Everybody hurts sometimes - Pt II

Depression begins with an imbalance in the brain, but it affects the entire body. The symptoms range from mood changes to sleep disturbance, physical fatigue, stomach upset and backache, headaches, appetite changes, weight loss or gain, decreased sex drive and even suicidal thoughts and behaviour.

Generally, psychotherapy and self-help measures alone are helpful for mild depression, but moderate to severe depression usually calls for medication combined with psychotherapy.

What's available here?

Antidepressants top up chemicals that run low in the brain of a depressed person. The wide array of antidepressant medications available here is mind-boggling. If it's advertised on the cable channels, it's probably here in Jamaica. Older types like amitriptyline, imipramine and clomipramine are relatively cheap, and just as effective as newer ones.

Newer types like fluoxetine, paroxetine, venlafaxine, sertraline and bupropion have fewer side effects, but can be pretty pricey in private health care. The National Health Fund subsidises the cost of drugs used to treat depression, plus there are some generic brands available which are less expensive.

Best-fit medication

The first challenge for the doctor is to find the best-fit medication for the client. Each drug has its own benefits, mechanism of action and possible side effects. The benefits and side effects may beexperienced by some patients and not by others.

The doctor may follow up on side effects by giving a lower strength of the medication, or by changing it. If the patient is not improving, the doctor might increase the dose, switch to a different medication or add another antidepressant to the first one.

Patient compliance

The second challenge is patient compliance. Antidepressants take some time (usually weeks) to start working, and they need to be taken consistently as prescribed, for weeks, months or even years. Some people take the medication for a few days or weeks then throw in the towel, because they feel better and think they can do without medication. Sometimes they don't like the side effects, cost or just feel that the tablet is not working.

There is no craving

Regarding patient compliance, some people see antidepressants as mind-altering drugs, so they refuse to take them. Some people believe that antidepressants are addictive, even though there is no craving for them when the depressive episode is over.

Remember that depression itself can recur and some people have several depressive episodes over time. With follow-up evaluation, the doctor may decide to gradually wean the patient off medication. Weaning is necessary since patients complain of feeling 'weird' if the antidepressant is stopped suddenly. But if the patient experiences repeat episodes of depression, the doctor will prescribe long-term medication therapy to prevent relapse.

The first rule of engagement for people on medication is not to suddenly stop the tablets without discussing their concerns with the doctor or pharmacist.

Dahlia McDaniel is a pharmacist and final year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.