Antidepressants. What are they?

What are antidepressants?

Antidepressants are psychiatric drugs which are available on prescription, and are licensed to treat depression. Some are also licensed to treat other conditions, such as:

• anxiety
• phobias
• bulimia (an eating disorder)
• some physical conditions

I took medication for six months. It helped lift the fog and gave me the energy I needed to tackle the root cause of my depression. There is no shame in taking medication to treat an illness.

How do they work?

All antidepressants work by boosting or prolonging the activity of particular brain chemicals, such as noradrenaline and serotonin, which are both thought to be involved with regulating mood.
Noradrenaline and serotonin are neurotransmitters. This means that they pass messages between nerve cells in your brain and also between nerves and other target organs in the rest of your body.

What different types of antidepressant are there?

There are several different types of antidepressants, which were developed at different times. They all tend to act on the same brain chemicals and cause similar effects, but the different types have different chemical structures, and may have different side effects.
The different types are:

• serotonin reuptake inhibitors (SSRIs)
• serotonin and norepinephrine reuptake inhibitors (SNRIs)
• tricyclics and tricyclic-related drugs
• monoamine oxidase inhibitors (MAOIs) 
• other antidepressants

(For a list of all antidepressants grouped by type see our page on comparing antidepressants, or for detailed information on an individual antidepressant see our antidepressants A–Z.)

Selective serotonin reuptake inhibitors (SSRIs)

About SSRIs:

• They were first developed in the late 1980s, so they have been in use for about 30 years.
• They work by blocking the re-uptake of serotonin into the nerve cell that released it, which prolongs its action in the brain.
• The side effects SSRIs can cause are generally easier to cope with than those of other types of antidepressants.
• They're the most commonly prescribed type of antidepressant in the UK.

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

About SNRIs:

• The first of these was developed in the early 1990s, so they're one of the newer types of antidepressant.
• The're very similar in action to SSRIs, but they act on noradrenaline as well as serotonin.
• They have a more selective action than tricyclics, which means they're better at targeting the brain chemicals which affect your mood without causing unwanted side effects by affecting other chemicals and other parts of the body as well.
• They're sometimes preferred for treating more severe depression and anxiety.

Tricyclic and tricyclic-related drugs

About tricyclics:

• They're the oldest type of antidepressant, first developed in the 1950s.
• They work by prolonging the action of noradrenaline and serotonin in the brain.
• They're called ‘tricyclic’ because of their chemical structure, which has 3 rings.
• They tend to cause more unpleasant side effects compared with other types of antidepressants.

About tricyclic-related drugs:

• They act in a very similar way to tricyclics, but they have slightly different chemical structure.
• They tend to cause more unpleasant side effects compared with other types of antidepressants, but they're less likely to cause antimuscarinic effects than tricyclics.

Monoamine oxidase inhibitors (MAOIs)

About MAOIs:

• They work by making it harder for an enzyme (monoamine oxidase) that breaks down noradrenaline and serotonin to do its job, causing these chemicals to stay active in the body for longer.
• They can have dangerous interactions with some kinds of food, so when taking MAOIs you need to follow a careful diet.
• Because of these interactions, you're not likely to be prescribed an MAOI unless you've tried all other types of antidepressant and none of them have worked for you.
• They should only be prescribed by specialists.

Source:  http://www.mind.org.uk/information-support/drugs-and-treatments/antidepressants/about-antidepressants/?o=7247#.VdMeyH2jJpU

How to beat depression – without drugs

Dr Steve Ilardi is slim and enthusiastic, with intense eyes. The clinical psychologist is 4,400 miles away, in Kansas, and we are chatting about his new book via Skype, the online videophone service. "I've spent a lot of time pondering Skype," he says. "On the one hand it provides a degree of social connectedness. On the other, you're still essentially by yourself." But, he concludes, "a large part of the human cortex is devoted to the processing of visual information, so I guess Skype is less alienating than voice calls."
Social connectedness is important to Ilardi. In The Depression Cure, he argues that the brain mistakenly interprets the pain of depression as an infection. Thinking that isolation is needed, it sends messages to the sufferer to "crawl into a hole and wait for it all to go away". This can be disastrous because what depressed people really need is the opposite: more human contact.
Which is why social connectedness forms one-sixth of his "lifestyle based" cure for depression. The other five elements are meaningful activity (to prevent "ruminating" on negative thoughts); regular exercise; a diet rich in omega-3 fatty acids; daily exposure to sunlight; and good quality, restorative sleep.
The programme has one glaring omission: anti-depressant medication. Because according to Ilardi, the drugs simply don't work. "Meds have only around a 50% success rate," he says. "Moreover, of the people who do improve, half experience a relapse. This lowers the recovery rate to only 25%. To make matters worse, the side effects often include emotional numbing, sexual dysfunction and weight gain."
As a respected clinical psychologist and university professor, Ilardi's views are hard to dismiss. A research team at his workplace, the University of Kansas, has been testing his system – known as TLC (Therapeutic Lifestyle Change) – in clinical trials. The preliminary results show, he says, that every patient who put the full programme into practice got better.
Ilardi is convinced that the medical profession's readiness to prescribe anti-depression medication is obscuring an important debate. Up to 20% of the UK population will have clinical depression at some point, he says – twice as many as 30 years ago. Where has this depression epidemic come from?
The answer, he suggests, lies in our lifestyle. "Our standard of living is better now than ever before, but technological progress comes with a dark underbelly. Human beings were not designed for this poorly nourished, sedentary, indoor, sleep-deprived, socially isolated, frenzied pace of life. So depression continues its relentless march."

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Our environment may have evolved rapidly but our physical evolution hasn't kept up. "Our genome hasn't moved on since 12,000 years ago, when everyone on the planet were hunter- gatherers," he says. "Biologically, we still have Stone Age bodies. And when Stone Age body meets modern environment, the health consequences can be disastrous."
To counteract this Ilardi focuses on the aspects of a primitive lifestyle that militate against depression. "Hunter- gatherer tribes still exist today in some parts of the world," he says, "and their level of depression is almost zero. The reasons? They're too busy to sit around brooding. They get lots of physical activity and sunlight. Their diet is rich in omega-3, their level of social connection is extraordinary, and they regularly have as much as 10 hours of sleep." Ten hours? "We need eight. At the moment we average 6.7."
So we should all burn our possessions and head out into the forest? "Of course not," Iladi shudders. "That would be like a lifelong camping trip with 30 close relatives for company. Nobody would recommend that."
Instead we can adapt our modern lifestyle to match our genome by harnessing modern technology, such as fish oil supplements to increase our intake of omega-3. All well and good. But I can't escape the feeling that the six-step programme seems like common sense. Isn't it obvious that more sleep, exercise and social connectedness are good for you?
"The devil is in the detail," replies Ilardi. "People need to know how much sunlight is most effective, and at which time of day. And taking supplements, for example, is a complex business. You need anti-oxidants to ensure that the fish oil is effective, as well as a multivitamin. Without someone spelling it out, most people would never do it." Ilardi practises the programme himself. He's never been depressed, he tells me, but it increases his sense of wellbeing and reduces his absentmindedness (his college nickname was "Spaced").
It all makes sense, but will I try it myself? I don't suffer from depression, but wellbeing sounds nice. I'm not so sure about the fish oil, but I might just give it a go.

Enjoy the sunshine, get plenty of sleep – and be sociable

▶ Take 1,500mg of omega-3 daily (in the form of fish oil capsules), with a multivitamin and 500mg vitamin C.
▶ Don't dwell on negative thoughts – instead of ruminating start an activity; even conversation counts.
▶ Exercise for 90 minutes a week.
▶ Get 15-30 minutes of sunlight each morning in the summer. In the winter, consider using a lightbox.
▶ Be sociable.
▶ Get eight hours of sleep
Source:  http://www.theguardian.com/lifeandstyle/2010/jul/19/beat-depression-without-drugs

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Our terrifying addiction to antidepressants: GPs dole out 25% more 'happy pills' in just three years

ritons are increasingly relying on antidepressants – with the number of prescriptions soaring by a quarter in just three years.

NHS figures reveal that 53million were issued last year – a record high – compared with just 42.8million in 2010, and 20.1million in 1999.

Some psychiatrists say that people suffering what used to be a bout of the everyday blues are now being diagnosed with a medical condition and prescribed treatment.

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Soaring: NHS figures reveal a sharp increase in the number of antidepressants, such as Prozac, being handed out in Britain

There is also concern that GPs are handing out pills such as Prozac and Seroxat too freely when they should be referring patients for counselling or other therapies.

Doctors say they have no choice but to prescribe medication because the waiting times for talking therapies are so long and patients are reluctant to leave without treatment.

 

But some experts say there is little evidence that the pills even work and they can cause debilitating side effects such as agitation, tiredness and suicidal thoughts.

Dr Joanna Moncrieff, an author on mental health drugs and consultant psychiatrist at North East London NHS Foundation Trust, said: ‘Being depressed from time to time is a universal human experience.

‘Diagnosing people with a medical disorder and prescribing a pill may appear to offer an easy answer, but it stores up more problems than it solves.

As a society, our dependence on antidepressants makes us less resilient and less resourceful in the face of the everyday challenges of modern living.

In my clinical experience, many people just carry on taking their antidepressant because they are too fearful to stop, and research in general practice confirms that people are taking these drugs for longer and longer periods.’

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Dangers: experts have spoken out about how people using the pills can become too afraid to stop, even when they do not need them any more

Labour MP Jim Dobbin, chairman of the all-party parliamentary group on involuntary tranquilliser addiction, said there were ‘serious problems’ with addiction to antidepressants.

‘We need closer regulation of this,’ he said. ‘The pharmaceutical industry is very powerful and puts  too much pressure on the medical profession to prescribe them.’

A report by the Health and Social Care Information Centre last year showed that in some parts of the UK as many as one in six adults is on antidepressants.

One such area is the South Wales borough of Blaenau Gwent, where the NHS issues almost 10,000 prescriptions for different types of ‘happy pills’ each month.

It is one of the most economically depressed areas of the UK and local GP Greg Graham has spoken of the problems that lead to the heavy use of medication.

‘There remains a lot of low morale, issues of poor health and lack of opportunities,’ he said.

A charity has set up a drop-in centre in one of the towns, Brynmawr, for people on antidepressants to receive counselling or just have a cup of tea. It is said to be used by a ‘significant number’ of people in their early 20s.

Separate data from the Organisation for Economic Co-Operation and Development shows that the UK has the seventh highest prescribing rate for antidepressants in the Western world.

There are 71 daily doses for every 1,000 people, compared with 38 daily doses per 1,000 people a decade ago.

In France and Germany the figure is 50 doses a day, while in Italy it is 42 doses a day.

Sophie Corlett, from the mental health charity Mind, said: ‘The number of prescriptions for antidepressants issued in the UK has been rising for many years. These new figures show no sign of this trend slowing and we need to know why we are seeing persistent increases.

‘We know that people are more aware of other treatment options and many do not want to be treated with drugs but cannot, and should not have to, wait months for therapy.’

Source: http://www.dailymail.co.uk/health/article-2609114/Our-terrifying-addiction-antidepressants-GPs-dole-25-happy-pills-just-three-years.html

How to Get Rid of Depression

Depression is a clinical condition, a disease just as real as a cold or flu. Treatment for depression varies widely from person to person, but there are some approaches that seem to work more often than others. Read this guide to learn about them and consider which ones are worth trying yourself.

Method 1 of 3: Focus on Health and Fitness

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   1
   Exercise. Physical exercise releases chemicals in the brain that help boost your mood. It's long been known that vigorous, regular exercise can serve to lessen and in some cases even cure depression in many patients. The best part of exercise as a treatment for depression is that it's basically free. On the other hand, some people suffering from depression find it almost impossible to get motivated enough to start a regular exercise routine.
   • Cardiovascular exercise is an ideal core exercise for treating depression, as the body can sustain cardio activity for a much longer period of time than resistance exercise, without any ill effects. Choose cardio exercise that's easy on your joints, such as swimming laps or cycling, if you possibly can.
     
   • If you'd like to try exercise a s a means of fighting your depression, but just can't seem to work up the will to do it, talk to a trusted friend or loved one and ask them to help you get out and start doing it. Explain that it won't be easy to motivate you, but that any help they can give will be sincerely appreciated.
     
   • Exercise for at least 30 minutes a day, 3 times a week to begin to feel a sustained effect on your mood. It may take a few weeks to really notice a change.
     • If you're exercising a lot and still feel just as depressed as before, you should try something else instead. However, for purely physical reasons, you should also continue with your fitness regimen as long as you're able to make yourself do so.
2. 
   2
   Control your diet. There's some research that suggests certain dietary guidelines can help people suffering from depression, by providing the body the correct chemical tools it needs to heal the chemical imbalances that often cause depression. The dietary approach doesn't work for everybody, but like exercise, it's a relatively inexpensive treatment that has no negative side effects to speak of.
   • Eat foods rich in depression-fighting nutrients. Studies have shown links between lowered rates of depression and the nutrients folate, vitamin B12, vitamin D, selenium, and Omega-3. Start by focusing on foods that are rich in some or all of these nutrients, such as dark green vegetables, legumes (beans), nuts, extra-lean meat, whole fruit, and yogurt.
   • Get plenty of antioxidants. Antioxidants seem to help the brain (and the rest of the body) stay in better shape overall by neutralizing free radicals, damaging particles that are seen as a leading cause of cellular degeneration over time. Although antioxidants aren't strictly indicated as a treatment for depression, they do allow your brain to function more smoothly overall. Look for foods high in beta carotene, vitamin C, and vitamin E, such as carrots, squash, citrus fruit, and nuts.
   • Eat complex carbohydrates to relax. Carbohydrates have a well-known stress-reduction effect when eaten, but some carbs are better for you than others. Avoid simple carbs like sugar and milled grain; opt for brown rice, whole grains, and legumes instead.
   • Get plenty of protein. Protein in foods like turkey and fish helps boost energy and alertness levels, improving overall mood.
3. 
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   Get some sunshine. Your body naturally produces vitamin D, which is known to help combat depression and mood swings, when your skin is exposed to the sun. This is why some counselors prescribe sunlight lamps for depression patients who live in areas with low winter sunlight: it stimulates the same effect as going outside and standing under bright sunlight. Make a commitment to do the real thing yourself, for at least 15 or 20 minutes, whenever you have the chance.
   • If you're going to be out in the sun for more than a few minutes, take sensible precautions by applying sunscreen to your bare skin and wearing sunglasses. Your skin will still manufacture vitamin D even if you wear sunscreen.
   • You don't necessarily have to do anything while you're outside. Just find a bench and sit for a while, or take a leisurely walk around your neighborhood.

Method 2 of 3: Use Therapy and Medication

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   Visit a counselor. Counselors are the first line of treatment professionals in the world of mental health. They're somewhat less trained than psychiatrists and psychologists, but they still spend years in graduate school and are highly skilled and knowledgeable in treating depression and other mental illness with the power of speaking therapy. Counselors are usually cheaper to visit than psychiatrists or psychologists as well, making them a good first choice.
   • As a patient, you have the right to shop around and find a counselor who makes you feel welcome and at ease. A bad counseling experience can put you off the whole idea for years, which could deprive you of valuable therapy. Remember that not all counselors are alike; find one you like and stick with him or her.
   • Counselors will generally prompt you to speak with careful questions, and then listen to what you have to say. It can be nerve-wracking at first to open up to your counselor, but most people find it hard to stop talking after a few minutes have passed. The counselor will listen for significant ideas and phrases, and discuss them in greater detail with you to help you work out mental and emotional hangups that may be contributing to your depression.
   • The effects of counseling are gradual. Expect to attend regular sessions for at least a few months before noticing any permanent effect. Don't give up hope before you've given it time to work.
2. 
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   See a psychiatrist or clinical psychologist. The difference between these two professionals is in their doctorates: Psychiatrists hold a medical doctorate, while psychologists hold a Ph.D. or a Psy. D. (Doctorate in Psychology). Both are exceptionally well-trained, and both can tend to patients. Psychologists rely on psychotherapy, and cannot generally prescribe medication; psychiatrists combine therapy with medication.
   • Whichever type of professional you see, therapy sessions will be a significant part of your treatment. They may have less common psychotherapy methods that will work better for you than a counselor's standard approach; again, feel free to meet and discuss this until you find a doctor you're comfortable with.
   • As with all therapeutic treatments for depression, the typical treatments you receive from a psychologist or psychiatrist will take some time to have a lasting effect. In extreme cases, these professionals may recommend unorthodox or experimental treatments. If you've tried everything and are at the end of your rope, speak to them about such treatments.
3. 
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   Try antidepressant medication. Antidepressants can normally only be prescribed by a medical doctor. Psychiatrists are best qualified to prescribe them, but your regular family doctor may also have some power to judge your mental state and write you a prescription. Antidepressants comprise a wide field of many different types of drugs, all of which have some effect on your brain chemistry, which is generally seen as the source of most clinical depression. The most common types are SSRIs, SNRIs, MAOIs, and tricyclics.
   • Because there are so many different types of antidepressant, your psychiatrist may have you try a few different medications until one seems to work. Some antidepressants backfire on some people, so it's very important to stay in close contact with your practitioner and note any negative or unwelcome change in mood immediately. Usually, switching to a different class of drug will fix the problem.
   • Antidepressants take time to work, because they slowly and gently modify the brain's chemical balance. Generally speaking, it will take at least three months to see any lasting effect from an antidepressant.

Method 3 of 3: Try Uncommon Treatments

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   Shock your depression away with electroconvulsive therapy. Electroconvulsive therapy, or ECT, is commonly seen as a ghastly and barbaric treatment used in horror movies and soap opera plots more than anything else. The truth is, despite the treatment's checkered past, modern ECT is experiencing a recent surge in popularity as a last-ditch treatment for people with severe, major depressive disorder. The procedure is completely voluntary, and the shocks are administered under mild anesthesia so that the patient experiences no discomfort.
   • ECT treatments are not used except in extreme and recurring cases of depression. They're much safer than they were 60 years ago, but there are still risks associated with them, partly because their antidepressant effect on the brain isn't yet fully understood. If your doctor doesn't suggest ECT, it's unlikely he or she will sign off on it when you suggest it.
   • The treatment begins with a mild anesthetic, followed by several shocks delivered to the brain. The antidepressant effect is powerful and immediate; however, in most cases, more sessions are required to achieve a permanent cure. Sessions gradually get spaced farther apart, and last for a year at most (at which point they're typically administered just once per month).
   • Side effects of ECT include temporary short-term memory loss, confusion, and dizziness. However, studies have shown no long-term side effects whatsoever, including cognitive effects. Therefore, it's seen as a legitimately viable option for people who can't seem to recover from depression any other way.
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   Try herbal therapy if you want. Studies haven't shown any conclusive links between herbs like St. John's Wort, which is a common folk remedy for depression, and increased rates of recovery from major forms of the disease. However, comprehensive studies of its effects on mild and moderate depression aren't available yet, and many people swear by it.
   • If you buy herbal supplements, be sure to by from a reputable seller. Supplements are only very loosely patrolled by the FDA, and as such, levels of purity and quality vary wildly from manufacturer to manufacturer.
   • St. John's Wort in particular has been shown to interact negatively with clinical antidepressants. Ask your psychiatrist before taking it if you're already on a clinical drug.
   Source: http://www.wikihow.com/Image:Get-Rid-of-Depression-Step-8-Version-2.jpg