1. Depression – When the Initial Treatment Doesn’t Work

    January 31, 2014

    Depression - When the Initial Treatment Doesn’t Work

    Depression is a condition that stems from a variety of different factors, and this makes it difficult to treat effectively.  Upon diagnosis and development of a treatment plan, there is no guarantee it will be effective. While this can be quite discouraging, it is important to consider why things didn’t work. If you are someone who suffers from depression, consider the following points of view as an explanation for why, and see if it applies to you in any given way.

    Wrong Diagnosis

    It can be uncommon, but sometimes the diagnosis of depression can be wrong all together. There are various mental illnesses that have the patterns that depression follows, and if this is the case, then the treatment of depression isn’t going to be the answer. An example would be something like hypothyroidism, which is a condition that produces consistent fatigue, a lack of overall motivation, and problems with concentration. While these all sound like depression, and the similarity is significant without question, a treatment for depression will not cure hypothyroidism.

    Substance Abuse

    When there is a plan put together to help resolve depression symptoms, the use of alcohol or other drugs can hinder the effect of the medication. Something as simple as a beer or a glass of wine can interfere with the medicine being absorbed properly, and the intended effect will not take place.

    Living Situation

    Sometimes the individual diagnosed with depression is in a living situation with many different stressors that need to be addressed. Without successfully dealing with the stressors, the depression will be very hard to treat. If there is a lot of tension at home, work, or other areas of the person’s life, then the effective treatment of depression will be very hard to achieve.

    Unhealthy Sleep Patterns

    While depression medication is geared to help the mind deal with any chemical imbalances, it isn’t necessarily designed to cure insomnia. If an individual is not sleeping properly, the lack of rest can prevent the mood from improving.  Lack of sleep can prevent someone from getting better all together. The likelihood for heightened anxiety is more likely from someone who doesn’t get the proper amount of rest, as well.

    Stopping a medication too soon

    When a person is prescribed anti-depressants, the concern for dependence might cause fear, and in some cases, this will stop the person from using the medication. This will prevent the medication from developing its optimal effects. Medication has to be taken as prescribed for a period of at least 2 weeks to see any improvement, and for several months to gain the desired effect.  Coming off of the medication too quickly can cause side effects or even withdrawal symptoms, and the positive developments will have to be started all over again.  This can take longer each time the person starts and stops his/her medication.

    Depression is something that can be very difficult to understand, and it’s even more of a challenge when you are the individual with the condition. While discouragement is something that may occur during your first attempts at treatment, it’s essential to consider the reasons as to why it didn’t work, and to continue pushing forward for other solutions. Depression is a very intense feeling to manage, but as long as there is a will there, then a way will be available in due time.

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  2. The End of Anti-Depressants as We Know Them

    November 26, 2013

     

    How the future of antidepressants is diverging from its scattershot past

     

    The End of Anti-Depressants as We Know Them

    by Amy Maxmen

    Sixty-one years ago, in a Staten Island hospital complex, doctors testing a new drug on tuberculosis patients observed a strange side effect: While the drug, known as an MAO inhibitor, was no miracle cure

    for the hospital’s debilitated residents, it seemed to have an energizing, almost magical effect on their mood. One report noted that patients were “dancing in the halls tho’ there were holes in their lungs.’

    The early history of what would come to be known as antidepressants is dominated by such stories of serendipity, and many pharmaceuticals prescribed for depression today are, by and large, descendents of these decades-old happy accidents. Newer drugs replaced old ones because they were safer, not more effective, explains William Potter, senior advisor to the director of the National Institute of Mental Health.

    Now, as psychiatry inches toward a more refined understanding of the neurochemistry of depression, the course of drug discovery is changing. Roughly half of all clinically depressed patients fail to respond to available antidepressants-all of which target one neurotransmitter or another-and the lack of relief provides an important clue: Depression is not a monolithic disease, but a set of symptoms that can spring from a variety of causes. A treatment may work, scientists are finding, only when it is tailored to the type of depression found in a particular patient. “Today’s antidepressants seem to change the brain only slowly and indirectly,” explains Olivier Berton, a neuroscientist at the University of Pennsylvania.

    How the future of antidepressants is diverging from its scattershot past

    Because doctors knew that some early antidepressants boosted serotonin, they hypothesized that the neurotransmitter may be linked to depression. But a person’s outlook doesn’t start to shift until a month after beginning serotonin-altering drugs like Prozac, even when they work. The delay suggests another process is involved. Enter neural plasticity. Researchers have long observed the growth of new brain cells following antidepressant use. It may be that the sluggishness and stunted outlook that characterize depression at bottom  reflect a failure to generate  new nerve cells, and yet the role of serotonin in neurogenesis is indirect, at best. The chain of reactions that link them remains largely unknown.

    Recently, however, new research has begun to point to substances in the brain that act closer to the scene of neurogenesis, suggesting  more logical drug targets.  In June, researchers reported one important step in Nature Medicine. After mice took Prozac-Iike antidepressants, the levels of a fat molecule in the brain called ceramide plummeted.  Ceramide normally stalls brain cell growth;  by blocking ceramide, the drugs presumably  jump-started  neural regeneration.  New drugs that inhibit ceramide  could  work  faster than  drugs that  act on serotonin   because  they  are more directly linked to neurogenesis, the authors suggest.

    Others   are  entirely    abandoning approaches related to serotonin. Researchers know that individuals who are obese or who take immune-altering   medications may not respond to antidepressants. What such people have in common  is chronic inflammation,  explains Emory University psychiatrist Andrew  Miller. He believes that inflammation   is a particular  path to depression  that  stems from  a beneficial adaptation. Depression is often characterized by what are called sickness behaviors – withdrawal  from others, loss of appetite, lethargy.  These are typical  responses  to physical  injury  and infection, and, in the short term, may foster recovery. Such responses become a problem, Miller says, only when the inflammation   is chronic. Then the depressive behavior endures.

    Earlier this year, Miller investigated whether a drug  currently used to tame inflammation in rheumatoid arthritis might  help people  who found  no relief in antidepressants   and failed to respond to talk therapy. The drug indeed  helped depressed patients with excess inflammation and did little for those without.

    Depression  that stems from trauma can  also be especially resistant   to conventional    antidepressants. Scientists believe that trauma  may cause epigenetic changes-lastingly modifying molecules that  turn  mood-  and  behavior-related genes on or off. The upshot  may be that those who experience trauma early in life may be unable to bounce back from later hardship the way other people can.

    Penn’s   Berton  recently studied trauma-induced depression in  mice. Bullying – one type  of trauma, easily modeled  in animals – typically causes a meeker mouse to act asocial, refrain from favored foods, and scare easily-behaviors analogous to those of depressed humans. But when Berton blocked a particular protein in the bullied  mice, they showed no such symptoms.  Berton  is now collaborating  with  a pharmaceutical  company to develop  a drug  that  blocks  the same protein. Other researchers are also experimenting  with drugs that block different proteins that may act as on/off switches for the genes affected by trauma.

    “For  a long  time,  people  focused only  on serotonin,   and  that  inhibited new avenues  of investigation,” Berton says.  Now that the variety of mechanisms underlying depression is becoming clearer, a one-size-fits-all approach may soon be a thing of the past.

    (article originally published at Psychology Today – Nov/Dec 2013)


  3. Should You Take Medication for Anxiety?

    April 9, 2013

    Should You Take Medication for Anxiety?

    by Robert Davies

     

    Whilst we all experience a touch of anxiousness or stress from time to time, for sufferers of Generalized Anxiety Disorder, anxiety can be crippling. Anxiety can lead to sleep deprivation, fear of social engagement, incapacity at work or physical illness. Psychotherapy provided by a clinical psychologist or psychotherapist is commonly used to treat anxiety yet. in severe cases the medication may be necessary to alleviate anxiety symptoms.

    Certain medications may be useful as a way to contain and improve symptoms of anxiety. Keep in mind that medication does not cure anxiety and that it is used primarily for symptomatic treatment, i.e. to alleviate anxiety symptoms. Ideally medication should be used under the supervision of a psychiatrist or a doctor and in conjunction with counselling.

    Listed below are the types of medication that are normally used to treat severe anxiety or mild depression:

    ANTIDEPRESSANTS

    In addition to supporting sufferers of depression, anti-depressant medication was also found to be effective for the treatment of anxiety. This category of medication includes tricyclic antidepressants, MAOIs and SSRIs, which are the most popular anti-depressant commonly used in the treatment of anxiety.

    Anti-depressants typically take more than 4 weeks to start alleviating the symptoms of anxiety and they must be taken every day. They cannot be taken on an ‘as needed’ basis.

    SSRIs – Selective Serotonin Reuptake Inhibitor

    This type of medication increases the amount of serotonin in the brain. Serotonin is a neurotransmitter that is involved with mood regulation and feelings of well-being. Low levels of this chemical in the brain can cause anxiety and depression.

    Common medications that fall under this category include Celexa, Cipramil, Lexapro, Cipralex, Prozac, Luvox, Paxil, Aropax and Zoloft.

    TRANQUILIZERS

    Tranquillizers are useful for short-term anxiety issues, such as occurs in a person who has a fear of flying. Tranquilizers can be used on a ‘as needed’ basis, for e.g., when you need to fly. Tranquilizers include barbiturates, azapirones and benzodiazepines, which is the type most commonly used for anxiety treatment.

    BENZODIAZEPINES

    Benzodiazepines start to produce an effect very fast, i.e., in about 30 minutes after the intake. The intensity of the effect will depend on the dose and also if the medication was taken on an empty stomach or not.

    These medications work by calming the nervous system. They also produce muscle relaxation.

    The following medications fall within this category: Alprazolam (Xanax), Chlordiazepoxide (Librium), Clonazepam (Klonopin), Diazepam (Valium) and Lorazepam (Ativan).

    BETA-BLOCKERS

    Beta-Blockers are a type of medication used mainly to treat diseases related to the heart and high-blood pressure. Beta-Blockers can alleviate symptoms of anxiety such as shaky hands, sweating and pounding heart. Because of that, it helps anxious people to concentrate better on the task being performed.

    This medication can be used as an aid for social anxiety treatment and also to help with performance anxiety.

    Beta blocker medication that is utilized for anxiety includes Propranolol (Inderal) and Atenolol (Tenormin).

    SIDE-EFFECTS

    Side effects of anxiety medication will vary from person to person and will depend upon the specific medication being taken. Listed below are some common side effects for each different category of medication:

    SSRIs

    • Dry mouth
    • Weight gain or loss
    • Suicidal thoughts
    • Restlessness
    • Aggressiveness
    • Insomnia
    • Drowsiness
    • Nausea

    Benzodiazepines

    • Dizziness
    • Drowsiness
    • Decreased alertness
    • Decreased concentration
    • Slower reaction
    • Slower thinking
    • Paradoxical reactions (aggressiveness, irritability, impulsivity, etc.)

    Beta-Blockers

    • Weakness, dizziness
    • Cold hands and feet
    • Fatigue
    • Dry mouth, eyes, and skin

    It is essential that anxiety medication is only taken with a doctor’s prescription and under supervision of a mental health professional. Consult your doctor if you think that anxiety treatment medication might assist in managing your anxiety.

     

    About Author

    Robert Davies has written for the www.counsellingsutherland.com.au websites for many years. As a content contributor on a variety of mental health issues, Robert understands issues including depression and low mood, panic and anxiety, bereavement, addiction, anger management and relationships. Counselling Sutherland is the Shire’s leading provider of counselling and relationship therapy services.

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