Depression Treatment
-Dr. C.H. Asrani Dr. Nilesh Baxi
Indian Council for Health Education and Health Services
Source: My Doctor
Issue: January 1998
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For a patient of Depression it is not treatment that is to be discussed but all round management, involving patient, physician, family and counselor. Work mates wherever required have to chip in their contribution. As we have seen earlier, Depression is of 2 types Primary & Secondary, So is the management. Depression can be treated either by Drugs or by Counselling but more often by a combination of the two. For proper treatment, correct diagnosis is essential. Whether the Depression is Primary or Secondary and if Secondary what has precipitated it?
The mainstay of management of a case of Depression is Anti Depressant drug. Counselling, of course, forms a very important pillar of the management. Having seen in practice, myths surrounding long-term therapy with medicines, we thought it is justified in devoting this article to commonly used Anti Depressants. It is not at all our intention to promote self-medication, but to caution our readers against it. It has lots of information that your doctor may not have the time to impart or you may not have the patience to hear.
Antidepressants :
A group of medicines prescribed to treat mental depression. These are broadly classified into two groups.
MAO (Mono Amine Oxidase) Inhibitors :
A special group of drugs prescribed for mental depression. These are not as popular as in years past because of a relatively high incidence of adverse effects. These drugs include isocarboxazid (Marplan), tranylcypromine (Parnate).
Tricyclic (TCA) Antidepressants :
A group of medicines with similar chemical structure and pharmacological activity used to treat mental depression. These drugs include amitriptyline, amoxapine clomipramine, doxepin, imipramine, nortriptyline, trimipramine.
We, in India, use TCA group of drugs. These are also known as "Mood Elevators" - as they bring back the patient who is down in dumps to a near normal state of mood. Logically speaking, if a mood elevator works fast enough, it will be habit forming and will be one of the addicting 'drugs'. Anti depressants start their action slowly. It may take as long as 15 days for full action to manifest. Newer drugs may start action in 5-10 days. Since all these drugs act slowly and the condition is of a chronic nature, long term treatment is mandatory. If one is going to be on a certain group of drugs, it is advisable that the patient and the family is conversant various facets of the drug.
Warnings and Precautions
Don't take if :
- You are allergic to any tricyclic antidepressant.
- You drink alcohol.
- You have had a heart attack within 6 weeks.
- You have glaucoma.
- Patient is younger than 12 years.
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TRICYCLIC ANTIDEPRESSANTS
Possible Adverse Reactions Or Side Effects |
| SYMPTOMS |
WHAT TO DO |
| Overdose Symptoms |
Hallucinations, drowsiness, enlarged pupils, respiratory failure, fever,
cardiac arrhythmia, convulsions, coma. |
Stop the medicine and call the doctor |
| Common |
| Tremor. |
Discontinue. Call doctor right away' |
Headache, dry mouth or unpleasant taste, constipation or diarrhea, nausea,
indigestion, fatigues, weakness, drowsiness, nervousness, anxiety, excessive sweating. |
Continue. Inform doctor |
| Insomnia, 'sweet tooth.' |
Continue. Tell doctor at next visit. |
| Infrequent |
| Convulsions |
Discontinue.
Seek emergency treatment. |
Hallucinations, shakiness, dizziness, fainting, blurred vision, eye pain, vomiting, irregular
heartbeat or slow pulse, inflamed tongue, abdominal pain, jaundice, hair loss, rash,
fever, chills, joint pain, palpitations, hiccups, visual changes. |
Discontinue. Call doctor right away. |
Difficult or frequent urination; decreased sex drive; muscle aches; abnormal dreams;
nasal congestion; weakness and faintness when arising from bed or chair; back pain. |
Continue. Inform doctor. |
Rare
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Itchy skin; sore throat; involuntary movements of jaw, lips and tongue; nightmares;
confusion; swollen breasts; swollen testicles. |
Discontinue. Call doctor right away. |
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Before you start, inform your doctor :
- If you are posted for surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.
- If you have an enlarged prostate.
- If you have heart disease or high blood pressure.
- If you have stomach or intestinal problems.
- If you have an overactive thyroid.
- If you have asthma.
- If you have liver disease.
Over Age 60 :
More likely to develop urination difficulty and side effects such as seizures, hallucinations, shaking, dizziness, fainting, headache, insomnia.
Pregnancy :
Studies in humans are inconclusive about harm to unborn child. Animal studies show fetal abnormalities. Decide with your doctor whether drug benefits justify risk to unborn child.
Breast-Feeding :
Drug passes into milk. Avoid drug or discontinue nursing until you finish medicine. Consult doctor about maintaining milk supply.
Infants & Children :
Don't give to children younger than 12 years.
Prolonged Use :
Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check complete blood counts (white blood cell count, platelet count, red blood cell count, hemoglobin, hematocrit), blood pressure, eyes, teeth.
Skin & Sunlight :
May cause rash or intensify sunburn in areas exposed to sun.
Driving and Hazardous Work :
Don't drive until you learn how medicine affects you. Don't work around dangerous machinery. Don't climb ladders or work in high places. Danger increases if you drink alcohol or take medicine affecting alertness and reflexes.
Discontinuing
- Don't discontinue without consulting your doctor. Dose may require gradual reduction if you have taken a drug for a long time. Doses of other drugs may also require adjustment.
- Withdrawal symptoms such as convulsions, muscle cramps, nightmares, insomnia, abdominal pain. Call your physician right away if any of these occur.
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