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Should you take antidepressants?

Created date

September 20th, 2011

"If I prescribe a medication for high blood pressure, my patients understand why and agree to take it every day. But if I prescribe an antidepressant, many hesitate, says Thomas Morris, D.O., an Erickson Living health and wellness expert. When prescribed for depression, antidepressants may improve your mood, sleep quality, appetite, and concentration. According to the Agency for Healthcare Quality and Research, 60% of adults feel better when first prescribed an antidepressant. Unfortunately, some people don t want to take antidepressants because of the stigma associated with a psychiatric disorder, says Daniel D. Sewell, M.D., medical director of the Senior Behavioral Health Program at UC San Diego Health System. There are false beliefs that these problems are a matter of personal character, personal weakness, poor lifestyle choices, or bad habits.

Troublesome side effects

In general, older patients are at greater risk for medication side effects because of bodily changes that go along with normal aging, such as a decreased ability of your liver to process medications, Sewell explains. Certain side effects such as dizziness, memory problems, or bowel and bladder changes can be especially difficult to deal with or even dangerous. After starting antidepressants, side effects are the most common reason people discontinue their medication. Fatigue is a common complaint. This side effect, like many others, tends to improve after about six weeks the length of time it takes for most antidepressants to reach their full effectiveness, Morris says. Making sure your doctor knows all of your health conditions and medications is essential for minimizing side effects and interactions. Some antidepressants are associated with increased bruising so if someone is taking anticoagulants, their medication dosages may need adjusting, Morris says. Talk to your doctor about how to manage side effects. Physical activity can help decrease side effects and make you feel better overall, Morris says, So can eating a healthy diet and getting enough sleep. We may not know about all of the side effects of antidepressants in seniors because historically research has not included an optimal proportion of older adults, Sewell says. One recent study showed that selective serotonin reuptake inhibitors (SSRIs), when compared to tricyclic antidepressants (TCAs), may be associated with an increased risk of stroke, falls, fractures, and seizures among seniors. The study s authors caution that this could be in part due to the fact that TCAs were prescribed at lower doses than the SSRIs, or that there could be other individual factors at play.

Beyond depression

Prescribing some antidepressants for disorders besides depression is sometimes considered an off-label use. That means that the Food and Drug Administration (FDA) has not approved the drug for other conditions but it does not necessarily mean that there is no scientific basis for their use or that they will not be effective for these other conditions, Sewell says. An example of one that is FDA-approved for other conditions is Paxil (paroxetine), which can be prescribed for depression, obsessive compulsive disorder, panic disorder, social anxiety, and generalized anxiety disorder, Sewell explains. When someone is in the initial stages of dementia or memory loss, an antidepressant is sometimes helpful, Morris says. Memory loss is associated with depression, and the two conditions can exist together and complicate each other. Antidepressants are sometimes used for chronic pain. There s really no way to know if they are lessening the pain, or if the drug is helping a patient deal with it better, or if it s a combination effect, Morris says. The antidepressant Cymbalta (duloxetine) is FDA-approved for two conditions in which pain may be a prominent feature: diabetic peripheral neuropathy and fibromyalgia, Sewell adds. Antidepressants may also help to prevent migraines. It s up to the doctor s discretion whether to prescribe an antidepressant for something other than depression, Sewell says. Although depression is a fairly common disorder among seniors, some people think that it s normal for them to be grouchy, unhappy, or irritable; or that depression is a natural part of aging. Research has dispelled these myths by showing that the opposite is true. Older adults score high in terms of quality of life and happiness, Sewell explains. Most antidepressants are safe, Sewell says, so if you are depressed, medication along with counseling is essential for your sense of well-being.

Types of antidepressants

There are several classifications of antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs): Examples are Prozac (fluoxetine), Celexa (citalopram), and Paxil (paroxetine) Serotonin and Norepinephrine Reuptake Inhibitors (SSNIs): Examples are Effexor (venlafaxine) and Cymbalta (duloxetine) Tricyclic antidepressants (TCAs): Examples are Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline) Monoamine Oxidase Inhibitors (MAOIs): Examples are Nardil (phenelzine) and Parnate (tranylcypromine) There are other antidepressants that don t fall into any of these classifications and are considered unique, such as: Remeron (mirtazapine) Wellbutrin (bupropion)

Common side effects

Many people who take antidepressants have at least one side effect. Side effects can include: headache night sweats nausea agitation sexual problems dry mouth constipation weight gain or loss exacerbation of depression symptoms Discuss all side effects with your doctor.

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