One Pill Makes You Smaller

It’s a fact of life that sometimes you get down. For many people, this feeling passes with time. For others, it’s a constant condition. When your behavior changes because of this feeling, it becomes clinical depression. For many years, there was little outside of therapy that science could do for those suffering from depression. In recent years, however, advances in pharmacology have led to many medications for depression. Unlike Alice in Wonderland, you can’t just take a pill, or eat a cookie to affect a change in yourself.

Depression is not just feeling bad. That’s a state of mind, but while it can be a symptom of depression, just feeling bad doesn’t mean you are clinically depressed. Depression occurs when this sadness lasts for an extended period of time. It’s also accompanied by abnormal behaviors – obsessive eating or starving one’s self, inability to sleep or sleeping too much. Loss of interest in sex is often a sign of depression. Disinterest in friends, family, career and life in general are also hallmarks of depression. Depression can also be accompanied by obsessive/compulsive behaviors – counting, constant cleaning, excessive ordering and neatness.

Here is a checklist of clinical depression symptoms – if you find many of these apply to you, consider seeking help.

Depressed Mood: You are sad, grumpy or irritable most or all of the time.

Loss of Interest: You are not interested in things you used to enjoy; this includes hobbies, sex and relationships.

Diminished Ability to Concentrate: You find yourself easily distracted, or have trouble remembering things. It may be hard for you to focus on tasks at work.

Recurrent Thoughts of Death: This is the most serious symptom of depression. The despair can range from feeling as if others would be better off if you were dead to actually making plans for suicide.

Sleeping Difficulties: Insomnia is a common symptom of depression. There are several forms of insomnia; Early Insomnia, when you cannot fall asleep, Middle Insomnia, when you awake several times during the night, or only sleep lightly and Late Insomnia when you awake too early and cannot go back to sleep. Another form of sleeping difficulties occurs with hypersomnia – where you feel sleepy/drowsy all the time, despite getting enough sleep.

Like most clinical diagnoses, depression isn’t the same in everyone, but if you have several of the above symptoms, you may be clinically depressed. It’s a good idea to be examined and diagnosed by a psychiatrist or your doctor, rather than just asking your doctor for a prescription. Often, the symptoms of depression can dictate which medications are appropriate.

Depression is prevalent in the gay community, usually in the early pre and post-coming out years. But often the end of a relationship, or another big change in life can trigger depression. Beyond therapy, there are very effective medications to treat the physical condition of depression. Treatment is not an exact science, and much to the dismay of both doctors and patients, there is a trial period of ‘mix and match’ between medication and patient. But when the "fit" is good, the results can be dramatic.

Why is medication effective when therapy alone isn’t? Current thinking about depression is that it’s a chemical condition in your brain. For whatever reason, genetic or environmental, your brain develops an imbalance of certain chemicals, called neurotransmitters, which do the business of the brain. They exist in a delicate balance, transmitting messages between nerve cells across junctions called synapses. Two neurotransmitters relevant to depression are serotonin and norepinephrine. They exist in a balance, but when serotonin levels drop below normal, things begin to change. Sleep becomes difficult, or one sleeps too deeply. Appetite can change; meaning a person overeats or doesn’t eat enough. Anxiety often increases, and thoughts can become obsessive or muddled. Antidepressants work to restore the natural balance of these neurochemicals. After a period of adjustment, many patients find the fog lifts and their feelings and behaviors return to a more normal, predictable pattern.

The first class of antidepressants were the tricyclics (TCAs). Tricyclics work by blocking the receptors that take up serotonin in your synapses, keeping the levels of serotonin higher, allowing them to return to normal levels. Popular TCAs are marketed under with names Elavil (Amitriptyline), Ludomil (Maprotiline) and Pamelor (Nortriptiline). For the sake of clarity, I am using both the trade name and the pharmaceutical name in parenthesis. Tricyclics are an older class of antidepressants, and are less prescribed than the second class. They usually require stepped dosages, and have more difficult side effects than other drugs. However, a recent study by Canadian physicians indicates that TCAs are as effective as other drugs and are much less expensive.

The second class of antidepressants are the selective serotonin reuptake inhibitors or SSRIs. Classic SSRI are Prozac (Fluoxitine), Paxil (Paroxitine) and Zoloft (Sertraline). Prior to the appearance of Viagra, Prozac was the one of the most prescribed drugs in America. Strangely, there is no firm evidence that it works better than any other antidepressant.

Like the tricyclics, SSRIs keep serotonin levels higher, allowing the balance of neurochemicals to be restored. They are more selective in their action, so they are less sedating than the TCAs. SSRIs are more perscribed than the tricyclics because they have fewer side effects, and are better tolerated by patients. SSRIs are not totally without side effects, and they can be disturbing.

Classic SSRI side effects include dry mouth, excess perspiration, and slight dizziness at the beginning of treatment. These symptoms usually disappear during the course of treatment. Long-term side effects include a frustrating change in sexual function. Many on SSRIs, especially Zoloft and Paxil, find themselves able to become aroused sexually, but unable to achieve orgasm. This can be very disturbing and aggravating for both patient and partner. New studies of antidepressants indicate there may be combinations of drugs that eliminate this. SSRIs often increase appetite, resulting in slight weight gain. Other side effects include constipation, blurred vision and difficulty urinating.

Recently, newer antidepressants have appeared which are purported to combine the effectiveness of the SSRIs and the power of the tricyclics, with fewer side effects. Effexor (Venlafazine) and Remeron (Mirtazapine) are members of this new class of drugs.

All antidepressants are slow acting medications. This means you often have to take the medication for several days or weeks before you notice a change. There is a common misperception that one can take Prozac and feel better the next day. This is a placebo effect, where thinking you will feel better actually makes you feel better.

After taking antidepressants for a few weeks, most patients feel better, less sad, less preoccupied, and more hopeful. Patients suffering from anxiety-related depression often find a sense of calm returns to their life, and they stop obsessing and fixating. Many with sleep-disruption symptoms find their sleep patterns stabilize. Some find they have not been sleeping well for some time, and have increased energy and improved emotional state.

People who have been successfully treated for depression report feeling better, thinking more clearly, loss of obsessive thoughts or behaviors, renewed interest in sex, life, career and relationships. These successes are usually the result of a combination of psychotherapy and medication.

Because antidepressants work directly on brain chemistry, those with a history of seizure disorders, eating disorders (organically derived), or under treatment with certain kinds of blood pressure medication (MAO Inhibitors) should consult with their doctor. Other drugs, including alcohol are not a good idea while on antidepressants. People being treated with antidepressants often find the effects of alcohol intensified. Ecstasy, Acid and GHB are especially bad. These drugs act directly on serotonin levels, and can result in toxic side effects, such as seizure, coma or psychotic behavior.

Will antidepressants cure your depression? Probably not; Depression may be a medical condition, but there is almost always an environmental component to the illness. The best strategies for treating depression combine drugs and therapy: drugs calm or relieve symptoms so emotional work can be done on the patient’s psyche. Once problems surface and are resolved through therapy, medication can often be discontinued. In many cases, therapy alone was shown as effective as medication for dealing with depression.