometimes its hard to see how much you can bring your self down. Recently, my life has been turned upside down. I lost someone close to me and the world became a dark place. Neuromodulation Is Now The Mainstream Therapy For Chronic Depression The cover of the March 7, 2005 issue of Business Week titled REWIRING THE HUMAN BODY, describes how neuromodulation brings new hope to the four million desperate patients in the United States who suffer from the debilitating disease of chronic or treatment-resistant depression. How to Put an End to Depression Depression can have many, many faces. If you are not aware of your feelings and emotions on a daily basis then it can creep up on you and cause misery in your life when you least expect it.
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