David Poon, BSc. Immunology and Infection, PharmD Candidate
Depression
Last week, we discussed the symptoms of depression, how to screen for depression, and important helplines in times of crisis. This week, we talk about common methods for treating depression.
Although there are many, one common misconception is that when someone is diagnosed with depression, they must be on lifelong medication. While this may be the case for some, this statement is not entirely true. The length of treatment depends on the individual and severity of the depression. Our focus this week is to discuss how depression is managed and what you can expect from drug therapy.
The Best Drug
Like with most drugs, there isn’t a single magic pill that works better than all the other drugs. Antidepressants are prescribed based on multiple factors such as:
- Medical conditions
- Current list of medications
- Tolerance to medication side effects
- Past successes or failures with certain antidepressants
Typically clinicians will start patients on a SSRI or SNRI, which are classes of antidepressants that work on the serotonin and serotonin/norepinephrine receptors in the brain, respectively.1 SSRIs and SNRIs are classes of medications that have been shown to be effective with relatively few intolerable side effects. While these are considered a first line treatment option for depression, they’re not the only antidepressants available. Based on a comprehensive discussion with your healthcare professional, what is considered the best option for you may be different than for others.
Importance of Adherence
Regardless of the antidepressant used, adherence – that is, staying on the medication regularly may be one of the most important factors in determining the success of antidepressants. Unlike some drugs, such as Advil® or Tylenol®, antidepressants don’t work right away. In fact, it may take up to 1-4 weeks to see a partial response and up to 8 weeks to achieve remission.2 Remission is achieved when individuals no longer experience symptoms of depression and is the main goal when using antidepressants. It can be very frustrating to wait 8 weeks to feel like yourself again, but don’t be discouraged if you don’t see immediate improvements in your emotional symptoms. In fact, only 33% of patients achieve remission the first time they try medication, while the rest try at least one other antidepressants before achieving remission.
To see the full benefits of antidepressant medications, it’s important to continue taking the antidepressant as prescribed and avoid missing a dose. But, if improvements don’t occur in 1-4 weeks at a proper dose, then it’s time to speak to a healthcare professional. This might just mean that you need to switch antidepressants. Depending on the severity of depression as well as various other factors, treatment usually continues for at least 6-9 months after achieving remission to prevent relapse of your symptoms. So, even after you start to feel better, it’s important to continue taking your medication.
Side Effects
Unfortunately, like every other drug available, there are side effects to every antidepressant. Due to the extensive list of medications available for treatment and the corresponding side effects associated with each, we won’t be discussing this today. However, any side effects must be discussed with your healthcare professional. One thing to note regarding side effects is that the majority of them, including upset stomach, nausea, and headache may go away in a couple of weeks.3 However, some side effects such as insomnia, sexual dysfunction and weight gain, don’t go away with time. So, it’s important to discuss the side effects of the medication and what is important to you before you start.
Comorbidities
Comorbidities are other medical conditions that go alongside a particular medical condition. Anorexia, anxiety, bipolar, bulimia, and substance abuse are some of the common comorbidities that go along with depression.2 Not everyone has these comorbidities, but your healthcare professional will most likely screen for these other comorbidities. Comorbidities can affect the treatment success of depression, and it’s important that if comorbidities are present, they’re also treated.
The Bottom Line
Treating depression can be frustrating for many. The path to remission is not an easy one to walk. It requires strict adherence to a medication and patience if the first medication doesn’t work. Sometimes, individuals can be cured of depression and sometimes, antidepressants need to be continued for a longer period of time. It truly does depend on the individual. If you’re depressed, I hope you find the courage to speak to someone about it. There is light at the end of the tunnel. And if you know someone who you might think is being affected by depression, reach out to them and offer a helping hand. It’s better to be wrong and look silly than to let someone suffer alone. On behalf of the team, if you’re out there reading this and struggling, then I hope these articles have helped you in some way, and that you feel more confident and informed about depression.
We hope you took away something valuable from this piece. If you have any questions or concerns regarding this article or others, feel free to reach out to us on Instagram, Facebook, or at ask@orbishealth.ca with your feedback. We’d love to hear from you.
RESOURCES
- Trivedi, M. H., Rush, A. J., Wisniewski, S. R., Nierenberg, A. A., Warden, D., Ritz, L., . . . Fava, M. (2006). Evaluation of Outcomes With Citalopram for Depression Using Measurement-Based Care in STAR*D: Implications for Clinical Practice. American Journal of Psychiatry,163(1), 28-40. doi:10.1176/appi.ajp.163.1.28
- Kennedy, S. H., M.D., Lam, R. W., M.D., McIntyre, R. S., M.D., Tourjman, S. V., Bhat, V., M.D., Blier, Pierre,M.D., PhD., . . . Uher, Rudolf,M.B., PhD. (2016). Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 3. pharmacological treatments. Canadian Journal of Psychiatry, 61(9), 540-560. doi:http://dx.doi.org.login.ezproxy.library.ualberta.ca/10.1177/0706743716659417
- Kennedy, S. H., Parikh, S. V., & Grigoriadis, S. (2017). Depression. RxTx.
