 |
Introduction |
|
Reactive, Biological, and Mixed Depressions |
|
Advances in Antidepressant Medications |
NOTE: The author is a licensed, clinical social worker who provides outpatient behavioral medicine services for children, adolescents, and adults.
Introduction
Some of the most frequent questions I am asked by clients involve the use of antidepressant medications. Clients often either think that antidepressants don’t really work (“They just give those pills to anybody!”), that they should be able to feel better without any medication (“I don’t need a pill to feel OK!”), or that antidepressant medications are somehow dangerous and/or addictive.
While not everyone needs or would benefit from antidepressant medication, some individuals have depressions that will only respond to medication. The benefits of appropriately treating these depressions far outweigh any potential risks. The key lies in being able to identify who needs treatment with medication and who does not.
Recent years have seen remarkable breakthroughs in the science of psychopharmacology – the use of medications in the treatment of mental and emotional disorders. These advances are especially evident in the treatment of depression. However, the effectiveness of antidepressant medication depends on the specific type of depression and symptoms experienced.
Reactive, Biological, and Mixed Depressions
Many individuals will experience what’s generally thought of as a reactive depression at some point in their lives. This type of depression is a direct response to something that is obviously causing stress in a person’s life. The depression can range in intensity from mild to severe, but basic physical functions such as sleep and energy levels remain relatively unaffected.
Others may experience a biological depression. With this type of depression there is obvious stressful or worrisome situation that can be identified as the cause of the person’s depression. This type of depression can result from medical illnesses, female hormonal fluctuations, medication and recreational drug use, or biochemical imbalances in the brain, which cause physiological symptoms.
These conditions can cause actual chemical changes in the brain, which affect specific areas of physiological function such as sleep cycles, appetite, energy levels, concentration/distractibility, and short-term memory. Attempting to “talk” or simply “will” these symptoms away is as incomplete a treatment as is attempting to control diabetes or high blood pressure without medication.
However, most depressed people suffer from a mixed depression. A mixed depression starts as a reactive depression. However, the person may soon develop the kind of physiological symptoms seen in biological depressions.
Advances in Antidepressant Medications
There have been significant advances made in recent years regarding antidepressant medications, and there are several effective and relatively safe alternatives available. All antidepressants work by altering levels of neurochemicals in the brain, but different “families” of medications act in different ways. (These medications are only available with a doctor’s prescription.) Generally, the antidepressants affect one or more of the primary chemicals in the brain believed to be related to the symptoms of depression. These brain chemicals include norepinephrine, serotonin, monoamine oxidase, and dopamine.
One of the newer categories of antidepressants called selective serotonin reuptake inhibitors, or SSRI’s for short, have been widely used due to their relatively mild side effects and few drug interactions. The most common side effects of these drugs are nausea and an upset stomach, sleepiness, and problems with sexual function. However, these effects are generally mild and short-lived. None of the antidepressants are addictive, although there has been evidence of some people who abruptly stop taking their SSRI’s rather than tapering off them experiencing some negative side effects for a relative short period of time (a few days).
A physician will prescribe an antidepressant based on a person’s physiological symptoms. While antidepressant medication can be very successful in treating the physiological symptoms of a depression, it does not address any underlying sadness or sense of loss. For those symptoms, psychotherapy is the treatment of choice.
So, when my clients ask me about antidepressant medications, I try to provide them with the same accurate and complete information that I would expect to receive. I also tell them that, overall, antidepressant medications are safe and effective in the treatment of the physiological symptoms of depression and, when combined with psychotherapy, can often make all the difference in the world.
The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
