The Gist:
Antidepressant use in the U.S. doubled from 1996 to 2005, according to a new report in the August issue of Archives of General Psychiatry. During that decade — the last period in which data were available — the percentage of Americans using antidepressants surged from less than 6% to more than 10%, or more than 27 million people. The study, which surveyed nearly 50,000 people above the age of six, reveals that antidepressants — the most commonly prescribed class of medicine in the U.S. — are being used to treat not just depression and anxiety but disorders ranging from back pain to sleeplessness. The authors also underline the degree to which pharmacology often supplants psychotherapy as the primary treatment for mental ailments.
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Posted: Aug 07, 2009
tags: antidepressant medication,
antidepressants,
antidepressant treatment,
depression treatment
1. Be clear about your reason(s) for wanting to switch antidepressants. Is it that the side effects are intolerable, or is it that you are not satisfied with the response? If you want to switch for the latter reason, you need to determine exactly what you mean and communicate that to your doctor. Did you antidepressant ever work fully? Bear in mind that you need to give the medication up to four weeks before you would definitely be seeing an improvement. Or did it lift your mood to some extent and then plateau? That's called a partial response. In first case, your doctor will probably be open to your switching to a new antidepressant. If it's the latter, however, your doctor may want to raise the dose or possibly augment your current antidepressant with another medication.
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Posted: Jun 22, 2009
tags: antidepressant medication,
antidepressants,
antidepressant treatment
The other day, I took an impromptu break at work to buy something to drink. "I'm just so dehydrated," I told my boss. "My blood pressure medication does that to me - maybe yours is having the same effect."
Aha. That was probably it. Due to my elevated blood pressure, my doctor had strongly suggested I start on medication, which I had done a few days before. I remember from the last time that I took it that it also can cause moments of dizziness. Yay. I grimaced when the doctor suggested that I start on the medication again, and she said, "The side effects can be unpleasant, but so can your heart enlarging." Geez, when you put it that way.
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Posted: Jun 16, 2009
tags: antidepressant medication,
antidepressants,
antidepressant side effects,
antidepressant treatment
I've been taking antidepressant medication for almost twenty years solid, with the exception of the period when I was switching antidepressants and when I was pregnant. The first antidepressant my depression was treated with was Norpramin, also known as Desipramine. I was very lucky, as it worked very well for me. Not everyone has that kind of success with their first antidepressant. There were a couple of uncomfortable side effects, but I was willing to live with them.
After almost I had been on Norpramin for two years,I got a new doctor at the clinic I went to (they were on a six month rotation). He did a complete intake instead of merely relying on what was in the file, and diagnosed me with mild to moderate Obsessive Compulsive Disorder. Because of this, he suggested that we switch my antidepressant to Prozac, which he said would treat both my depression and my OCD. We started my dosage at 20mg, but it was doubled and then tripled when the stress from my upcoming wedding brought on a recurrence of my depression.
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Posted: Jun 08, 2009
tags: antidepressant medication,
antidepressants,
antidepressant treatment,
norpramin,
prozac,
wellbutrin
In the '90s, Americans grew fond of the idea that you can fix depression simply by taking a pill — most famously fluoxetine (better known as Prozac), though fluoxetine is just one of at least seven selective serotonin reuptake inhibitors (SSRIs) that have been prescribed to treat hundreds of millions of people around the world.
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Posted: May 07, 2009
tags: antidepressant medication,
antidepressants,
antidepressant treatment
(HealthDay News) -- Relapse is common among women with severe premenstrual syndrome (PMS) who stop taking the antidepressant sertraline to treat their symptoms, a new study concludes.
It included 174 women with PMS or the most severe form of PMS -- premenstrual dysphoric disorder (PMDD). The women were randomly assigned to take sertraline for four months and then switch to placebo for 14 months or to take sertraline for 12 months and a placebo for six months.
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Posted: May 04, 2009
tags: antidepressant medication,
antidepressants,
antidepressant treatment,
pms
(HealthDay News) -- In a unanimous vote, a U.S. Food and Drug Administration advisory panel determined Wednesday that AstraZeneca's antipsychotic drug Seroquel has too many safety concerns to make it a first-line treatment against depression or anxiety disorders.
However, in a separate 6-to-3 vote, the panelists recommended that the medication could be used as supplemental treatment for patients with depression who do not get symptom relief from other drugs, the Associated Press reported. The expert panel did not hold a similar vote for anxiety disorders.
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Posted: Apr 09, 2009
tags: antidepressant medication,
antidepressants,
antidepressant treatment
(Reuters) – Just weeks after prosecutors accused Forest Laboratories Inc of illegally marketing its anti-depressants Celexa and Lexapro to children and paying pediatricians kickbacks, U.S. health regulators have approved Lexapro for depression in kids.
Forest said Lexapro, its biggest product with annual sales of more than $2 billion, was approved by the U.S. Food and Drug Administration to treat major depressive disorder in adolescents aged 12 to 17 and as a maintenance therapy, meaning to maintain control of symptoms. It is already approved for adults.
Read on
Posted: Mar 23, 2009
tags: antidepressant medication,
antidepressants,
antidepressant treatment,
children and depression
(HealthDay News) -- Women who use antidepressants appear to be at heightened risk for sudden cardiac death, although the exact nature of the link remains unclear, researchers say.
The finding doesn't necessarily mean that antidepressant drugs are dangerous, the researchers said.
"We suspect that their use is a marker for people with worse depression," explained study lead author Dr. William Whang, an assistant professor of clinical medicine at Columbia University Medical Center in New York City. "The elevated risk seems more specific for antidepressant use, but that use may well be a marker of more severe symptoms."
Posted: Mar 17, 2009
tags: antidepressants,
treatment
Part 2 of 5
===========
**Causes** (cont.)
- What initiates the alteration in brain chemistry?
- Is a tendency to depression inherited?
**Treatment**
- What sorts of psychotherapy are effective for depression?
**Medication**
- Do certain drugs work best with certain depressive illnesses? What are the guidelines for choosing a drug?
- How do you tell when a treatment is not working? How do you know when to switch treatments?
- How do antidepressants relieve depression?
- Are Antidepressants just "happy pills?"
- What percentage of depressed people will respond to antidepressants?
- What does it feel like to respond to an antidepressant? Will I feel euphoric if my depression responds to an antidepressant?
- What are the major categories of anti-depressants?
- What are the side-effects of some of the commonly used antidepressants?
- What are some techniques that can be used by people taking antidepressants to make side effects more tolerable?
- Many antidepressants seem to have sexual side effects. Can anything be done about those side-effects?
- What should I do if my antidepressant does not work?
Causes (cont.)
--------------
Q. What initiates the alteration in brain chemistry?
It can be either a psychological or a physical event. On the physical side, a hormonal change may provide the initial trigger: some women dip into depression briefly each month during their premenstrual phase; some find that the hormone balance created by oral contraceptives disposes them to depression; pregnancy, the end of pregnancy, and menopause have also been cited. Men's hormone levels fluctuate as deeply but less obviously.
It is well known that certain chronic illnesses have depression as a frequent consequence: some forms of heart disease, for example, and Parkinsonism. This seems to be the result of a chemical effect rather than a purely psychological one, since other, equally traumatic and serious illnesses don't show the same high risk of depression.
Q. Is a tendency to depression inherited?
It seems there are some people whose brain chemistry is predisposed to the depressive response, and others who are at much lower risk of depression even if exposed to the same physical or psychological triggers. The genetic relations of manic-depressives are at a higher risk for unipolar depression than the population at large or their adopted/by marriage relations. There seems to be a link between high creativity and the gene for manic-depression: artists and writers often are not manic-depressive themselves, but have a family member who is. Studies of families in which members of each generation develop manic-depressive illness found that those with the illness have a somewhat different genetic make-up than those who do not get ill. However, the reverse is not true: not everybody with the genetic make-up that causes vulnerability to manic-depressive illness has the disorder. Apparently additional factors, possibly a stressful environment, are involved in its onset.
Major depression also seems to occur, generation after generation, in some families. However, depression can occur in people with no family history of any form of mental illness. And I would be reluctant to suggest that there is any human who is entirely immune to depression under all possible conditions.
Psychological triggers: many, if not most, people with depression can point to some incident or condition which they believe is responsible for their unhappiness. Of course, people with severe depression are prone to astonishingly virulent and inappropriate guilt and self-hatred.
The (genuine) life events that most often appear in connection with depression are various, but there is one distinguishing feature that appears in many cases, over and over: loss of self-determination, of empowerment, of self-confidence. More profoundly: a loss of self, of the abilities or activities that a person identifies with herself. Stereotypically: a man loses the job that had defined him to himself and others, whether that definition was "executive" or "breadwinner"; a woman who had spent her whole life preparing for and living the role of wife, supporter, caretaker, is suddenly left alone by divorce or death. In general, any life change, often caused by events beyond one's control, which damages the structure that gave life meaning.
The ability of a person to respond to such an event will depend on many factors, including genetic predisposition, support from friends, physical health, even the weather. It can also depend on internal psychological factors which may best be explored in talk therapy: why is the person's self-esteem so bound up in the position or state that has been lost? Can she find a new source of self-esteem? Therapy can be immensely helpful here.
Obviously, not everyone to whom this sort of event happens becomes depressed, and not every person who becomes depressed has had this sort of catastrophe befall them. In fact, if a person suffers a loss and then becomes depressed, it may well be that they weathered the loss in fine style and then succumbed to a much less obvious trigger, psychological or physical.
Some depressions may well be caused by a spontaneous aberration in brain chemistry, with no trigger that we can currently identify, just as a seizure or migraine may have an obvious trigger or be apparently spontaneous.
However, once the depressive state has set in, both physical and psychological problems will be generated in abundance. What faster way to lose a job or a spouse than to be too depressed to work or to communicate? What worse psychological state for coping with a blow to identity can there be than a chemically promoted, pathological self-hatred? And what can be worse for self-esteem than watching one's appearance and household disintegrate as one loses the motivation to shower, straighten up, wash dishes or laundry, or choose attractive clothes? Health deteriorates as well: some depressed people can't sleep or eat, others sleep constantly (a real help on the job!) and eat incessantly, sometimes in order to stay awake, sometimes because it's the only thing that gives a little pleasure or comfort. (Carbohydrates induce production of serotonin, so there may be an element of self-medication here); almost no one has the impulse to exercise or get fresh air and sunshine. Most if not all of these effects form feedback loops, increasing in magnitude and becoming triggers for further depression.
The question, "Is depression mostly physical or psychological," is rather beside the point. Depression may be triggered by either physical or psychological events. Most commonly, both seem to be involved, though it is often difficult to separate the two when one is talking about psychology and neurochemistry. But however it begins, depression quickly develops into a set of physical and psychological problems which feed on each other and grow. This is why a combination of physical and psychological intervention has been shown to give the best results for most patients, regardless of any classifications that doctors may have tried to impose on their depression and its cause.
Treatment
---------
Q. What sorts of psychotherapy are effective for depression?
Two effective methods of psychotherapy for people with depressions are cognitive therapy and interpersonal therapy. Both psychoanalysis, and insight oriented psychotherapy have not been shown to be effective treatments for people with a depressive disorder. Cognitive (and cognitive-behavioral) therapists can be found in most major cities.
For a referral to a properly trained cognitive therapist practicing close to your location, contact:
Aaron T. Beck, MD.
The Center for Cognitive Therapy
3600 Market Street
Philadelphia, PA 19101
(215) 898-4100.
While many therapists call themselves cognitive therapists and interpersonal therapists, only a few have had proper training. To find an interpersonal therapist with the best training, contact:
Myrna Weissman, Ph.D.
New Your State Psychiatric Institute
722 West 168th Street
New York, NY 10032
(212) 996-6390
Medication
----------
Q. Do certain drugs work best with certain depressive illnesses? What are the guidelines for choosing a drug?
There are very few kinds of depression for which there are specific antidepressant treatments. When it comes to people with Bipolar Disorder who are depressed there are some major problems. Most importantly, with any antidepressant, there is a possibility that the antidepressant treatment will cause depressed bipolar people not just to come out of their depressions, but to develop manic episodes. The possibility of an antidepressant causing mania is least when the antidepressant is bupropion (Wellbutrin). The possibility of mania is greatly reduced if depressed bipolar folks are on a mood stabilizer such as lithium, Tegretol or Depakote when they are started on an antidepressant.
Q. How do you tell when a treatment is not working? How do you know when to switch treatments?
Antidepressant treatment is clearly not working when the individual receiving the treatment remains depressed or becomes depressed again. When a recently started antidepressant fails to cause improvement, the depressed individual often asks that the medication be stopped, and a new one started. It generally does not make sense to change antidepressants until 8-weeks at the maximum tolerated dose have elapsed. With some tricyclic antidepressants, it is important to check the blood level of the antidepressant before it is stopped. The blood test can tell if the amount in the blood has been adequate. Only after an adequate trial of one antidepressant should another be tried. To have been on four antidepressants in an 8-week period means that one has not had an adequate trial on any of them.
Q. How do antidepressants relieve depression?
There are several classes of antidepressants, all of which seem to work by increasing levels of certain neurotransmitters (most commonly serotonin, norepinephrine, and dopamine) in the brain. It is not entirely clear why increasing neurotransmitter levels should reduce the severity of a depression. One theory holds that the increased concentration of neurotransmitters causes changes in the brain's concentration of molecules, receptors, to which these transmitters bind. In some unknown way it is the changes in the receptors that are thought responsible for improvement.
Q. Are Antidepressants just "happy pills?"
No matter what their exact mode of action may be, it is clear that antidepressants are not "happy pills." There is no street-market in antidepressants, for unlike "speed" which will improve the mood of almost everybody, antidepressants only improve the mood of depressed people. Also unlike the almost instant effects of speed, the mood-improving effects of antidepressants develop slowly over a number of weeks. "Speed" induces a highly artificial state, antidepressants cause the brain to slowly increase its production of naturally occurring neurotransmitters.
Q. What percentage of depressed people will respond to antidepressants?
Generally, about 2/3 of depressed people will respond to any given antidepressant. People who do not respond to the first antidepressant they have taken, have an excellent chance of responding to another.
Q. What does it feel like to respond to an antidepressant? Will I feel euphoric if my depression responds to an antidepressant?
The most common description of the effects of antidepressants is that of feeling the depression gradually lift, and for the person to feel normal again. People who have responded to antidepressants are not euphoric. They are not unfeeling automatons. The are still able to feel sad when bad things happen, and they are able to feel very happy in response to happy events. The sadness they feel with disappointments is not depression, but is the sadness anyone feels when disappointed or when having experienced a loss. Antidepressants do not bring about happiness, they just relieve depression. Happiness is not something that can be had from a pill.
Q. What are the major categories of anti-depressants?
There are many classes of antidepressants. Two kinds of antidepressants have been around for over 30 years. These are the tricyclic antidepressants and the monoamine oxidase inhibitors. While there are newer antidepressants, many with fewer side-effects, none of the newer antidepressants has been shown to be more effective than these two classes of drugs. In fact, many people who have not responded to newer antidepressants have been successfully treated with one of these classes of drugs.
The tricyclic antidepressants (TCAs) include such drugs as imipramine (Tofranil, amitriptyline (Elavil), desipramine (Norpramin), nortriptyline (Aventyl and Pamelor).
The monoamine oxidase inhibitors (MAOIs) include tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan) which has recently been taken off the market in the U.S.A. for marketing rather than safety or efficacy reasons.
One of the popular new classes of antidepressants are the selective serotonin reuptake inhibitors (SSRIs). The first of these drugs to be marketed in the USA was fluoxetine (Prozac). Sertraline (Zoloft), and paroxetine (Paxil) soon followed, and fluvoxamine (Luvox) is scheduled to be marketed in late 1994, or early 1995.
Bupropion (Wellbutrin) is the only drug in its class, as is trazodone (Desyrel). The most recently marketed antidepressant (4/94) is venlafaxine (Effexor), the first drug in yet another class of drugs.
Q. What are the side-effects of some of the commonly used antidepressants?
Below is a list of some of the more frequently prescribed antidepressants, and their most common side effects. The figure following each side effect is the percentage of people taking the medication who experience that side effect.
Aventyl (nortriptyline): Dry mouth (15); Constipation (15);
Weakness-fatigue (10); Tremor (10).
Effexor (venlafaxine) Nausea (35); Headache (25); Sleepiness (25);
Dry mouth (20); Insomnia (20); Constipation (15).
Elavil (amitriptyline): Dry mouth (40); Drowsiness (30); Weight gain
(30); Constipation (25); Sweating (20).
Nardil (phenelzine): dry mouth (30); insomnia (25); Increased heart
rate (25); Lowered blood pressure (20); Sedation (15); Over
stimulation (10);
Norpramin (desipramine): dry mouth (15); increased pulse (15);
constipation (10); reduced blood pressure (10).
Pamelor - see Aventyl
Parnate (tranylcypromine) Dry mouth (20); Insomnia (20); Increased
pulse rate (20); Lowered blood pressure (15); Over stimulation (15);
Sedation (15).
Paxil (paroxetine): Decreased sexual interest and/or problems
achieving orgasm (30); Nausea (25); Sedation (25); Dizziness (15)
Insomnia (15)
Prozac (fluoxetine): Decreased sexual interest and/or problems
achieving orgasm (30); Nausea (20); Headache (20); Nervousness (15);
Insomnia (15); Diarrhea (15).
Sinequan (doxepin): Dry mouth (40); Sedation (40); Weight gain (30);
Lowered blood pressure (25); Constipation (25); Sweating (20).
Tofranil (imipramine): Dry mouth (30), Reduced blood pressure (30),
Constipation (20), Difficulty with urination (15).
Wellbutrin (bupropion): Agitation (30); Weight loss (25), Dizziness
(20); Decreased appetite (20);
Zoloft (sertraline): Decreased sexual interest and/or problems
achieving orgasm (30);Nausea (25); Headache (20); Diarrhea (20);
Insomnia 15); Dry mouth (15); Sedation (15).
Q. What are some techniques that can be used by people taking antidepressants to make side effects more tolerable?
Listed below are some frequent side effects of antidepressants, and some techniques to reduce their severity:
Dry mouth: Drink lots of water, chew sugarless gum, clean teeth daily, ask the dentist to suggest a fluoride rinse to prevent cavities, visit the dentist more often than usual for tooth and gum hygiene
Constipation: Drink at least six 8-ounce glasses of water every day, eat bran cereals, eat salads twice a day, exercise daily (walk for at least 30 minutes a day), ask your doctor about taking a bulk producing agent such as Metamucil, also ask about taking a stool softener such as Colace, be sure to avoid laxatives such as Ex-Lax.
Bladder problems: The effects of some antidepressants, especially the tricyclic medications may make it difficult for you to start the stream of urine. There may be some hesitation between the time you try to urinate and the time your urine starts to flow. If it takes you over 5-minutes to start the stream, call your doctor.
Blurred vision: The tricyclic antidepressants may make it difficult for you to read. Distant vision is usually unaffected. If reading is important to you the effects of the antidepressant can be compensated for by a change in glasses. As you may compensate for the change in your vision, try to postpone getting new glasses as long as possible.
Dizziness: Dizziness when getting out of bed or when standing up from a chair, or when climbing stairs may be a problem when taking tricyclic antidepressants and monoamine oxidase inhibitors. Changing posture slowly may help prevent this kind of dizziness. Drinking adequate amounts of liquid and eating enough salt each day is important. Be sure to speak to your doctor if this side-effect is severe.
Drowsiness: This side effect often passes as you get used to taking the antidepressant that has been prescribed for you. Ask your doctor if it is safe for you to increase your intake of caffeine, and if so, by how much. If you are drowsy be sure not to drive or operate dangerous machinery.
Q. Many antidepressants seem to have sexual side effects. Can anything be done about those side-effects?
Both lowered sexual desire and difficulties having an orgasm, in both men and women, are particularly a problem with the selective serotonin re-uptake inhibitors (Prozac, Zoloft, Paxil and Luvox), and the monoamine oxidase inhibitors (Nardil and Parnate). There is no treatment for decreased sexual interest except lowering the dose or switching to a drug that does not have sexual side effects such as bupropion (Wellbutrin). Difficulty having orgasms may be treated by a number of medications. Among those medications are: Periactin, Urecholine, and Symmetrel. None of these are over-the-counter drugs and they must be prescribed by a physician. Unfortunately, many psychiatrists are not familiar with using these medications to treat the sexual side-effects of antidepressants.
Q. What should I do if my antidepressant does not work?
Many people decide that their antidepressant is not working prematurely. When one starts an antidepressant the hope is for rapid relief from depression. What must be remembered is that for an antidepressant to work, you must be on an adequate dose of the drug for an adequate length of time. A fair trial of any antidepressant is at least two months. Prior to a two month trial the only reason to abandon an antidepressant trial is if the medication is causing severe side effects. With many antidepressants the dose has to be increased at intervals far above the starting dose. Unfortunately, the two-month period mentioned above, refers to two months following the most recent increase in the dose, not the time from starting the particular antidepressant.
Posted: Mar 02, 2009
tags: antidepressant medication,
antidepressants,
depression,
depression treatment,
faq
Part 3 of 5
===========
**Medication** (cont.)
- If an antidepressant has produced a partial response, but has not fully eliminated depression, what can be done about it?
**Electroconvulsive Therapy**
- What is electroconvulsive therapy (ECT) and when is it used?
- Exactly what happens when someone gets ECT?
- How do individuals who have had ECT feel about having had the treatments?
- How long do the beneficial effects of ECT last?
- Is it true that ECT causes brain damage?
- Why is there so much controversy about ECT?
**Substance Abuse**
- May I drink alcohol while taking antidepressants?
- If I plan to drink alcohol while on medication, what precautions should I take?
- What's the relationship between depression and recovery from substance abuse?
- What does the term "dual-diagnosis" mean?
- Is it safe for a person recovering from substance abuse to take drugs?
- How do you know when depression is severe enough that help should be sought?
**Getting Help**
-Where should a person go for help?
-Where can I find help in the United Kingdom?
-Where can I find out about support groups for depression?
-How can family and friends help the depressed person?
**Choosing A Doctor**
-What should you look for in a doctor? How can you tell if he/she really understands depression?
**Self-care**
- How may I measure the effects my treatment is having on my depression?
Medication (cont.)
------------------
Q. If an antidepressant has produced a partial response, but has not fully eliminated depression, what can be done about it?
There are many techniques to help an antidepressant work more completely. The simplest is to increase the dose until relief is experienced or side- effects are severe. If the dose can not be increased, lithium can be added to any antidepressant to augment its effect. With all antidepressants it is possible to add small doses of stimulants such as pemoline (Cylert), methylphenidate (Ritalin), or dextroamphetamine (Dexedrine) to augment the antidepressant effect.Selective serotonin re-uptake inhibitors often work better when small doses of desipramine (Norpramin) or nortriptyline (Aventyl and Pamelor) are co-administered. Thyroid hormones (Synthroid or Cytomel) may be used to augment any antidepressant. At times combinations of these techniques may be utilized.
Electroconvulsive Therapy
-------------------------
Q. What is electroconvulsive therapy (ECT) and when is it used?;
ECT is an effective form of treatment for people with depressions and other mood disorders. ECT may be used when a severely depressed patient has not responded to antidepressants, is unable to tolerate the side effects of antidepressants, or must improve rapidly. Some depressed people simply do not respond to antidepressants or mood controlling drugs, and ECT is a way for such people to be effectively treated. ECT is utilized in the treatment of both mania and depression. There are some people who because of severe physical illness are unable to tolerate the side-effects of the medications used to treat mood disorders. Many of these people can be successfully be treated with ECT. Pregnant women and people who have recently had heart attacks can be safely treated with ECT. Because of time pressure regarding occupational, social, or family events, some people do not have the time to wait for antidepressants or mood regulating medications to become effective. As ECT quite regularly brings about improvement within two or three weeks, people who are under such time pressure are also excellent candidates for ECT.
Q. Exactly what happens when someone gets ECT?
The physician must fully explain the benefits and dangers of ECT, and the patient give consent, before ECT can be administered. The patient should be encouraged to ask questions about the procedure and should be told that consent for treatments can be withdrawn at any time, and in the event that this happens, the treatments will be stopped. After giving consent, the patient undergoes a complete physical examination, including a chest x-ray, electrocardiogram, and blood and urine tests. A series of ECTs usually consists of six to twelve treatments. Treatments can be administered to either in-patients or out-patients. Nothing should be taken by mouth for 8-hours prior to a treatment. An intravenous drip is started and through it medications to induce sleep, relax the muscles of the body, and reduce saliva are given. Once these medications are fully effective, an electrical stimulus is administered through electrodes to the head. The electrical stimulus produces brain wave (EEG) changes that are characteristic of a grand mal seizure. It is believed that this seizure activity leads to the clinical improvement seen after a series of ECT. About 30-minutes after the treatment the patient awakens from sleep. While confused at first, the patient is soon oriented enough to eat breakfast, and return home if the treatments are being done in an outpatient setting.
Q. How do individuals who have had ECT feel about having had the
treatments?
In studies of people treated with ECT it has been found that 80% of such people report that they were helped by the treatments. About 75% say that ECT is no more frightening than going to the dentist.
Q. How long do the beneficial effects of ECT last?;
While ECT is a highly successful way of helping people come out of
depressions, it has to be followed by antidepressant therapy. If antidepressants are not administered after a series of ECTs, there is a 50% relapse rate within 6-months.
Q. Is it true that ECT causes brain damage?;
There is no scientific evidence that ECT causes brain damage. A woman who had over 1,000 ECT died of natural causes, and her brain was examined for evidence of ECT-induced brain damage. None was found. ECT does cause memory problems. These memory problems may take a number of months to clear. A small number of people who have received ECT complain of longer lasting memory problems. Such problems do not show up on psychological tests, it is not clear what causes them.
Q. Why is there so much controversy about ECT?
There is little controversy about ECT among psychiatrists. Much of the opposition to ECT seems political in nature and originates in the anti-psychiatry groups that oppose the use of Ritalin for the treatment of children with attention deficit disorder, and who oppose the use of Prozac for the treatment of depressed people.
Substance Abuse
---------------
Q. May I drink alcohol while taking antidepressants?
There are a number of problems with the mixture of alcohol and antidepressants. First, antidepressants may make you especially susceptible to the intoxicating effects of alcohol. Second, if you drink more than three or four drinks a week, the effects of alcohol may prevent the antidepressants from working. Many people who seem not to benefit from antidepressants, do so, if they reduce or eliminate their intake of alcohol. Third, you may be taking along with the antidepressant a drug such as clonazepan (Klonopin) with which one should not drink at all.
Q. If I plan to drink alcohol while on medication, what precautions should I take?
There is much misinformation about drinking while on anti-depressants. Alcohol can prevent antidepressants from being effective. This is not so much because it interferes with the absorption of antidepressants, it is because of the effects of alcohol upon brain chemistry. Antidepressants can also increase one's susceptibility to the intoxicating effects of alcohol. Also, both alcohol and some anti-depressants (especially Wellbutrin) increase the possibility of seizures.
If you are determined to drink despite taking antidepressants you
should discuss the matter with your psychiatrist. If you get
permission you might want to determine the extent to which the
medication has made you more sensitive to the alcohol. You might
start by seeing what are the effects of half a glass of wine. You
might then experiment with a full glass. Remember, a 4 oz glass of
wine, a 12 oz bottle of beer, and 1 oz of "hard stuff" all contain
the same amount of alcohol.
Q. What's the relationship between depression and recovery from
substance abuse?
It is not unusual for people who have recently been withdrawn from
alcohol, or other abusable drugs to become depressed. These
depressions are often self-limited, and clear in about 8-weeks. If
depression has not cleared by the end of that period, anti-depressant
therapy should be started.
Q. What does the term "dual-diagnosis" mean?
Dual-diagnosis is a phrase used to indicate the combination of
substance abuse and a psychiatric disorder. A path to alcohol or
other substance abuse is an attempt to self- medicate uncomfortable
symptoms such as depression, anxiety, agitation or feelings of
emptiness. The psychiatric disorders that cause such symptoms are
often diagnosed in substance abusers.
Q. Is it safe for a person recovering from substance abuse to take
drugs?
People recovering from substance abuse can safely take many kinds of
psychiatric drugs. Most psychiatric drugs are unable to be abused.
The best evidence for this is that there are not street markets for
such drugs. On the other hand, The benzodiazepines (diazepam
[Valium], lorazepam [Ativan], alprazolam [Xanax], etc.) and the
psycho-stimulants (dextroamphetamine [Dexedrine], methamphetamine
[Desoxyn], and Ritalin [methylphenidate]) are quite abusable.
For people active in AA please read the pamphlet "The AA
Member--Medications & Other Drugs." This outlines AA's official
attitude toward medication--that it is necessary for certain
illnesses including depression. Too many depressed people who have
been talked out of taking antidepressants by members of their AA
groups have killed themselves as a result.
Q. How do you know when depression is severe enough that help should be
sought?
Professional help is needed when symptoms of depression arise without
a clear precipitating cause, when emotional reactions are out of
proportion to life events, and especially when symptoms interfere
with day-to-day functioning.. Professional help should definitely be
sought if a person is experiencing suicidal thoughts.
Getting Help
------------
Q. Where should a person go for help?
If you think you might need help, see your internist or general
practitioner and explain your situation. Sometimes an actual physical
illness can cause depression-like symptoms so that is why it is best
to see your regular physician first to be checked out. Your doctor
should be able to refer you to a psychiatrist if the severity of your
depression warrants it.
Other sources of help include the members of the clergy, local
suicide hotline, local hospital emergency room, local mental health
center.
Q. Where can I find help in the United Kingdom?
The following are places one might find help in Great Britain:
Depressives Associated
PO Box 1022
London SE1 7QB
Depressives Anonymous
36 Chestnut Avenue
Beverley
Humberside
HU17 9QU
MIND (National association for mental health)
22 Harley Street
London W1N 2ED
To find a psychiatrist/ psychologist near you, call or write:
Royal College of Psychiatrists
17 Belgrave Square
London SW1X 8PG
Q. Where can I find out about support groups for depression?
The following is a list of national organizations dealing with the
issues of depression. Please note: Model groups are not national
organizations and should be contacted primarily by persons wishing to
start a similar group in their area. Also, please enclose a
self-addressed stamped envelope when requesting information from any
group. When calling a contact number, remember that many of them are
home numbers, so be considerate of the time you call. Keep in mind
the different time zones.
[Reprinted from The Self-Help Sourcebook, 4th Edition, 1992. American
Self-Help Clearinghouse, St.Clares' Riverside Medical Center,
Denville, New Jersey 07834]
**Depressed Anonymous** Int'l. 8 affiliated groups. Founded 1985.
12-step program to help depressed persons believe & hope they can
feel better. Newsletter, phone support, information & referrals, pen
pals, workshops, conference & seminars. Information packet ($5),
group starting manual ($10.95).Newsletter. Write: 1013 Wagner Ave.,
Louisville, KY 40217. Call Hugh S. 502-969-3359.
**Depression After Deliver** National. 85 chapters. Founded 1985.
Support & Information for women who have suffered from post-partum
depression. Telephone support in most states, newsletter, group
development guidelines, pen pals, conferences. Write: PO. Box 1281,
Morrisville, PA 19067. Call 215-295-3994 or 800-944-4773 (to leave name & address for information to be sent).
**Emotions Anonymous** National. 1200 chapters. Founded 1971. Fellowship sharing experiences, hopes & strengths with each other, using the 12-step program to gain better emotional health. Correspondence program for those who cannot attend meetings. Chapter development guidelines. Write: PO. Box 4245, St. Paul, MN 55104. Call
612-647-9712.
**National Depressive & Manic-Depressive Association** National. 250 chapters. Founded 1986. Mutual support & information for manic-depressives, depressives & their families. Public education on the biochemical nature of depressive illnesses. Annual conferences, chapter development guidelines. Newsletter. Write: NDMDA, 730 Franklin, 501, Chicago, IL 60610. Call 800-82-NDMDA or 312-642-0049.
**National Foundation for Depressive Illness**. An informational service, which provides a recorded message of the clear warning signs of depression and manic-depression, and instructs how to get help and further information. Call 1-800-239-1295. For a bibliography and referral list of physicians and support groups in your area, send $5 (if you can afford it) and a self-addressed, stamped business-size envelope with 98 cents postage to, NAAFDI, PO. Box 2257, New York, NY
100116.
NOSAD (**National Organization for Seasonal Affective Disorder**) National. groups. Founded 1988. Provides information & education re: the causes, nature & treatment of Seasonal Affective Disorder. Encourages development of services to patients & families, research into causes & treatment. Newsletter. Write: PO. Box 451, Vienna, VA 22180. Call 301-762-0768.
(Model) **Helping Hands** Founded 1985. A comfortable & homey atmosphere for people with manic-depression, schizophrenia or clinical depression who seek an environment that makes them more aware of themselves & eliminates a negative attitude. Group development guidelines. Write: c/o Rita Martone, 86 Poor St, Andover, MA 01810.
Call 508-475-3388.
(Model) MDSG-NY (**Mood Disorders Support Group, Inc.**) Founded 1981. Support & education for people with manic-depression or depression & their families & friends. Guest lectures, newsletter, rap groups, assistance in starting groups. Write: PO. Box 1747, Madison Square Station, New York, NY 10159. Call 212-533-MDSG.
Q. How can family and friends help the depressed person?
The most important things anyone can do for depressed people is to help them get appropriate diagnosis and treatment. This may involve encouraging a depressed individual to stay with treatment until symptoms begin to abate (several weeks) or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication.
The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Always report them to the doctor. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon.
The depressed person needs diversion and company. but too many demands can increase feelings of failure. Do not accuse the depressed person of faking illness or laziness or expect him or her to "snap out of it." Eventually, with treatment, most depressed people do yet better. Keep that in mind, and keep reassuring the depressed person that with time and help, he or she will feel better.
Choosing A Doctor
-----------------
Q. What should you look for in a doctor? How can you tell if he/she really understands depression?
If you are looking for a psychopharmacologist to prescribe medications to help control your depression there are a number of things to check. If you are in psychotherapy, it is important to ask prospective doctors about their opinions on the psychotherapeutic treatment of depression. Psychopharmacologists who are hostile to psychotherapy are difficult to deal with while you are in therapy.
It is always legitimate to ask any professionals you are thinking about seeing regularly about their understanding of depression, their beliefs about the causes of depression and their philosophy of treatment. You might ask about how often the prospective doctor has worked with people who have had your particular variety of depression. If you have a rapidly cycling Bipolar depression, for example, you should seek a doctor who has much experience dealing with people who have this problem. Prior to the first visit it is important to clarify with the doctor or the secretary the fee of the initial and subsequent visits, the doctor's policy regarding missed and changed appointments, whether the doctor will accept assignment from insurance companies. If you have Medicare or Medicaid it is important to make sure that the doctor sees people with these forms of medical coverage.
Another aspect of the style of doctors is the extent to which they include their patients in the decision-making process. You might ask "How do you go about deciding which treatment is right for me?" See if you are comfortable with the method the doctor describes. Much can also be learned from how doctors respond to questions such as these. There is much difference between a doctor who welcomes such questions and answers them fully and one who is annoyed by them and answers them superficially.
Self-care
---------
Q. How may I measure the effects my treatment is having on my depression?
If one completes the following scale each week, and keeps track of the scores, one would have a detailed record of one's progress.
Name _________________________ Date _________
The items below refer to how you have felt and behaved **during the past
week.** For each item, indicate the extent to which it is true, by
circling one of the numbers that follows it. Use the following scale:
0 = Not at all
1 = Just a little
2 = Somewhat
3 = Moderately
4 = Quite a lot
5 = Very much
_______________________
1. I do things slowly............................0 1 2 3 4 5
2. My future seems hopeless......................0 1 2 3 4 5
3. It is hard for me to concentrate on reading...0 1 2 3 4 5
4. The pleasure and joy has gone out of my life..0 1 2 3 4 5
5. I have difficulty making decisions............0 1 2 3 4 5
6. I have lost interest in aspects of life that
used to be important to me...................0 1 2 3 4 5
7. I feel sad, blue, and unhappy.................0 1 2 3 4 5
8. I am agitated and keep moving around..........0 1 2 3 4 5
9. I feel fatigued...............................0 1 2 3 4 5
10. It takes great effort for me to do simple
things.......................................0 1 2 3 4 5
11. I feel that I am a guilty person who
deserves to be punished......................0 1 2 3 4 5
12. I feel like a failure.........................0 1 2 3 4 5
13. I feel lifeless--more dead than alive.........0 1 2 3 4 5
14. My sleep has been disturbed:
too little, too much, or broken sleep........0 1 2 3 4 5
15. I spend time thinking about HOW I might kill myself..................................0 1 2 3 4 5
16. I feel trapped or caught......................0 1 2 3 4 5
17. I feel depressed even when good things happen to me.................................0 1 2 3 4 5
18. Without trying to diet, I have lost, or gained, weight............................0 1 2 3 4 5
Note: This scale is designed to measure changes in the severity of depression and it has been shown to be sensitive to the changes that result from psychotherapeutic or psychopharmacologic treatment. These scales are not designed to diagnose the presence or absence of either depression or mania.
Copyright (c) 1993 Ivan Goldberg
Posted: Mar 02, 2009
tags: antidepressant medication,
antidepressants,
depression,
depression treatment,
faq
A few months ago, my psychiatrist recommended that I take folic acid supplements, as they might boost the effectiveness of my antidepressants. I was surprised to hear his recommendation, as the idea was completely new to me. I had of course taken folic acid when my husband and I were trying to conceive, but didn't know much about it otherwise.
Read on
Posted: Feb 14, 2009
tags: antidepressants,
treatment
Chances are you're not having quite so many devastatingly low days now. You're functioning a little better overall, but you're still not ready to run any marathons yet or run for public office. Don't worry about it - this recovery takes time, and it happens so subtly you may not notice it till someone else points it out. You're probably still not eager to spend too much time outside your home, but the cyberworld provides many diversions (you can wander around it in your pajamas, and no one will know). I've found that things of beauty are both soothing and refreshing at this point, so that's where we'll start first.
Art/History
Fitness(Mental and Physical)
- Paradoxically, it's during this time when most depressed people are beginning to feel better that some attempt suicide. This is due to the fact that while someone is profoundly depressed, they don't have the energy or clear mental processes necessary to plan and carry out a suicide. Please remember, if you begin to have suicidal thoughts, that there are people available to help you deal with your feelings. SA\VE - Suicide Awareness\Voices of Education is a web page which provides suicide education and support. See the Suicide Links section for more resources.
- The philosophy behind holistic medicine, that we should treat the body as a whole entity instead of just addressing the sick "part", is appropriate both for treating depression and for this stage in your recovery. De-stressing is important, since it will relieve the depression to some extent. To this end, think about exercising. I know it's hard to even keep up with normal stuff, but even a half hour walking a few times a week should help. I hate to exercise, but I've been forcing myself to do it for the last couple of years since it makes such a difference in whether I slide back into depression during stressful times.
- If you're not ready for aerobic exercise yet, get your body ready by doing some stretches. Yoga Class and Yoga.com have a lot of good info.
- You might be ready to stretch spiritually or re-discover your faith. About.com's Religion section is a good place to start. The ORCT (Ontario Consultants on Religious Tolerance) page covers many aspects and issues of many different religions. Interlude: An Internet Retreat is a site with inspirational meditations, prayers and poetry. My favorite is the Native American prayers.
The World Outside
Music
- In keeping with this page's theme of bringing the outside world in to soothe and stimulate you, I highly recommend listening to sounds of nature, either alone or mixed with new-age music. I myself love listening to either the sounds of the ocean, to rain or a mountain stream (hard to believe I wasn't born under a water sign!).
Reading
- The Power of Myth is a life-altering book that sprang from a series of conversations between Bill Moyers and mythologist/storyteller Joseph Campbell, and is said to have inspired George Lucas to create Star Wars.
Socializing
- How about just "pretend" socializing? The Sims 2 is a game that lets you create a family or a single person. You can either make them into an anti-social loner or the life of the party. It's very addictive.
- You're probably not ready to meet people in real life, so how about getting to know some people online?
- Join an online community that revolves around a passion or hobby. I spend a lot of time at Ravelry, a knitting and crochet community.
- Online games are a good way to socialize without going outside. I play a Gnome Warlock, among other characters, on World of Warcraft. If you're more of a fantasy purist, there's Lord of the Rings Online.
- The WELL is the original online community, where the talk is intelligent.
- Cafe Utne is another online community with intelligent discussion.
- bianca: the alternative online community
First Two Weeks
Last Two Weeks
Posted: Feb 08, 2009
tags: antidepressants,
living with depression,
recovery
Finding the effective antidepressant for the depressive is at this point far from an exact science, although the outlook is improving as we discover more about depression. Doctors for the most part take their best guess based on their experience and the prevailing wisdom. They consider the type of depression the patient suffers from, other medications he or she is taking, the patient's age, how well he or she will deal with the side effects, and other factors. Some patients have to try three, four or more medications before one "clicks" with their chemistry. Some, like me, are successful with the first medication they try. Remember that the chances are very good that your doctor will be able to find an effective medicine for you. As hard as it is, be patient and hopeful and keep trying different medications.
I hear again and again of doctors who start a patient out at a low dosage, and keep the patient at that dosage even when the medication is not working. Before switching you to another medication, your doctor should try raising the dosage. I had to have the level of both the antidepressants I was on raised not once, but several times. Buy a medication "bible" like The Pill Book, and find out what the normal range of dosage is for your medication.
Your best bet, as with other aspects of this illness, is to educate yourself about the medications available. You are then, in essence, your own "second opinion." I have known of doctors who forget to tell patients of possible side effects of medication, or what other medication or foods should be avoided while taking their antidepressants. Make sure you know what questions to ask the doctor to attain the maximum effect from your medication.
Posted: Feb 06, 2009
tags: antidepressants,
treatment
If it can be said that there is anything good about depression, this is when you'll see it. Assuming that you are feeling much better than you did a month ago (and if you're not, please check the info on my Treatment section), you may feel almost as if you've been reborn. After having been deprived of the ability to enjoy everything your life has to offer, you'll notice that colors are brighter, sounds are sweeter, smells and tastes have more depth. Having had a lack of interest in things you normally enjoyed before being depressed, you may find, as I did, that you are all of a sudden interested in everything, even things you never thought about before.
Fitness (Mental and Physical)
Keeping physically fit is one of the best ways to supplement what your medication is doing. The more fit and less tense you are, the less work your medicine has to do.
- Sex? What's that? Seriously, if your sex drive has returned, check out the Good Vibes web page for supplies and inspiration (21 and over only, please).
- I always know that I'm getting better when I start singing along with music. Then I usually put on some good music with a beat and dance around my room. Try it - it really gets the blood flowing, and makes you feel alive.
Beauty and Fashion
- Check out the web pages from these cosmetic companies:
- I use skin care from Paula Begoun, because I have very sensitive skin, and her skin care works and is cheap.
- BeautyNet and Cosmetic Connection are online beauty magazines.
- alt.fashion is the fashion/beauty newsgroup, which is extremely active, although somewhat clique-ish. You may feel like you're in high school listening to the cool girl's table, but you can't sit down.
- If you're feeling adventurous, take a look at Tattoos.Com or BME/Tattoo and consider getting a tattoo. It's a very bad idea to get one while you're depressed (kind of like making a decision when you're drunk), but perfectly fine when you're feeling good about yourself. I got my first tattoo the year I came out of my depression - now I have three.
- Feel like fashion is fun again (as opposed to only noticing or caring that you were wearing something)? Get back in the swing of things at FashionUK, Fashion Net or Lumiere.
Useful Stuff for Getting Your Life Back Together
I know that when I "awakened" from depression, I realized that I had let the weirdest things go, like renewing my car registration. Other depressives, especially bipolars, may find that they need to get out of a financial hole, either due to overspending or just letting the finances go down the tubes. I hope you find something useful here to help you get things back together.
Exploration/Learning
As your thoughts begin to turn more outward than inward, you may have some interest in discovery and learning.
Nature/Ecology
I realized when I came out of my depression that I had by virtue of the illness been very self-absorbed. Un-depressed, I looked at survival on a more global scale. If you do too, here are some earthwise sites to inspire you.
- Environmental News Network has environmental news, features and a calendar of meetings and conferences.
- The Rainforest Action Network page is beautifully done, with extensive information about getting involved in non-violent action to save the rainforests and their occupants.
- Sierra Club Home Page provides information about its programs, mission and chapters.
- I was surprised at how fascinating the bios of the individual wolves were on the Wolf Haven International page. It also contains photos of such wolves as Angel, Little John and Morning Star, who you can adopt.
- GardenWeb has gardening tips and links to botanical gardens around the world. Virtual Garden is a huge site with a database of plants, the Garden Guru and even a section that lets you check your weather.
Food/Entertaining
Now that you're back to your old self (or better, as in my case) you might feel that you want to renew friendships that might have gone south during your depression by entertaining. Or maybe you want to just renew your acquaintance with good food and drink. Either way, the links below will help to get your tastebuds ready. Note: although I have links to alcohol-related sites, bear in mind that drinking alcohol can affect your medication's effectiveness. Drink lightly, or not at all, and only make drinks for your guests.
Travel
Tired of being an armchair traveler? If you're getting the urge to get out and see the world for real instead of virtually, the sites below should be a great help.
- I love the Civilized Explorer. It's got great photos and good writing.
- Conde Nast Traveler has a polished and comprehensive site.
- To get information about my most favorite travel destination, Disney World, go to the Disney home page.
- Lonely Planet delves a little deeper into the culture of different destinations than other travel guides.
- Salon|Wanderlust
- I've found some wonderful guidebooks called Eyewitness Travel Guides. They have tons of color photos, floor plans of landmarks, aerial views of cities, and facts about the area that are actually interesting.
First Two Weeks
Middle Two Weeks
Posted: Feb 06, 2009
tags: antidepressants,
antidepressant treatment,
living with depression,
recovery
The key words here are indulge yourself. Listen, you're having enough trouble getting out of bed every day and going to work or school. You don'tneed to push yourself. Think of yourself as an invalid recuperating from a very debilitating illness. You have to pamper yourself, body and spirit. This page is therefore all about "cocooning", that is, wrapping yourself up in layers of comfort to protect yourself.
By the way, don't let anyone convince you that you should be thinking happy thoughts or "pulling yourself up by your bootstraps". That will come later. Right now you could get happy about slugging anyone who tells you to be happy, right? (Or, possibly, someone who even has a sunny disposition.) Maybe you can point them here and here.
Okay, gather up whatever energy you have, and see what interests you below:
Music
I find that classical music is good for what you're feeling right now. These selections are some of my favorites for expressing the depths of depression:
- Bach - Concerto in D Minor for 2 violins and orchestra, Second Movement
- Albioni - Adagio in G
- Barber - Adagio for strings, op. 11
- Henryk Gorecki - Third Symphony (Symphony of Sorrows)
I think you'll also find music by Enigma soothing and hypnotic.
- Sadeness - from MCMXC a.D.
- Return to Innocence - from The Cross of Changes
Your Body
Here's where some of the real pampering comes in. These suggestions all are good for men as wellas women; men, don't be afraid to try some things that you may havethought were just for women. Pampering is not gender-specific.
- If you can afford it, a visit to a day spa is in order. Spas and salons are soothing places set up for the sole purpose of pampering you. My favorite is a day with a massage, facial, manicure, pedicure and maybe an aromatherapy scalp massage.
- Get a professional massage. Really! Non-sexual touching is just what the doctor ordered. Make an appointment for a full-body massage. If you're feeling uncomfortable about anyone seeing you nude (you will be covered by a sheet or towel), start off by having a neck and shoulder massage or foot reflexology. Check out the Yellow Pages or search Yahoo's Massage section for a masseuse or spa near you.
- If you can't afford a visit to a spa, re-create some of the elements of a spa at home. Play some soothing New Age music, light scented candles or get a potpourri burner. Treat yourself to a bath scented with fragrant oils. Kneipp bath oils are one of my favorites. You can find them in upscale pharmacies. You might want to read Water Magic: Healing Bath Recipes for the Body, Spirit and Soul, which has recipes for baths. Here are two recipes from The Scented Bath, a previous book written by Maribeth Riggs which is now out of print. The Royal Treatment is a great book that tells you how to create spa treatments at home. Lush is one of my favorite sources for bath products. Go here for tips on How to Create a Spa Experience.
- Look into aromatherapy, an alternative way to treat the mind and body with essential oils. Clary sage is good for depression, fatigue, lavender is calming and soothing, neroli is a sedative and anti-depressant. Most essential oils can be found at your local health-food store or online. Note: None of the essential oil anti-depressants should be used as a replacement for your prescribed medication.
- Comfort food is what's on the menu now. Calorie counting will come when you have a little more motivation and a little less depression. Two of my favorite comfort food dishes are welsh rarebit and red beans and rice. Tea is a wonderful emotional panacea. I don't have any medical findings on this, but it's a fact as far as I'm concerned, so while you brew up a pot, look at The Tea Home Page, David Rio or Tealuxe. Peet's Tea is my favorite. It's on the West Coast, for the most part, but you can buy it online. If you've been missing candy from the past such as Bit 'O Honey, Skybars (one of my favorites) or Nik-L-Nip wax bottles, you can find them at HomeTown Favorites. Another panacea for your sweet tooth might be Tastykake.
Services
- Don't feel like leaving the house to do your grocery shopping? Shop online (for non-perishables) at NetGrocer or PeaPod and have your food delivered.
- You can get all your health and beauty stuff at Drugstore.com. Yes, I know it's tempting to let those things go, but you'll feel better.
Socializing
- My suggestion is: stay away from large groups. I look back with horror on a wedding reception that I attended while in the throes of depression. Only because the bride was a dear friend did I manage to stay half an hour before fleeing. Limit your socializing to small groups of friends who at least will try to understand what you're dealing with. To help them, have them read Best Things to Say to Someone Who is Depressed and Worst Things to Say to Someone Who is Depressed.
Escapism
Your own life is just too painful right now, so you need some entertaining diversions. However, they can't be too demanding intellectually or too depressing. This is not the time to be watching Ingmar Bergman movies or playing computer games like Sanitarium, as worthy as both of those entertainments are. What you need right now is escapism. Sure, watch Star Trek and old Bette Davis movies on TV. But also take the suggestions below into account.
- If you're into computer games, don't try to play any strategy or complex CRPGs (Computer Role-Playing Games). You'll only end up getting frustrated instead of amusing yourself. An online game that's light on statistics and is great escapism is World of Warcraft. Lord of the Rings Online has a bit more depth (and mature players).
- Text adventure games, or Interactive Fiction, are not as dead as you may think, despite the emphasis on flash and graphics in games today. The Lurking Horror and the Zork games are among the text adventures I would recommend. You can download them here or play them online here. You probably want to read my article about interactive fiction first. Here's a list of recommended games.
- A fantastic computer adventure game that is a few years old is The Longest Journey. The storyline and characters are superior to what you normally find in games. If you get stuck, try using the Universal Hint System. Instead of outright answers, you are given hints, although if you persist, you can get the explicit answers. The hints can give your brain a nudge without spoiling the game.
- Big Fish Games has lots of casual games for a reasonable fee.
- The Company Therapist is a cyber-soap based on a fictitious therapist's files.
- If you want to lose yourself in a movie, first check out the Internet Movie Database. Not only is it huge, but it's updated more often than ones you'll find on CD ROM.
Reading
- Read romance novels. Regency novels are my favorites; they transport you back to the time when the only thing a person had to worry about was finding an eligible person to marry, and being a success in society. Don't miss the web page for the grande dame of Regencies, Jane Austen. Georgette Heyer is the best contemporary author of regency romances. Try The Romance Reader, All About Romance and Romantic Times for ideas on what to read. Two good Regency videos are Emma with Gwyneth Paltrow and Sense and Sensibility with Emma Thompson. My all-time favorite Regency video is A&E's six-hour version of Pride and Prejudice.
- Retreat to another world in a good fantasy book. Urban Fantasy is a genre that's exploded in the past few years. One excellent series is Jim Butcher's Dresden Files. Another is Kim Harrison's The Hollows Series, with titles inspired by Clint Eastwood movies, like Dead Witch Walking. Simon Green's Nightside Series is original and creepy. Tad Williams, David Eddings, Robin Hobb and Carol Berg write more traditional fantasy. The Feminist Science Fiction, Fantasy and Utopia page is a reference guide to works of such authors as Marion Zimmer Bradley, Ursula K. Le Guin and Suzy McKee Charnas.
- If you're into mysteries, MysteryNet.com should be right up your alley.
- The proliferation of ezines and electronic versions of print magazines on the Web is one of its strengths. Best of all, you don't have to actually go to a newsstand to get one!
Warm and Fuzzy
Middle Two Weeks
Last Two Weeks
Posted: Feb 06, 2009
tags: antidepressant medication,
antidepressants,
antidepressant treatment,
living with depression,
recovery
I've been there; I've done that. I've suffered from depression nearly my whole life, although I've only been treated the last few years. I know all the stages you go through when you're waiting those six interminable weeks for your antidepressant meds to start working. So, as my gift to you, since I know your mind might be kind of cloudy if you're depressed right now, I've compiled this list of suggestions. I hope they give you some moments of relief. Just so I'm not accused of discriminating against non-depressives, you all who don't suffer from depression can feel free to check out my suggestions too. Someone pointed out to me that it takes some people more than six weeks to feel much better. That's definitely true. Everyone's different, and some people could even take fewer than six weeks to feel normal again. And the newer antidepressants can take considerably less time than six weeks to be effective. This page is divided the way it is as just a general guideline.
A note about antidepressants:
Finding the effective antidepressant for the depressive is at this point far from an exact science, although the outlook is improving as we discover more about depression. Doctors for the most part take their best guess based on their experience and the prevailing wisdom. They consider the type of depression the patient suffers from, other medications he or she is taking, the patient's age, how well he or she will deal with the side effects, and other factors. Some patients have to try three, four or more medications before one "clicks" with their chemistry. Some, like me, are successful with the first medication they try. Remember that the chances are very good that your doctor will be able to find an effective medicine for you. As hard as it is, be patient and hopeful and keep trying different medications.
I hear again and again of doctors who start a patient out at a low dosage, and keep the patient at that dosage even when the medication is not working. Before switching you to another medication, your doctor should try raising the dosage. I had to have the level of both the antidepressants I was on raised not once, but several times. Buy a medication "bible" like The Pill Book, and find out what the normal range of dosage is for your medication.
Your best bet, as with other aspects of this illness, is to educate yourself about the medications available. You are then, in essence, your own "second opinion." I have known of doctors who forget to tell patients of possible side effects of medication, or what other medication or foods should be avoided while taking their antidepressants. Make sure you know what questions to ask the doctor to attain the maximum effect from your medication.
Most of the paintings on these pages are from all over the Web, although manyof them are from Carol Jackson Presents Fine Art and Brian Yoder's GoodArt Gallery.
Posted: Feb 06, 2009
tags: antidepressant medication,
antidepressants,
antidepressant treatment,
living with depression,
recovery
