Medication Management for Depression
Medication management plays a huge role in treating depression. With 17% of the population having major depressive disorder during their lifetime, improving treatment as needed for each individual patient is critical to treating the disorder. During the initial assessment, our experienced staff with attempt to rule out or identify any other potential sources of depressive symptoms and treat the underlying cause before coming up with an effective treatment plan.
The Role of Medication
Major depression is a common and treatable disease with many patients benefitting from pharmacologic treatment. Medication choices are made based on patient characteristics, safety and anticipated side effects. Many patients will see a significant decrease in symptoms, though some may not see complete symptom relief. All antidepressants can produce harmful side effects, thus needing to be closely monitored by a qualified healthcare provider; the risk of suicide is always a concern with depression and is not necessarily reduced by the use of antidepressants.
Tricyclic antidepressants (TCAs) block norepinephrine reuptake pumps and, to some degree, serotonin reuptake pumps. TCAs can act on different receptors to help aleviate symptoms of depression, but may also cause some unwanted side effects, such as:
- Weight gain
- Dry mouth
- Drop in blood pressure when standing up
- and Reflex tachycardia
Patients will start off at a lower dosage of around 75-100 mg a day when using TCAs before gradually increasing as needed. Compared to SSRIs, TCAs have a higher risk of cardiovascular issues in patients with certain types of heart trouble, so it’s important for patients to disclose medical history before starting any kind of medication.
Other medications used to treat depression are selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). SSRIs have been the most popular treatment for depression since Prozac (fluoxetine) was introduced to the market in 1986. This class of medication works by inhibiting the reuptake of serotonin in certain receptors within the brain, allowing more seratonin to influence mood. Side effects of SSRIs can include:
- nsomnia or sleepiness
- Sexual dysfunction
- and Weight gain
SNRIs work in a similar fashion, but inhibit both serotonin and norepinephrine reuptake at higher doses. Side effects of SNRIs are:
- Upset stomach
- Sexual dysfunction
- and Minor increase in blood pressure
During the initial assessment phase, patients should discuss medications family members have used to treat depression in the past. Sometimes, is a family member has responded well to a treatment, the same treatment may work for the patient. Other times, patients may need to try several medications or combinations of medications before finding one that works. This will require some patience and consistency as it can take several weeks for the medication to build up within the system and begin to take effect.
Part of the challenge of medication and why medication management is important is determining the specific dose and timining of medication for each individual. There are no consistent relationships between height, age and clinical response to a medication. Trial often is the best determining factor to finding the most beneficial dosage. Typically, patients will start with a lower dose, increasing dosage in three to seven day intervals until clinical benefits are achieved.