Research has show that the importance of personality features such as neuroticism is a definite risk factor for depression. Additionally, studies have also found an overlap in the genes associated with a high level of neuroticism and genes associated with depression. Finally, both neuroticism and extroversion have a link to the brain’s serotonin system, largely targeted by SSRI antidepressants.

In the study, 120 participants were randomly assigned to receive Paxil and 60 were randomly assigned to undergo cognitive therapy. Personalities and depressive symptoms were assessed previous to the study and after the treatment. After treatment, those that responded to Paxil (69) were followed for a year to analyze depression relapse. Those taking Paxil reported 6.8 times as much change in neuroticism and 3.5 times as much change in extroversion and those placebo participants.

These results provide proof that may dispel the common assumption that personality changes during SSRI treatment occur only because of the alleviation of depressive symptoms. In fact, perhaps an alternative explanation is that it’s the biochemical properties of SSRIs directly produce real personality change. The personality changes that occur as a result of taking the anti-depressant medications may play a crucial role in decreasing depression symptoms.

Is Medication Even an Option While Pregnant or Nursing?

Depression medication is easily the first treatment choice for patients who are suffering from depression. These medications can improve the quality of life and relieve symptoms for sufferers, but they are among the list of medications that can cause problems when a woman becomes pregnant or is nursing. Get the real story by checking the facts and talking with your doctor so that you don’t make a serious mistake or put yourself or your child at risk.

Pregnancy and Anti-Depressants

Pregnancy causes the body’s hormones to go into an uproar. All of the hormonal changes can easily make depression harder to cope with. Therefore, stopping medication completely is usually not the solution that is chosen by doctors and pregnant women. Instead, you should work with your doctor to find a medication that can provide the relief that you need with the safety of your unborn child in mind. The price of leaving depression untreated during pregnancy might be very high, including issues with poor self-care, drinking, smoking, binge eating, and unhealthy lifestyle choices, which can all lead to health problems for newborns.

Here is a list of anti-depressants, arranged by whether they are recommended, should be avoided, and the potential risks with use during pregnancy. This information is courtesy of the Mayo Clinic’s Pregnancy Guide.

Recommended Medications:

Celexa (Citalopram): Risks—rare but serious lung problems in newborns when taken during last half of the pregnancy; also associated with septal heart defects, birth defects that affect the brain and skull, abdominal organs, and sutures on the head.

Prozac, Sarafem (Fluoxetine): Risks—associated with PPHN (persistent pulmonary hypertension in newborns) when taken during second half of the pregnancy.

Zoloft (Sertraline): Risks—association with omphalocele and septal heart defects, as well as PPHN during second half of the pregnancy.

Amitriptyline:  Risks—no confirmed risks associated with use during pregnancy.

Pamelor (Nortryptaline): Risks—no associated risks with pregnancy.

Wellbutrin (Bupropion): Risks—no pregnancy-related risks.

*Risks of PPHN and other birth defects are very rare, and the risks associated with them are extremely low.

Medications to Avoid:

Paxil(Paroxetine): Risks—fetal heart defects when taken during first trimester, PPHN when taken during final months of pregnancy, also associated with higher risks of birth defects anencephaly, craniosynostosis, and omphalocele.

Nardil (Phenelzine): Risks—Severe blood pressure increases that can trigger strokes.

Parnate (Tranylcypromine): Risks—Severe blood pressure increases that can trigger a stroke.

Breastfeeding and Anti-Depressants

According to About.com’s Depression and Pregnancy Website, studies have shown that breastfeeding mothers can safely take anti-depressants of certain kinds. The safest types of anti-depressants are the SSRI medications, or the Selective Serotonin Reuptake Inhibitors. Paxil and Zoloft are the two that have shown the lowest blood levels in infants who are being breastfed by mothers on anti-depressants. Prozac is also a medication that can be considered post-partum, but should be used carefully because it elevates blood levels more than other SSRI medications.

Withdrawal in Infants of Mothers on Anti-Depressants

In some cases, babies might appear to be more colicky or have withdrawal symptoms when they are born or stop breastfeeding because they are no longer getting the anti-depressants that their mother is taking. To reduce these symptoms, many doctors will recommend tapering dosage or discontinuing use for the last week or two during pregnancy. With weaning, the process is usually a gradual transition to formula or milk, so the tapering process of the medication will occur naturally.

The Bottom Line—Depression Medication is Circumstantial

You will need to discuss your specific situation with your doctor to ensure that you do what is best. Every situation is different, and you need to make sure that you get the antidepressant drug treatment that works for your pregnancy or breastfeeding experience.

First generation antidepressant drug treatment, for the most part, involved two major classes of drugs:    tricyclic antidepressants and monoamine oxidase inhibitors.  Tricyclic depression medication works by increasing levels of certain neurotransmitters, or chemicals, in the brain.  Unlike the newer depression medications, most of which selectively increase serotonin, the tricyclics are non-selective and increase serotonin, norepinephrine and, to a lesser extent, dopamine.  They also interfere with the action of other chemicals, such as histamine.  Although they are effective in elevating mood and decreasing anxiety, because they have so many and varied actions, they have considerably more side-effects than the newer agents.  The most common undesirable effects are drowsiness, dry mouth, dizziness, blurred vision, increased appetite, weight gain, palpitations, and sexual dysfunction. Tricyclic overdosage is extremely toxic, and is one of the leading causes of death due to drug overdose in the United States. For this reason, this class of medication is relatively contraindicated in severely depressed patients at risk for suicide.

Because of the relatively high incidence of side-effects with tricyclic anti-depressants, they are rarely used today as first line therapy for depression.  On the other hand, due to their non-selectivity and multiple actions, they are useful for a number of other indications and, fortunately, are often effective in smaller doses than would be required for depression treatment. Thus, they are better tolerated and cause fewer undesirable symptoms. Protriptyline (Vivactil) and desipramine (Norpramine) are used to treat Attention Deficit Hyperactivity Disorder (ADHD). Clomipramine (Anafranil) can relive the symptoms of obsessive-compulsive disorder (OCD) and narcolepsy. Imipramine (Tofranil) has been shown to be effective in the treatment of bed-wetting.

Monoamine oxidase (MAO) inhibitors, such as phenelzine (Nardil) and tranylcypromine (Parnate) also increase neurotransmitter levels in the brain.  They do this by inhibiting the enzyme, monoamime oxidase, that breaks down the neurotransmitters. Like the tricyclics, they are effective in relieving depression, but their use today is limited by their side-effects. One of their most serious adverse effects involves a reaction that takes place when a person taking an MAO inhibitor ingests a food containing tyramine.  The combination is extremely toxic and may result in a marked rise in blood pressure, headache, nausea, vomiting, confusion, seizures, stroke, coma or death. Strict adherence to a restricted diet is essential and tyramine-rich foods, such as aged cheese, smoked or processed meats, fish and soy products, red wine, fava beans, ripe figs, and foods containing monosodium glutamate MSG), must be avoided.  MAO inhibitors can also have dangerous interactions with alcohol, local anesthetics, cold and allergy medication, and a number of prescription drugs.  They are still prescribed occasionally, and can provide relief to some patients who have not responded to other therapies.  With careful monitoring and strict compliance to dietary restrictions, they can be used safely and successfully.

Antidepressants help millions  of people manage the disease. And that can take a blah day and infuse it with a dose of sunshine. Maybe you will start to laugh again or notice an amazing sunset. With a variety of depression medication on the market, knowing about the different classes of medicines is helpful when talking to your doctor. The Mayo Clinic offers a wealth of information about various types of depression and the medications used for treatment. Following are some of the different classes of depression medication:

• SSRI — selective serotonin reuptake inhibitor
• SNRIs — serotonin and norepinephrine reuptake inhibitors
• NDRIs — norepinephrine and dopamine reuptake inhibitors
• TCAs—tricyclic antidepressants

Monitor depression medication side effects. Sometimes the cure is worse than the illness. According to Mayo Clinic, some reported side effects include dry mouth, sexual dysfunction in men and women, nausea, headaches,and  sleepiness. According to Psych Central, Wellbutrin (Bupropion) had fewer overall sexual dysfunction side effects. Talk to your doctor if you experience debilitating or unexpected side effects.

The National Institute of Mental Health is charged with the task of not only researching the causes and cures of depression, but also educates people about new treatments for depression.  New depression medications seem to spring up almost daily with each new TV commercial. According to NYTimes.com, debate still swirls about new medications used to treat depression, but some medical experts say the new drugs show promise.  Sometimes doctors will prescribe more than 2 or 3 medications, referred to as augmentation, to treat depressive symptoms.

Natural depression medication may not require medication. Support groups may be one answer, sunshine or light therapy another. But if you want to try a pill straight from mother nature, consider these options. According to WebMD, fish oil and its omega-3 fatty acids can help with depression symptoms. Natural sources of omega-3 include mackerel, herring, tuna, halibut, and salmon. St. John’s Wort is one herb used to treat depression (but be aware that this herb renders your Birth Control Pill ineffective). Another commonly used natural depression fighter getting attention for both depression and anxiety is Valerian. However, insufficient results from research studies prevent scientists from endorsing the use of these natural remedies to treat mood disorders.

The Placebo Effect

Now a growing number of studies are mounting a clinical counterattack against antidepressant drugs by showing that they are ineffective in treating less severe forms of depression. Upsetting conventional wisdom, recent studies—a 2008 UK study on Initial Severity and Antidepressant Benefits in PLoS Medicine and, more recently, a 2010 US study on Antidepressant Drugs Effects and Depression Severity in the Journal of the American Medical Association—show no difference between a placebo and medication effect in sub-threshold and mild depression, which comprises three-quarters of those treated for depression.

These studies not only offer an explanation for the lack of effect of depression medication but also are having a large influence on options for replacing ineffective medication. Notably, there is a movement toward psychological and psychosocial over pharmacological treatments for milder forms of depression.

Psychological and Psychosocial Treatment

Health bodies, citing limited evidence, acknowledge that studies have failed to draw definitive conclusions on the effectiveness of medication management. Thus, no new recommendations have been made. Although they have recognized that medication management is more effective as part of a more complex intervention plan. In contrast, there is strong evidential support for the success of psychological and psychosocial interventions in the treatment of depression.

Confronting a lack of effect in depression medication should not necessarily result in non-adherence. Keep in mind that identifying the severity of depression is difficult. Depression treatment has proven to be reversible after nine months of treatment. Depending on the type and duration of treatment, your doctor may suggest increasing the dosage, switching to a new drug, or augmenting your current drug treatment.

Whether or not you stay on the antidepressants, the evidence strongly supports an intervention that includes psychological support, which may involve counsellng, cognitive behavioral therapy or psychodynamic therapy.

According to Everyday Health, the most common antidepressants on the market today are selective serotonin reuptake inhibitors (such as Prozac, Paxil, Luvox, Zoloft, Lexapro and Celexa). This type of medication is followed closely in popularity by serotonin-norepinephrine reuptake inhibitors (like Effexor, Cymbalta and Remeron). Both categories cause some form of antidepressant side effects in patients.

Weight gain—This is one the most common depression medication side effects. Fluid retention, reduced physical activity, and gaining back your appetite can all lead to weight gain. The tips for staving off weight gain on antidepressants are the same for people who want to lose weight. Cut out empty calories like soda, fast food, and sweet treats. Increase your intake of vegetables, fruits, whole grains, and lean meats. If weight gain becomes a severe problem, talk with your doctor about switching medications.

Weight loss—Some people experience nausea when they first go on antidepressants. Although this typically goes away within a week or two, ongoing nausea can cause you to lose too much weight. If you don’t feel like eating, try smaller meals more frequently throughout the day. Drink lots of cold beverages to settle your stomach and try an antacid. If the problem persists, your doctor can switch your prescription to a slow-release form of the same medication.

Sexual side effects—SSRI medications are most likely to cause sexual side effects. Talk to your doctor about adjusting your dose of medication or ask about medication that only has one dose per day. You can also ask about taking what the Mayo Clinic refers to as a “drug holiday” (going off of medication for one day per week).

Take a chart of your common symptoms and their frequency to your doctor so you can communicate how much you are experiencing them. Although some side effects are just part of the territory, you should not be experiencing major problems on a long term basis. Often a switch in dosage or a change to another medication can be the solution.

Prozac was the first in a new class of depression medications called selective serotonin reuptake inhibitors (SSRIs). Serotonin is a neurotransmitter, or brain chemical, thought to be decreased in depression.  It is released from the brain cells and then reabsorbed.  SSRIs prevent that reabsorption, effectively increasing  serotonin levels and elevating mood. There are now at least 6 available SSRIs (e.g. Lexapro, Zoloft) as well as even newer agents, such as selective serotonin norepinephrine reuptake inhibitors (SSNRIs, e.g. Effexor) and tetracyclics (e.g. Remeron).  Although the mechanism of the more recently developed drugs differs from that of SSRIs, the actions are essentially the same: elevating levels of neurotransmitters to improve mood and sense of well-being.

Because improvement of symptoms due to antidepressant drug treatment is dependent upon increasing levels of brain chemicals, relief is not immediate.  You should expect to feel some changes after approximately 2 weeks of therapy, but the full effect may not be apparent for up to 4-6 weeks.  Initially you may experience an increase in anxiety, but this should subside within a week or two.  Most studies show that approximately 60% of depressed patients achieve symptom relief with antidepressant medication, but up to 40% of these do not respond to the first drug tried.  It is important to monitor your symptoms and, if you are not feeling considerably better after 6-8 weeks, see your doctor and try a different agent.  It is a trial and error process, with no one drug being clearly superior to any other.  Fortunately, there are now more than a dozen choices and perseverance frequently pays off.  The salutary effects of the medication are often bolstered by non-pharmacologic interventions, such as talk therapy, lifestyle modifications (e.g improved diet, exercise and sleep habits), peer support, and stress reduction techniques.

As with all drugs, antidepressant medications can have side-effects.  The most common ones are relatively mild, and include nausea, headache, anxiety, sleep disturbances and sexual dysfunction. A small percentage of patients may experience increased depression, aggression or suicidal thoughts or behavior.  This is especially likely in children and adolescents and use in these age groups requires careful monitoring.

There have been several recent studies suggesting that antidepressant medications are no more effective than placebo in all but the most severely depressed patient group. Jay C. Fournier of the University of Pennsylvania  recently pooled data from 6 well-designed clinical trials and concluded that, although the benefit of antidepressant medication in severely depressed patients is “substantial”,  improvement is minimal to nonexistent in those with mild to moderate depression. Fournier’s results are consistent with earlier work done by Dr. Irving Kirsch of the University of Hull, England. He, too, reported that only the most severely depressed patients respond to antidepressant medication. The American Psychiatric Association and others have challenged these results, suggesting that the study did not adequately account for the fact that many depressed patients do not respond to the first drug tried, but require a trial and error process to achieve optimal results.

In spite of the large number of people who take anti-depressants, there are still some things that every person needs to know about depression and depression medication safety.

1. Depressed people are at a high risk for suicide. Some medications can be lethal if taken at a high enough dose. If you are the one who is in danger, have a friend keep your meds for you, and only give you a one day supply at a time.
2. Don’t get 90 day supplies. It’s just not wise. You may feel fine one minute, and swallowing 90 pills the next.
3. Ask your doctor about what the main side effects might be, how long they may last, and when to call the doctor.
4. If you read the inserts that come with samples, do not allow any warnings to scare you out of taking your medication. Discuss concerns with your doctor, and research further to understand their potential impact on your health.

Some of the most common side effects of these medications are nausea and vomiting, drowsiness, blurred vision, dry mouth, and constipation.

A lot of media attention has been given to the fact that antidepressants may increase the risk of suicide in children, teens, and young adults. The best treatment in these cases is administration in a controlled environment until this risk is assessed and the patient is considered safe to be released.

Different classes of anti-depressants have side effects that occur more frequently in one group than in another. A little research on your part can assist your physician in making a good selection. Anti-depressant drug safety requires stringent precautions due to the serious nature of the disease. Education is the best way to understand, and hopefully prevent a tragedy, and this education should occur at the first signs of the illness.

Take care or yourself, your family, and your friends. Educate yourself. Pop that Prozac if the doctor recommends it and you feel the need to give it a shot;  don’t be critical if someone you know does the same. This decision is personal. Have hope and show support for all who are forced to make it.

Depression is widespread: about 18.8 million adult Americans suffer from the various types in any given year.

Depression can affect nearly every aspect of life. Suffering and pain afflict not only the ill person, but also their loved ones. Imagine living every day with an extremely negative person. The good news is that much of this suffering can be alleviated with depression treatment—there are several options.

Depression symptoms treatments include medications, electroconvulsive therapy (ECT), and psychotherapy. Your primary care physician may be able to treat your depression; if not, you may need to consult a psychologist or psychiatrist. Either way, you and your doctor can work out a plan that suits you.

Alternative depression treatment options include vagus nerve stimulation (for those resistant to other forms of treatment); deep brain stimulation (experimental); and transcranial magnetic stimulation, (TMS) which produces an electrical current inside the brain. Food can also play a part. Darlene Kvist, MS, CNS, LN, a licensed nutritionist, at Weight and Wellness, goes as far as to say, “there are more effective solutions to help restore emotional balance to life than relying on medication. My answer is, of course, in the healing power of food. As a nutritionist I understand that food is the most important factor in the prevention and treatment of depression and anxiety.”

I was surprised to learn that ethnicity also plays a role: various ethnic groups can respond differently and may be increasingly at risk for side effects.

Medications to treat depression:

Medications for depression are many and various, but all affect the biochemicals of the brain and, in turn, affect your mood. When making a choice, you and your doctor will consider your family history of depression (if any), your symptoms, possible side effects, possible conflicts with other medications you may be taking, and any underlying conditions you may have. The important thing, I learned, is not to give up until you find the medication or combination of medications that works for you. It can take some time to sort through the various types, so hang in there and don’t give up.

You may have heard of the common antidepressants doctors prescribe: selective serotonin reuptake inhibitors (SSRIs), such as Paxil, Celexa, Zoloft, Prozac, and Lexapro. Your doctor will most likely start you on one of these, as they have the best chance of helping you. Other possibilities include the tricyclics (TCAs). These drugs have been around a long time, and they still work, but they increase the frequency and severity side effects, which makes them second choices. Monoamine oxidase inhibitors would be a last resort when everything else has failed, as they can react negatively with certain foods. Your doctor will explain all this to you in depth.

I have had good luck with SSRIs in treating my depression. Currently, I am taking sertaline, the generic form of Zoloft, and trazadone for insomnia. The difference it has made in my life is spectacular!

Employing electroconvulsive therapy (ECT) for depression:

In ECT, an electrical current is sent through the brain, causing a seizure. ECT once had a bad reputation, caused largely by negative media coverage, and, in some cases, inappropriate usage, but these days techniques have improved, and for many it offers speedy, efficient relief of depressive symptoms. It is most often used with people who have proven resistant to other treatments or those at risk for suicide. Experts are not sure why this method works so well, they just know it does!

The benefits of psychotherapy:

Talk therapy is often used in conjunction with medication to resolve problems associated with depression. Patients are encouraged to gain insights into their feelings through verbal interactions with the psychologist or psychiatrist. Behavioral patterns can be traced and modified so that they no longer contribute to the patient’s depression.

Whichever treatment proves right for you, make a commitment to follow the plan you and your doctor have worked out until you reach a satisfactory conclusion. You’ll be glad you did!