After Prozac

Have You Taken Your Paxil Today?

2007-06-02T14:42:00.000-07:00

This little button made me laugh when I saw it. I think another good one would be "Be Glad I Took My Paxil Today!"

What do you think?

Generic Paxil CR Coming Soon

2007-06-02T14:16:00.000-07:00

Americans taking Paxil CR extended release (paroxetine) may soon have one more option when it comes to buying their prescriptions. According to United Press International, the US Food and Drug Administration tentatively approved a generic version of Paxil CR extended release tablets on May 31, 2007. The drug becomes eligible for final FDA approval on June 29, 2007, when GlaxoSmithKline's patent expires.

The generic drug-manufacturer Mylan is set to make the generic version of Paxil, which will go by the name paroxetine extended-release tablets. Paroxetine is a selective serotonin reuptake inhibitor (SSRI) prescribed to treat depression, dysthymia, panic disorder, social anxiety disorder and premenstrual dysphoric disorder. One of its most popular off-label uses is as a treatment for premature ejaculation.

For more info on selective serotonin reuptake inhibitors, including their pharmacology and medical uses, read this.

Lexapro-Is it really better than Celexa?

2007-05-18T19:26:00.000-07:00

CL Psych has a new post discussing the differences and similarities between Lexapro (escitalopram) and Celexa (citalopram). Both drugs are SSRI's manufactured by Forest Labs, and both have made lots of money. When Forest Labs' patent for Celexa was running out, they started selling Lexapro. For the record, Lexapro is a "cleaner" version of Celexa, with only a very small molecular difference. Even so, Forest labs claims Lexapro is far superior to its predecessor.

Considering generic Celexa is far cheaper than either of the name brands, I thought it was worth asking the question: In your personal experience, is Lexapro better than Celexa?

Proposed law would help new moms fight post-partum depression

2007-05-08T10:58:00.000-07:00

Democratic U.S. Senator Dick Durbin has proposed a new bill which would require health care providers screen for the post-partum depression. The bill, titled "Mom’s Opportunity to Access Help, Education, Research and Support for Postpartum Depression Act," would also increase funding for research on postpartum depression, a mood disorder affecting 10 to 20 percent of new mothers.

A recent Chicago Daily Herald article about the bill tells the story of Chicago resident Stephanie Vodopic who suffered a bout of post-partum depression after her last child:

Stephanie Vodopic of Chicago gave birth to a healthy boy a year ago and blamed herself for feelings of melancholy.

“I felt postpartum depression isn’t supposed to happen to people like me with a loving husband, in-laws and parents,” she said.

“It started slowly, then it just snowballed. I felt suicidal.”

After treatment, Vodopic is feeling “100 percent better,” as is Silha.

“Without treatment, I don’t know if I’d be sitting here today,” Silha said. “I don’t want another woman to go through the same misery I did.”

For help with depression connected with pregnancy, call the National Women’s Health Information Center at (800) 994-9662.

Researchers find genes responsible for bipolar disorder

2007-05-08T10:34:00.000-07:00

In a newly-released study by the National Institute of Mental Health, researchers found the genetic roots of bipolar disorder (manic depression), paving the way for new, better kinds of treatments in the future. The study, reported about in the UK's daily Telegraph, states that researchers were able to isolate the:

"... biochemical processes thought to play a role in bipolar disorder. Understanding the effects which variations of these genes have on the workings of brain cells could lead to explanations of how they contribute to the condition and how it might be better prevented or treated. "Treatments that target just a few of these genes or the proteins they make could yield substantial benefits for patients. Lithium is still the primary treatment for bipolar disorder, but DGKH is a promising target for new treatments that might be more effective and better tolerated," [researcher] Dr McMahon said."

56 percent of people taking Zoloft (sertraline) experience remission from depression

2006-11-26T10:54:00.000-08:00

I just finished reading a well-designed study by some researchers at Indiana University and the University of Heidelberg in Germany which evaluated the effectiveness of the SSRI antidepressant Zoloft (sertraline) for the treatment of depression.

What they found - After 12 weeks of treatment, they found that over 56 percent of patients taking Zoloft experienced remission from their depression. However, 87 percent of patients felt some symptom improvement.

How they judged symptom improvement - They judged severity of depression using two widely used psychological scales: the Patient Health Questionnaire depression scale (PHQ-9) and the Clinical Global Impression scale (CGI). In their study, if a patient scored a PHQ-9 score of 5 or below they were considered "in remission."

How they did their study - They studied patients in "routine clinical practice"-that is, ordinary people who visited their doctors who sought help for depression. In all, 563 office-based physicians reported on the treatement of 1878 patients. Each patient recieved a dosage of 50 - 200 mg/day of Zoloft.

People who generally did better with Zoloft - They used regression analysis to find predictors of success with Zoloft, and found some interesting tidbits. If patients had any of the following, they fared better than other types of people:

higher functional impairment

depression-related work disability

non-chronic depression

no previous antidepressant medication

absence of comorbid physical disease

sought help from a doctor who wasn't a psychiatrist

Side effects of Zoloft - Side effects were reported by 91 patients (4.8% of total sample). The most common side effects were:

nausea (0.5%)

diarrhea (0.5%)

abdominal pain (0.2%)

abdominal discomfort (0.2%)

restlessness (0.6%)

sleeping problems (0.5%)

headache, tremor, or dizziness (0.8%)

sexual problems (0.1%)

According to the researchers, "almost two-thirds of patients (64%)" experienced their side effects during the first week of treatment only.

What this study means - Zoloft seems to be a highly effective antidepressant, especially for people whose depression is relatively new, who haven't taken antidepressants before, and who don't have other physical ailments. If you've just started taking Zoloft and are feeling side effects, wait a week or two and see if they go away on their own.

Are you depressed? Quiz yourself with 7 online depression tests

2006-11-25T23:44:00.001-08:00

If you're not sure if you're depressed, test yourself with one of these online depression quizzes:

PsychCentral.com Goldberg depression screening test

iVillage.com depression screening test (developed by National Mental health Association)

About.com oneline depression test

WebMD.com quiz to rate your risk for depression

Oprah.com depression quiz (by Liz Brody)

About.com post-partum depression screening test

Depression self-test for caregivers (developed by the American Cancer Society)

Everyone gets sad and blue sometimes. Feeling sadness is a natural reaction to tragic or unfortunate circumstances we all find ourselves in.

But chronic depression that lasts months or years, that keeps us at home instead of out with friends, that makes us sleep for more hours than we're awake, and that makes normally pleasurable activities unpleasurable or boring - that's another thing altogether. That kind of sadness might be clinical depression.

These tests can't diagnose you; only a doctor can do that. But if that's what you're feeling, you should talk to your doctor about what's been going on in your life.

Diabetics face 90 percent higher risk for depression

2006-11-25T23:14:00.000-08:00

According to a recent report from the Centers of Disease Control and Prevention, diabetics have 90 percent higher odds than non-diabetics for experiencing "serious psychological distress." Researchers surverying 9,590 New Yorkers found that, overall, five percent of the sample had serious psychological disress. However, 10.4 percent of adults with diabetes reported having serious psychological distress-even after controlling for age, marital status, ethnicity, and income. The CDC report called for

"increased use of more effective methods for detecting and managing depression and other mental disorders might be particularly beneficial for persons with diabetes."

If you have diabetes and feel depressed, talk to your doctor about your treatment options.

Source

DHEA may help depression that starts in middle age

2006-11-25T13:36:00.000-08:00

Researchers studying the antidepressant benefits of the natural, over-the-counter supplement DHEA (dehydroepiandrosterone) say it may help alleviate depression that starts in middle age. DHEA is a natural steroid hormone produced by the human body, and is used by the body to make androstenedione, testosterone and estrogen.

DHEA for depression

The authors of the study, published in the medical journal American Family Physician, write that DHEA may be useful for alleviating some of the symptoms of minor and major depression. They studied 52 adults aged 45 to 65 years of age whose depression started less than 5 years previous. The researchers gave each patient 30 mg of DHEA three times a day for three weeks, followed by 150 mg three times a day for three weeks.

They write that:

"A 50 percent or greater reduction in baseline scores on the Hamilton Depression Rating Scale was reported by 23 patients (50 percent) after DHEA treatment compared with 13 patients. (28 percent) after placebo treatment."

It's important to note that DHEA treatment only appeared to help 50 percent of the patients in the study, and that none of the patients achieved a full remission from depression, they only achieved partial remission.

How to interpret this study

The authors conclude:

"Bottom Line: DHEA is moderately effective in the treatment of midlife-onset depression. Because other treatments have been studied for longer periods, it makes sense to use these approaches first until we have more long-term studies of DHEA."

This study has a small sample size (only 52 people), so it should be regarded with caution. It doesn't prove DHEA to be an effective antidepressant, and it doesn't seem to track potential side effects of taking DHEA as a supplement for depression. As with all supplements and drugs, I think it's best to discuss taking DHEA with your doctor.

This post is part of a series on Natural supplements to beat depression

Natural supplements to beat depression

2006-11-25T13:21:00.000-08:00

This series of posts is meant to give you a broad overview of the usefulness of natural supplements to alleviate and reduce depression. The focus of most of the articles is on findings from published medical research. Over the next couple weeks, I will be adding articles about all types of natural supplements, from St. John's Wort and DHEA to L-Tryptophan and fish oil. If you would like to see articles about specific supplements or types of depression, please let me know by leaving a comment below, and I'll be sure to add one.

Natural supplements for depression - the posts so far

St. John's Wort doesn't help dysthymia

DHEA may help depression that starts in middle age

Wellbutrin XL has fewer sexual side effects than Effexor XR

2006-11-25T11:41:00.000-08:00

If you're currently taking Effexor XR (venlafaxine) and are experiencing sexual side effects such as delayed ejaculation or lack of sexual desire, you may want to talk to your doctor about combining or switching to Wellbutrin XL (bupropion). According to a recent 12-week study of 348 adults published in Journal of Clinical Pharmacology, Wellbutrin XL and Effexor XR both reduce depression symptoms at approximately the same rates, but Effexor XR causes more sexual side effects.

Comparison of Wellbutrin XL and Effexor XR

The researchers write:

"Sexual functioning worsened in patients treated
with venlafaxine XR relative to patients treated with bupropion XL. Depression endpoints improved comparably in patients treated with bupropion XL and venlafaxine XR with the exception of remission rates, which favored bupropion XL over venlafaxine XR. Both antidepressants were generally well tolerated; however, patients perceived a greater side-effect burden with venlafaxine XR."

How Wellbutrin and Effexor work

Both Wellbutrin and Effexor are multiple reuptake inhibitors, which means they regulate more than one neurotransmitter in the brain. Wellbutrin regulates the neurotransmitters dopamine and norepinephrine (called noradrenaline in Europe) and Effexor regulates the neurotransmitters serotonin and norepinephrine. All three neurotransmitters (serotonin, norepinephrine, and dopamine) are thought to be associated with depression and emotions. Other studies show that Wellbutrin alleviates fatigue better than pure SSRIs. Still, this doesn't mean you shouldn't try Effexor, because each antidepressant medication works differently, and Effexor may work well for you.

If you're still trying to find the right antidepressant therapy, read you might enjoy my previous article What's the best antidepressant?.

Source

New study says Botox helps cure depression

2006-11-24T14:35:00.000-08:00

By now, most people know about Botox, the injectable form of botulism which reduces facial wrinkles by paralyzing facial muscles. Something you probably didn't know is that one physician is studying whether botulism can help cure depression.

In his pilot study, Doctor Eric Finzi injected Botox into the foreheads of ten people who were clinically depressed, making them unable to frown or express other "negative" emotions. At the end of 8 weeks, he evaluated them and found nine of ten people no longer depressed.

According to Finzi, Botox reduces depression because:

"To feel emotions, you have to express it on the face. ... You're basically preventing people from expressing those sad and angry emotions on their face. Somehow, that's feeding back directly to the brain."

Problems with the study

Before running out the door and getting yourself shot up with botox, you should be aware this study has numerous large problems:

The subjects aren't random depressed people, they're his plastic surgery patients. This is what scientists call a convenience sample, making it akin to asking people coming out of a supermarket if they are hungry.

Dr. Finizi doesn't say how he measures depression. Just what is "clinically depressed" to a dermatologic surgeon, as he is? This makes readers unable to compare his "before" to his "after" findings, and makes it impossible to compare his findings to the findings of other scientists.

He has no control group who recieve a placebo, so we can't identify how much of people feeling "better" is actually the result of enrolling in the study.

The study is very, very, very small. Ten people is ridiculously small for a scientific study.

His assumption that being unable to express an emotion makes us unable to feel an emotion is merely his conjecture. How many people have been sad at weddings and happy at funerals, but unable to express those emotions for fear of seeming inappropriate?

Personally, I consider this study a prime example of junk science. But I'm sure it will be profitable for Dr. Finzi. If you're looking for more scientifically validated depression research, start with these articles.

St. John's Wort doesn't help dysthymia

2006-11-24T09:22:00.000-08:00

If your doctor has diagnosed you with dysthymia or you think you're dysthymic, you might want to avoid taking the herbal supplement St. John's Wort. According to a new study in the medical journal Phytomedicine, St. John's Wort does not appear to help relieve symptoms of dysthymia.

Definition of dysthymia, or dysthymic disorder

Dysthymia, or dysthymic disorder, is defined as a chronic state of mild, low-grade depression that lasts for at least two years. Symptoms of dysthymia typically include at least two of the following critera: poor appetite or overeating, insomnia or, hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. Psychiatrists estimate that dysthymia affects about 3 percent of the population.

St. John's Wort for depression

A lot has been written about the antidepressant benefits of the herbal supplement St. John's Wort (hypericum). St. John's Wort is often called a "natural antidepressant," and is widely prescribed for depression in Europe, but hasn't yet caught on among American psychiatrists, who typically prescribe multiple reuptake inhibitors like Wellbutrin and Effexor or Selective Serotonin Reuptake Inhibitors like Lexapro and Prozac as a first course of treatment for depression. Numerous studies in the US and Europe have shown that the active ingredient in St. John's Wort, hypericum, may have therapeutic benefits for some types of depression, though the issue is still hotly debated. (I'll report on this topic soon. For now, you can read what the National Center for Complementary and Alternative Medicine thinks).

St. John's Wort is not effective in relieving dysthymia

According to researchers of this study, dysthymic patients taking St. John's Wort experienced symptom relief about the same as those taking the placebo. They write that:

"The finding of the present study is that Hypericum did not show a significant effect in dysthymic patients."

These findings suggest that people with dysthymia should not use St. John's Wort to treat their depression. If you think you are dysthymic, talk to your doctor about other treatment options.

This post is part of a series on Natural supplements to beat depression

Source

Lexapro is an effective treatment for generalized anxiety disorder

2006-11-23T19:09:00.000-08:00

According to a recently published article in the Journal of Affective Disorders, Lexapro (escitalopram) is an effective psychiatric treatment for GAD (generalized anxiety disorder). Symptoms of GAD include excessive, persistent and uncontrollable worry, nervousness or anxiety, with physical symptoms that may include fatigue, irritability, tension, insomnia, dry mouth and increased sweating. GAD patients also frequently experience depression, and doctors are increasingly prescribing Lexapro and other SSRIs as anxiety treatments.

Effectiveness of Lexapro (escitalopram) as an anxiety treatment

More than 850 patients with generalized anxiety disorder participated in this research. Each entered the study with a rating of 18 or higher on the Hamilton Anxiety Scale (HAMA), and began with 10 mg/day of either Lexapro or a placebo sugar pill. By week 8, patients treated with Lexapro decreased their HAMA scores by an average of 10.1 points, while those receiving the placebo decreased an average of 7.6 points.

Side effects of Lexapro

Side effects of Lexapro included (in order of frequency): nausea (18.2 percent), ejaculation disorder (14.3 percent), insomnia (11.9 percent), fatigue (7.7 percent), increased libido (6.8 percent), anorgasmia (5.7 percent).

Wellbutrin alleviates fatigue better than SSRI antidepressants

2006-11-23T11:48:00.000-08:00

Depression is tiring

Most people who are depressed are also fatigued - it's one the most common symptoms of major depression. In fact, doctors estimate that between 75 and 90 percent of people with major depression experience fatigue and excessive sleepiness.

If you're taking antidepressants, you should know that each will affect your energy level differently. Some medications might help you feel better emotionally, but leave your fatigue untouched (That happened with me: I just started taking Lexapro (escitalopram) and I feel it working on my low mood, but I'm still as tired as I was when my depression was at its worst.). Others might actually cause you to feel tired. And some might give increase your energy.

New study finds Wellbutrin better than SSRIs in treatment of fatigue and excessive sleepiness

A new research study published in Biological Psychiatry compared people's experiences taking Wellbutrin and SSRIs, and found Wellbutrin to be superior to SSRIs in relieving fatigue and excessive sleepiness. They wrote that:

"...treatment with bupropion resulted in a greater resolution of sleepiness and fatigue than SSRI treatment. This was true regardless of the degree of fatigue or sleepiness present immediately before treatment was initiated. Bupropion was more effective than placebo in resolving excessive sleepiness and fatigue as early as week 2, more effective than the SSRIs at resolving excessive sleepiness by week 2, and more effective than the SSRIs at resolving fatigue by week 4."

If you're currently taking an SSRI and are still feeling tired, you should talk to your doctor about switching to Wellbutrin or combining it with your current antidepressant. Not only does it relive depression at about the same rates as SSRIs like Prozac and Lexapro, but it can also be safely combined with SSRIs.

SSRI antidepressants pose higher risks of spontaneous abortion in pregnant women

2006-11-21T21:38:00.000-08:00

Women taking SSRI (selective serotonin reuptake inhibitor) antidepressants like Lexapro and Celexa during pregnancy have a higher risk of spontaneous abortion than women who don't take those medications, according to authors of a new study published in the November issue of Reproductive Toxicology. According to the researchers, pregnant women taking SSRIs for depression face between 1 to 2 times greater risk for spontaneous abortion.

Using existing medical research as their data, the researchers wanted to know if women on antidepressants face higher risks of spontaneous abortion and if the fetus faces higher risks of birth defects. The researchers found no higher risks of birth defects in the fetuses of women taking SSRIs.

Catch-22 for depressed pregnant women

Even with this knowledge, choosing the best treatment for depression is difficult. The researchers note that

"Due to concern that antidepressants may harm the fetus women frequently discontinue medications during pregnancy; however, for pregnant women with recurrent major depression who discontinue medication, the risk of relapse is high and untreated maternal mental illness itself may compromise prenatal care, obstetrical outcome, and the postpartum course. The decision for administration of antidepressants during pregnancy is thus complex and evaluation of the safety of this type of drugs during pregnancy is very important."

So pregnant women who are also depressed find themselves in a catch-22 bind. Left untreated, they risk higher rates of spontaneous abortion, but left depressed, they risk all the negative effects of untreated mental illness.

The researchers didn't study other classes of drugs, such as tricyclic antidepressants (TCAs), MAOIs, or multiple reuptake inhibitors like Wellbutrin, Effexor, or Cymbalta. I'll follow up and find out if there's more research out there.

The most commonly prescribed SSRI antidepressants in the US include Prozac (fluoetine), Lexapro (escitalopram), Celexa (citalopram), Zoloft (sertraline), Luvox (luvoxamine), and Paxil (paroxetine).

Sad people suffer more colds and flu

2006-11-21T09:30:00.000-08:00

Here's another reason to get your depression under control: Sad people may get sick more often than happy people, and when they do get sick, they may experience more severe symptoms.

CNN published an article on the research, in a recent issue of the journal Psychosomatic Medicine. Here's what they wrote:

"Cohen and his colleagues found that based on objective measures of nasal woes, happy people were less likely to develop a cold.

What's more, when happy folks did develop a cold, their self-rated symptoms were less severe than would be expected based on objective measures."

And the opposite was true, too. Depressed people were experienced their colds as worse-regardless of the objective symptoms:

"... people with negative dispositions were not at increased risk of developing a cold based on objective measures -- though they did tend to get down about their symptoms."

If you are a person dealing with long-term depression-like I am-this article may sound like one of those overly optimistic "pull yourself out of depression with positive thinking" pieces I hear all the time. But I don't think so. I take it as another good reason to keep on working on our depression in whatever ways we can.

At another level, I enjoy seeing the researchers' mental gymnastics. In essence, the study is basically saying sick people get sick more often and feel worse. It wouldn't be news to say that though.

Links

2006-11-20T19:57:00.000-08:00

Blog and web directories

Blogarama

AbiLogic Web Directory

Blue Host Professional Web Hosting

Interesting health-related web sites

Complete Guide to Egg Donation and Infertility

Q-Ray Ionized Bracelets and Ionic Jewelry

Cool web sites

Apple MacBook Buyer's Guide

Valdoxan (agomelatine) shows early promise in combatting depression

2006-11-20T16:43:00.000-08:00

Depression researchers at the Imperial College School of Medicine in London, UK, are reporting good news about a new antidepressant, which hasn't yet gained FDA approval. The drug, agomelatine, is a melatonergic agonist, which means it blocks reception of the neurotransmitter melatonin, associated with sleep and mood.

After six weeks, Valdoxan reduced study participants' depression about as much as Paxil (paroxetine), but with fewer and less severe side effects. I am especially enthusiastic about this part of their report:

Results suggest favorable tolerabitity of agomelatine compared with a serotonin and noradrenaline reuptake inhibitor, and agomelatine is associated with less sexual side effects that are troublesome with some antidepressants. As predicted from its pharmacological profile, agomelatine improves sleep quality without associated daytime drowsiness. Agomelatine was also shown not to induce a discontinuation syndrome.

Source:

2006. "The Melatonergic Approach in Depression: From Pharmacology to Clinical Evidence - Proceedings of a Satellite Symposium held on the occasion of the 19th ECNP Congress." European Neuropsychopharmacology.
Volume 16, Supplement 5 , September 2006, Pages S633-S638

After Prozac FAQ

2006-11-20T01:06:00.000-08:00

What platform do you use? I use Blogger Beta to manage this blog. It's free, easy to use, and highly customizable. For up-to-date news on Blogger Beta features and updates, check out Blogger Buzz. Blogger Beta comes with several default templates, but if you are feeling inspired, you can modify them. For Blogger Beta hacks, try Beautiful Beta, Freshblog, and Hackosphere. Reading each of those blogs was helpful in designing this one.

What kind of computer do you use to make this blog? I write and design this blog on an Apple iBook (12 inch, 1.5 mhz, 30 gig hd) running Mac OS X 10.4.8.

Who designed your blog? I designed this blog myself.

How old are you? I'm 35 years old.

What antidepressant should I take? People regularly ask me what meds they should be taking. It's an important question, but one I don't know the answer to, since every person's body responds to antidepressant treatments in a unique way. I've written an article about the topic here if you'd like to learn more.

What antidepressants are you taking? Currently, I take Lexapro (escitalopram) 10 mg a day. I take it with a glass of water. I used to take Wellbutrin (bupropion)-and that worked for a while-but then it pooped out on me. After discussing my treatment progress with my psychiatrist, we decided I should try Lexapro. I'll keep you updated on how it's working.

Why don't you publish your last name? I don't publicize my identity for several reasons. First, while this blog is a personal project, it's not really autobiographical, or at least I try not to make it solely about me. Second, depression and other mental illnesses are still attached with a social stigma. Because of this, I don't use my last name here.

Where do you live? I live in Boulder, Colorado, a city of over a 100,000 people about 25 miles outside of Denver. Boulder is nestled along the sides of the Flatiron mountains at over 5280 feet above sea level and is home to the University of Colorado at Boulder.

New study uncovers how SSRI antidepresants work

2006-11-19T16:07:00.000-08:00

A recent NPR story reports that scientists are one step closer to understanding how SSRIs (selective serotonin reuptake inhibitors) actually work in the brain:

Scientists have discovered a protein in the brain called P11 that may explain how drugs like Prozac fight depression -- and why they take so long to work. The finding, published in the current issue of Science, also could point the way to a new generation of drugs for depression.

Before this study, scientists knew that SSRIs regulate the absorption of serotonin, one of the neurotransmitters responsible for mood, but they didn't know the mechanism of action-that is, they envisioned SSRIs like a black box. They didn't know why serotonin levels rise quickly with SSRI's, but take several weeks before actually improving people's mood.

These researchers discovered that SSRI's also regulate p11, a chemical that allows serotonin to do its job:

What this discovery showed was that p11 plays a major role in mood," says Paul Greengard, a Nobel laureate from Rockefeller University. He says that's probably because P11 is helping brain cells respond to serotonin more efficiently.

And while this study was performed on laboratory rats, it could have ramifications for people suffering from depression. Even better, it points researchers towards developing new types of antidepressants.

Combining antidepressants may help antidepressant-resistant patients

2006-11-19T14:31:00.000-08:00

There's a dirty little secret about the psychiatric treatment of depression: only about one-third of patients with major depression respond to drug treatment with a single antidepressant. While this is good news if you're one of the thirty-three percent of people who start to feel better with single-drug treatment, it's bad news for non-responders, the two-thirds who won't get better.

Scientists at the NIMH (National Institute of Mental Health) have been researching the problem of antidepressant non-responders, and found something something surprising: adding a second antidepressant helps a third of non-responders achieve remission of depression symptoms.

The research studies, discussed in this NPR audio interview, were conducted using Celexa (citalopram) and adding either Wellbutrin (bupropion), Effexor (venlafaxine) or Zoloft (sertraline).

While these findings represent good news, the study has several drawbacks. It doesn't include a comparison group for people taking a placebo or one with people undergoing cognitive behavioral therapy.

About SSRIs (selective serotonin reuptake inhibitors)

2006-11-18T17:05:00.000-08:00

History of SSRIs

Selective Serotonin Reuptake Inhibitors (SSRIs) were hailed as the savior for people suffering with depression in the 1980s, when they were introduced. They have lower side effect profiles than tricyclic antidepressants(TCA's) and MAOIs, the two other classes of drugs available before them, and generally interact with other drugs better. To be clear: most SSRIs don't have higher remission or efficacy rates than the earlier drugs, they simply have fewer and less harsh side effects.

SSRIs currently approved in the US:

Celexa (citalopram)

Lexapro (escitalopram)

Luvox (fluvoxamine)

Paxil (paroxetine)

Prozac (fluoxetine)

Zoloft (sertraline)

How SSRIs work

In clinical studies, depression has been shown to be associated with low levels of the brain neurotransmitter serotonin, a chemical made in the brain and associated with regulation of mood, sleep, sexual libido, and appetite. SSRIs work by regulating the flow of that chemical in your brain.

Selective Serotonin Reuptake Inhibitors don't increase your brain's production of serotonin, they slow your brain's processing of it. By slowing down your brain's processing of serotonin and letting your brain "soak" in it longer, it's allowed to provide its positive effects.

SSRIs burst onto the psychotropic scene with Prozac, a drug which general practitioners and psychiatrists prescribed with zeal. In popular culture, Prozac became synonymous with the new antidepressants, and was quickly followed by other, more or less equally efficacious drugs.

Like all antidepressants, the key to finding the "right" one is a trial and error process that you must undergo with your physician. While, as a class, all SSRI's work at about the same rate, that's only true for large populations of people, not for each individual within the population. What this means is that it may take some time to find the best antidepressant for you.

How to support After Prozac

2006-11-18T15:39:00.000-08:00

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Thanks again,

Adam

What is the best antidepressant?

2006-11-17T17:01:00.000-08:00

I don't know. I wish I knew, but each drug works differently, and each person's body chemistry is different. What works well for one person may work horribly for another.

Besides the choice of drug, other issues factor in. What dosage works well for one person may work horribly for another. Some depressed people find a measure of relief with one medication, while others get better taking a cocktail of one, two, or three drugs. And then there is the issue of diagnosis. Are you diagnosed only with depression, or are you diagnosed with depression and anxiety? Or depression and obsessive-compulsive disorder? Or depression and insomnia. Or depression and ADHD? Or all of the above?

Thus, finding the "best" antidepressant is a highly individual affair, and one which takes patience, a good doctor who is willing to work with you, and one who you're willing to work with. I know this sounds glib, but its true.

Additionally, there's quite a bit of clinical evidence that suggests that drug therapy shouldn't be considered your only option. Other things can help, too. Talk therapy, especially cognitive behavioral therapy, has shown good results for getting depression under control. Exercise helps, as does having a good support network of friends and family.

About After Prozac

2006-11-17T16:50:00.000-08:00

Contrary to popular opinion, depression is a big deal. Consider the following:

In any one year, 9.5 percent of the US population, or about 21 million American adults, suffer from some form of depressive illness.

In the U.S. about 16 percent of the population can expect to be clinically depressed in at least once in their lives.

If you've experienced one episode of major depression, you have a greater than 50 percent chance of recurrence.

If you've experienced two episodes, you have a greater than 70 percent chance of recurrence.

Worse yet, after three episodes that figure jumps to 90 percent.

Depression is the leading cause of disability in the U.S. as well as other countries, and is expected to become the second leading cause of disability worldwide (after heart disease) by the year 2020, according to the World Health Organization.

Around the world, an estimated 121 million people currently suffer from depression.

Yet many depressed people lack solid, reliable information about effective treatments. Some think it can be cured by sheer force and willpower. Others think a cure is impossible, that it is somehow their 'fate' to be sad.

But the truth is, for most people, much of the time, depression is a treatable, if not curable condition. Armed with information about appropriate and available treatments, many depression sufferers can greatly reduce their most painful and debilitating symptoms. Yet without reliable information, without knowing who to talk to, what to ask for, getting better seems seems like a far-off possibility, if not downright impossible.

But there is hope for people suffering from depression. Drug therapies and talk therapies have come a long way in the last decades. The best way to get your depression under control is combing both talk and drug therapy. The problem is that the people who need the information the most-depressed people-don't have access to the most recent scientific research on effective depression treatments.

What's more, when scientific research does make its way into the public realm, it gets reported uncritically or just plain erroneously. There's a massive gap between what depressed people have a right to know, what they need to know and what they are allowed to know.

Thirty years ago this knowledge gap was probably not considered a big problem. Back then, we were "patients" who went to doctors for their "expert" knowledge.They told us what to do, and we did it. They talked, and we listened. This kind of relationship worked, because we trusted the infallibility of their expertise, because depression (and all mental illnesses) came with a potent social stigma, and because we were smart enough to admit we needed help. We took doctors on their word. They were the experts, after all.

Yet over the last 20 years or so, that model of the doctor-patient relationship has begun a slow, but unstoppable transformation. Patients began to demand more of doctors. Much more. We aren't just patients, we said. We are people. People who no longer choose to accept the "patient" role, and the passivity that label implies. We are people who claim the mental know-how to make choices about our treatments, and who deserve access to current, reliable medical knoweldge about their condition and treatment options.

Filling that information gap is the main reason I created "After Prozac."

I continue building it because I'm one of the 9.5 percent of Americans who is depressed. I think I've always been depressed, or at least those feelings have been close to me, at varying depths of my consciousness. I'm the third of three children, and each of us deals with depression in our own ways, though I'm the only one who takes meds for my depression. I didn't always take psychiatric meds, but over the last few years since I've been in graduate school, I've started. Grad school is a lonely, confidence-busting journey, and it takes its toll-even on the strongest of souls.

For me, building this site is a form of therapy. The more I researched depression and the newest depression treatments, I realized that much of what I was reading in the university library isn't widely available to the people who need it most. I hope you find it helpful.

With love and hope,

Bloggeroo, Site Owner