Are You Considering Anti-Depressant Medication for Depression?
Frequently Asked Questions and Answers
| Perhaps your counselor has mentioned the option of antidepressant medication to you, or you’ve wondered whether this option might be helpful based on something you’ve heard, or based on the experiences of friends or family members. |
This handout is designed to answer some of the most frequently asked
questions about antidepressants. We hope the information will serve
as a starting point for a more in-depth discussion with a counselor
and/or a psychiatrist. If you decide to explore the option of medication
further, you will want to meet with a medical care professional experienced
in prescribing antidepressants.
This may be a nurse practitioner, a physician, or a psychiatrist (a
medical doctor whose specialty is the diagnosis and treatment of emotional
and mental health problems.) A psychiatrist is specially trained in
the use of medication to treat depression.
List of questions:
1. Shouldn't I be able to feel better without taking medication?
Don't other people get through this without medication?
2. Is there a blood test for depression?
3. What is the first step in considering a medication?
4. How does an antidepressant work?
5. What might my doctor ask me to do before prescribing
medication?
6. How will my doctor choose which medication to prescribe?
7. What are the possible side effects of antidepressant
medication?
8. How long will it take before the medication helps me?
How will I know that the medication is working?
9. Is the medication addictive? Will I get "high"?
10. Will the medication change my personality?
11. Can I take other medications along with antidepressants?
12. Will the medication interfere with my birth control
pills?
13. How long will I take a medication?
14. Will the depression come back when I stop taking medication?
15. Are there "natural" substances I can use
to treat depression?
16. How much will antidepressant medication cost?
17. Why can't I use alcohol when taking medication?
18. What if I forget to take my medication on schedule?
19. How do I tell my family and friends?
20. If I am taking medication, will I still need counseling?
1. Shouldn't I be able to feel better without taking
medication? Don't other people get through this without medication?
Many people will feel better with the help of counseling, and medication
may not be necessary at all. However, if left untreated altogether,
depression can last longer or even worsen. It can seriously interfere
with your ability to study, work and enjoy relationships. Depression
also can be a life-threatening illness when there is a risk of suicide.
Many people get better without medication, but sometimes medication
is necessary to help lighten your mood and help you to function so that
you can begin working through other problems.
2. Is there a blood test for depression?
The diagnosis of depression is based on the recognition of certain characteristic
signs and symptoms affecting your mood state, thinking patterns and
physical well-being. At present, there is no blood test that can confirm
or eliminate the diagnosis of depression.
3. What is the first step in considering a medication?
If you are a student at Cal, the first step in seeking help is to
discuss your symptoms with a counselor. Stop by Counseling and Psychological
Services, 3rd Floor, Tang Center, or call (510) 642-9494. Your counselor
will evaluate your symptoms and recommend whether depression medication
is likely to help you, given your unique symptoms and circumstances.
If medication seems like a reasonable option, you will be referred
to a nurse practitioner or primary care physician in the health service
or to a psychiatrist (physician specializing in antidepressant medications)
at Tang or in the community.
4. How does an antidepressant work?
Depression is an illness in which factors such as genetics, chemical
changes in the body and external events may play an important role.
Research suggests that depression may be linked to changes in the functioning
of brain chemicals called neurotransmitters. Current research focuses
on the serotonin, norepinephrine and dopamine systems. Certain genetic
factors and changes in body hormones also have been implicated in some
depressive conditions. These complex biological changes can produce
profound changes in your mood and behavior. Antidepressants are thought
to correct some of the chemical imbalances present in a depressive illness.
5. What might my doctor ask me to do before
prescribing medication?
The first step is usually an appointment with a psychiatrist to discuss
your depressive symptoms. Your psychiatrist may ask the same questions
another professional already has asked you. While you may find this
repetition frustrating, keep in mind that questions are repeated so
that your doctor can gain a thorough understanding of your symptoms,
medical history, medication use, and drug or alcohol use. For female
patients it also will be important to discuss issues of pregnancy and
birth control use since medication may be potentially harmful to a fetus
or nursing infant. Since certain drugs, as well as some medical conditions,
can produce depressive symptoms, you also may be referred to another
physician for a complete physical exam and laboratory tests.
6. How will my doctor choose which medication to
prescribe?
There are approximately 20 antidepressants currently available and approved
for the treatment of depression. Antidepressants generally are classified
by the chemical properties of the drug and the way in which they are
thought to work. Groups of medications your doctor may refer to include:
Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclic Antidepressants
(TCAs) or Monamine Oxidase Inhibitors (MAOIs). Some clinicians may refer
to medications discovered in the last 10 to 15 years as "new"
medications and those medications that have been available in the last
30 years as "older" medications. There also are mood stabilizers
for those with bipolar disorder.
Like shoe sizes, not every medication is the right fit for every individual;
a medication that worked well for a friend may not be the best match
for you. Your doctor will consider your particular symptoms when selecting
your medication. He/she also will consider potential adverse effects
of medication. The goal of treatment is to effectively eliminate depression
with a medication that produces minimal problems or adverse effects.
Unfortunately, an "ideal" medication that does not pose some
potential problem or risk is not yet available. Side effects generally
are mild and decrease with time. Research is focusing on more selective
medications for depression that produce fewer and less problematic side
effects. It is important that you ask your doctor about any concerns
you might have about a medication or its potential side effects.
7. What are the possible side effects of antidepressant
medication?
Antidepressants are a relatively safe treatment option in otherwise
healthy individuals being treated for depression. Like most prescribed
(and some over-the-counter medications), antidepressants may cause mild,
and usually temporary, side effects in some people. Most of the time,
side effects are manageable and disappear over time. Common side effects
include nausea, loose stools or constipation, dizziness, drowsiness,
nervousness, sleep changes, dry mouth, headache and blurred vision.
Some people experience a change in sexual interest or functioning. While
more severe problems are less common, they are possible.
Your doctor or pharmacist will have information sheets that outline
a range of potential side effects. Each time you meet with your doctor
for follow-up sessions, she or he will ask about your response to the
medication and check for problematic effects. Unusual side effects or
those that could interfere with your ability to work or study should
be reported to your doctor immediately so that changes in the medication
can be made. Most side effects are reversible and gradually disappear
after a medication is stopped. Don't hesitate to talk to your doctor
if you have questions or concerns.
8. How long will it take before the medication helps
me? How will I know that the medication is working?
All antidepressants take time to work. Don't be discouraged if you don't
feel better right away. Therapeutic response typically occurs within
two to four weeks after treatment is started, although some people feel
better sooner. It is not unusual for your friends and family to notice
signs of improvement before you do. When the medication begins to work,
you may find yourself increasingly able to accomplish things and enjoy
life in a way that is more "normal" for you. If you do not
respond to one medication, your doctor may recommend a change of dosage
or a change to other medication(s).
Each person is unique in his or her response to medication. Treatment
of depression is an ongoing process, with your doctor monitoring and
"fine tuning" your medication, depending on how it is working
for you.
Each person is unique in his or her response to medication.
9. Is the medication addictive? Will I get "high"?
The currently prescribed medications that are approved for the treatment
of depression are not considered addictive. Drug addiction implies that
you would crave increasing amounts of a substance. While certain medications
used in treating unusual forms of depression do have potentially addictive
qualities, these medications are not considered standard antidepressants.
Although antidepressants are not addictive, you may experience some
symptoms that lead you to wonder whether you are getting "high."
Early on in treatment, antidepressants may cause you to feel unusually
energized, especially compared to your previous state. Feeling "high"
or intoxicated suggests an unusual reaction to your medication, an interaction
with another medication, complications from drug or alcohol use, or
an unwanted side effect. In addition, some patients with bipolar disorder
may experience an unwanted episode of euphoria. Should you experience
any of these problems, contact your psychiatrist immediately.
Antidepressants are not addictive.
10. Will the medication change my personality?
Medication will not change who you are as a person, your unique personal
characteristics, or your life circumstances. The goal of antidepressant
therapy is to allow you to work toward positive changes in your mood
state and thinking patterns. Antidepressant medication assists people
in experiencing the full range of human emotions without feeling overwhelmed.
Although these positive changes may seem like personality changes, most
often they are a sign that you are recovering your ability to react
to people and situations in a non-depressed way. Sometimes antidepressant
medication produces temporary side effects that feel like negative changes
in personality. In particular, you may feel less emotionally sensitive
or less "intense" than you did before taking medication. In
the event that this occurs and is distressing for you, don't hesitate
to discuss your concerns with your counselor or psychiatrist.
11. Can I take other medications along with antidepressants?
An important question! Sometimes when antidepressants are taken in combination
with other drugs, the chances of side effects or drug interactions increase.
It is very important to consult with your prescribing physician, particularly
about allergy medications. Be sure to tell your doctor about any medications
you use, even over-the-counter or "natural" vitamins and herbal
products.
12. Will the medication interfere with my birth
control pills?
There is no evidence that antidepressants decrease contraceptive protection.
However, like other medications, antidepressants are potentially harmful
to the fetus if you are or become pregnant
13. How long will I have to take a medication?
You and your treatment professional(s) will meet regularly after medication
is prescribed to assess any changes and/or concerns and to evaluate
how the medication is working for you. Typically, people take antidepressant
medications for eight to twelve months or longer. While it often is
tempting to stop taking the medication when you feel better, it is important
to continue until you and your doctor agree your depression is treated.
Stopping the medication early can result in the return of your original
symptoms or adverse reactions. You may be asked to gradually decrease
or "taper off" the medication. "Tapering off" is
particularly important with some medications to give your body an adjustment
period.
14. Will the depression come back when I stop taking
medication?
In the majority of cases, depression is an illness that can be effectively
treated with medication and counseling. However, there is always a chance
that your depression may return once a medication is stopped. Continuing
antidepressants and/or therapy for the recommended time period minimizes
this possibility. Unfortunately, in a small number of cases, depression
reoccurs after treatment is complete. Recognizing the signs of a new
depressive episode and seeking treatment early are very important. You
should also discuss this possibility with your doctor before ending
treatment.
15. Are there "natural" substances I can
use to treat depression?
There has been a great deal of publicity about herbal preparations,
such as St. John’s Wort, for the treatment of depression. Unfortunately,
in the U.S., there currently are no adequate studies to prove that this
or other herbal remedies are an effective treatment, especially when
compared to standard antidepressants for certain forms of clinical depression.
In addition, herbal preparations may not have any significant impact
on severe forms of depression. Currently it is not recommended that
traditional antidepressants be mixed with herbal antidepressants. If
you are curious about any new developments in the research on herbal
preparations, talk with your psychiatrist before “self-medicating.”
16. How much will antidepressant medication cost?
Although the cost of medication may be difficult for some students
to budget, the costs of not treating a depression also are high. You’ve
invested considerable time and money to attend Cal. Your ability to
function in school, relationships and outside employment may be significantly
affected by an untreated episode of depression. If you have the Student
Health Insurance Plan (SHIP), call (510) 642-5700 for benefit information.
If you do not have SHIP, you will need to check your individual insurance
policy to find out what is covered.
17. Why can't I use alcohol when taking medication?
Alcohol itself is an extremely potent depressant. You certainly don’t
want to feel more depressed! The use of alcohol and drugs can complicate
the diagnosis and treatment of a depressive illness. Many depressive
conditions are associated with the excessive use of alcohol and some
drugs. Using drugs or alcohol can increase the risk of dangerous behaviors,
including suicide; or cause complicated interactions with your prescribed
medication. In summary, alcohol or drug use can reduce the effectiveness
of your treatment, prolong your illness, and increase the risk of negative
medication side effects. Alcohol and drugs can make your depression
worse.
18. What if I forget to take my medication on schedule?
This is something you should discuss with your doctor. In most cases,
if you miss a dose, don’t take a double dose next time. Simply
continue with the next scheduled dose and try not to miss again. If
you miss several consecutive doses, you may experience problems such
as headache and nausea. Most important, if you often forget to take
the medication, your recovery is likely to take longer.
19. How do I tell my family and friends?
Often people who care about you already are aware of and concerned about
the changes in your mood and energy levels. They may be very relieved
you are getting help. Since depression can leave you feeling exhausted
or helpless, getting support from others is important. However, many
people have never experienced serious depression and may have trouble
understanding how disabling it can be. They might not mean to be insensitive
or unsupportive, but they may say or do things that hurt. It may help
to share this information with those you most care about so they can
better understand and help you.
20. If I am taking medication, will I still need counseling?
For many people the combination of medication and psychotherapy is the
most effective way to treat depression. While medication can help improve
depressive symptoms, it can’t change events, thoughts or behaviors
that are problematic or distressing for you. Even before becoming depressed
you may have been struggling with personal or family issues that affected
how you felt about yourself and your relationships. Psychotherapy can
help you explore and resolve these concerns. Individual and/or group
psychotherapy also may be recommended to help you in improve self-esteem,
relationship skills and strategies for managing stressful events. Good
nutrition, quality sleep and exercise also are important elements of
your recovery. To feel better as quickly as possible, consider all the
recommendations of your counselor and/or psychiatrist.
Disclaimer: The information provided here is not intended to diagnose, treat or provide a second opinion on any health problem or disease. It is meant to support, not replace, the relationship that exists between an individual and his/her clinician.
Last revised: September 2005
