Mental health articles

OF mental health care and mentally ill

The most common anti-depressants

The way that the most common form of anti-depressant (SSRIs) works is that they help make more serotonin available to the cells in your brain. Serotonin is a natural neurotransmitter and is used in the transmission of messages from one brain cell to another. The SSRI anti-depressant prevents the re-uptake, or re-absorption, of serotonin back into the vesicles in which it is stored; serotonin thus stays around in the links (synapses) between the brain cells, so that the next time a brain cell fires, the transmission of that impulse is easier because more serotonin is available and this means essentially easier brain message transmission. It acts as a form of neurotransmitter lubricant. You are therefore less likely to get “stuck” in some depressive thought pattern or negative mood cycle. You can also create more serotonin from various foods (see the section “Foods for depression”).

Noradrenalin and dopamine are other neurotransmitters that can also affect one’s mood. The SSRIs take about two weeks to boost you up to the right level of serotonin in your body. Taking just one or two capsules when you are feeling down is really NOT the way to take them: you should follow the instructions quite carefully. Afew people occasionally suffer some side effects from some of these SSRI antidepressants. These are usually not terribly serious, although sometimes your doctor will prescribe a different SSRI with less side effects. These anti-depressants can therefore be seen as acting a bit like a buoyancy aid: they help to keep your head above the surface, as you learn to swim in this sea of emotions, moods, feelings, and weird thoughts. After a while, you probably will not need them any more. Then you can come off them, but please come off them slowly and very gently. If you do not, there is a small risk that you will “bomb”—disappear suddenly into a black hole of depression again, or even become suicidal.

If it is decided to come off the SSRI anti-depressant medication, the following guidelines are strongly recommended:

(1) you MUST consult your doctor;(2) you SHOULD come off them very, very slowly. I quite often have to start seeing people again when they have come off their anti-depressant too quickly: they were feeling better so they stopped taking the tablets. After a discussion with your doctor (make a twenty-minute appointment), the best way to come off this type of medication is to drop (say) one tablet in four—i.e., don’t take the anti-depressant on every fourth day. Try this pattern for 3–4 weeks. Then, if everything seems OK, try dropping one in three (not taking a pill every third day) for about three weeks or a month; then drop one in two for another three weeks to a month. Now you are safely down to half your original dosage. At any time, if things start to feel strange or funny, you can easily go back up to the previous level where you were feeling all right. You have not “come off” the medication and therefore do not need to start again with the 2–3 weeks introductory period before they begin to have an effect.

The NICE Guidelines on Depression(CG23) now recommend that anti-depressants should NOT be prescribed immediately—unless there is very good cause. For mild to moderate depression, Step 1 in the recommended Stepped Care programme of self-help techniques, plus information, plus a combination of exercise and relaxation is recommended first, along with a period of “watchful waiting”. Many people get over their depression within a few months like this without any intervention. However, some cognitive behavioural therapy and/or psychosocial counselling or psychotherapy is appropriate at the next stage, Step 2, if this first stage is unsuccessful. For moderate to severe depression, Step 3, a combination of counselling and then (possibly) some anti-depressant medication is what is now recommended. However, the absolutely best anti-depressant known, and readily available, is—you won’t like this—about 30–45 minutes of aerobic exercise (where you get out of breath and hot and sweaty) about 4–5 times per week. This method works by eliminating (burning off) a lot of the stress hormones (adrenalin, cortisol, etc.) that are generated through stress and in depression, and by helping the brain to produce endorphines (the hormones associated with pleasure). Do NOT substitute this method for your anti-depressant medication until you have talked to your doctor. Just do the exercise anyway.

When you feel better, then you can decide about the medication. Some people take herbal remedies like St John’s Wort for depression. This can be effective, but if you take this you MUST NOT take any other medication, or any other herbal medicine. It can react violently with other drugs and herbs.

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