Tag Archives: Antidepressants

If antidepressant doesn’t work For depressed teen

If a depressed teen doesn’t respond to treatment with commonly prescribed antidepressants the first time around, new research suggests there’s still hope.

Switching medications and adding behavioral talk therapy turned out to be the most effective alternative, although just switching medications also helped many individuals.

“On average, these kids were ill for two years and no matter which treatment they got, at least 40 percent responded within 12 weeks,” said study author. “I really think the take-home message to families is if you don’t respond to the first treatment, don’t give up.”

The issue of whether depressed or troubled children should even take antidepressants has been at the center of an intense public debate in recent years.

Some research has turned up evidence that kids on antidepressants have a higher rate of suicide ideation, meaning suicidal thoughts and behavior.

Heeding this data, the U.S. Food and Drug Administration in 2004 asked manufacturers of antidepressants to add a black-box warning to their labels warning about the increased suicide risk.

Recent research, however, has found that the benefits of antidepressants outweigh the risks for children and teens under the age of 19.

About 60 percent of adolescents with depression respond to treatment with antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Guidelines recommend prescribing SSRI medications, psychotherapy or both as a first-line treatment for this younger population. (The only SSRI approved by the FDA for use in pediatric patients is Prozac, but others are prescribed on an off-label basis).

Unfortunately, 40 percent do not respond to the first therapy they try, and there’s little guidance on what to do next.

There’s just not that much research in kids, period

For this latest study, the researchers chose 334 patients aged 12 to 18 years, all of whom had major depressive disorder and had not responded to two months of SSRI treatment. They were randomly selected to receive one of four treatment possibilities for 12 weeks: a second, different SSRI; a different SSRI plus cognitive behavioral therapy; Effexor (a serotonin-norepinephrine reuptake inhibitor, or SNRI); or Effexor plus cognitive behavioral therapy.

While the drugs were taken for 12 weeks; therapy lasted nine sessions.

There was a 54.8 percent response rate among those teens who switched to talk therapy plus either medication, compared to 40.5 percent for a medication switch alone.

There was no difference in response rates between Effexor and a second SSRI. However, there was a greater increase in blood pressure and pulse and more frequent skin problems with Effexor than the other drugs.

About Depression

Depression isn’t a weakness, nor is it something that you can simply “snap out of.” Depression, formally called major depression, major depressive disorder or clinical depression, is a medical illness that involves the mind and body. It affects how you think and behave and can cause a variety of emotional and physical problems. You may not be able to go about your usual daily activities, and depression may make you feel as if life just isn’t worth living anymore.

Effective diagnosis and treatment can help reduce even severe depression symptoms. And with effective treatment, most people with depression feel better, often within weeks, and can return to the daily activities they previously enjoyed.

Signs and symptoms of depression

Symptoms of depression include:

  • Loss of interest in normal daily activities
  • Feeling sad or down
  • Feeling hopeless
  • Crying spells for no apparent reason
  • Problems sleeping
  • Trouble focusing or concentrating
  • Difficulty making decisions
  • Unintentional weight gain or loss
  • Irritability
  • Restlessness
  • Being easily annoyed
  • Feeling fatigued or weak
  • Feeling worthless
  • Loss of interest in sex
  • Thoughts of suicide or suicidal behavior
  • Unexplained physical problems, such as back pain or headaches

Depression symptoms can vary greatly because different people experience depression in different ways. A 25-year-old man with depression may not have the same symptoms as a 70-year-old man, for instance. For some people, depression symptoms are so severe that it’s obvious something isn’t right. Others may feel generally miserable or unhappy without really knowing why.

Continue reading About Depression

Antidepressants during pregnancy

Taking antidepressants during pregnancy may pose risks for your baby — but stopping may pose risks for you.
Antidepressants are the first line of treatment for most types of depression. Antidepressants can help relieve your symptoms and keep you feeling your best. But there’s more to the story when you’re pregnant or thinking about getting pregnant. Here’s what you need to know about antidepressants and pregnancy.
Pregnancy hormones were once thought to protect women from depression, but researchers now say this isn’t true. In fact, an estimated 10 percent of women experience depression during pregnancy. Although pregnancy doesn’t make depression worse, pregnancy often triggers a range of emotions that can make it more difficult to cope with depression.
If you don’t take proper care of depression during pregnancy, you may put your health — and your baby’s health — at risk. If you’re depressed, you may not have the energy to take good care of yourself. You may not seek optimal prenatal care or eat the healthy foods your baby needs to thrive. You may turn to smoking or drinking alcohol. And the price may be high, including premature birth, low birth weight, developmental problems and an increased risk of postpartum depression.
Few medications have been proved safe without question during pregnancy. Research continues, however, and the latest studies on antidepressants and pregnancy offer some reassurance. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, some types of antidepressants are safer than others.

Here’s an overview, arranged alphabetically by specific type of antidepressant:

Antidepressant name Risks Recommendations
                   Selective serotonin reuptake inhibitors (SSRIs)
Citalopram (Celexa) Associated with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn, or PPHN) when taken during the last half of pregnancy Consider as an option during pregnancy
Fluoxetine (Prozac, Sarafem) Associated with PPHN when taken during the last half of pregnancy Consider as an option during pregnancy
Paroxetine (Paxil) Associated with fetal heart defects when taken during the first three months of pregnancy Avoid during pregnancy
Sertraline (Zoloft) Associated with PPHN when taken during the last half of pregnancy Consider as an option during pregnancy
                Tricyclic antidpressants
Amitriptyline Suggested risk of limb malformation in early studies, but not confirmed with newer studies Consider as an option during pregnancy
Nortriptyline (Pamelor) Suggested risk of limb malformation in early studies, but not confirmed with newer studies Consider as an option during pregnancy
               Monoamine oxidase inhibitors (MAOIs)
Phenelzine (Nardil) May cause a severe increase in blood pressure that triggers a stroke Avoid during pregnancy
Tranylcypromine (Parnate) May cause a severe increase in blood pressure that triggers a stroke Avoid during pregnancy
              Other antidepressants
Bupropion (Wellbutrin) No established risks during pregnancy Consider as an option during pregnancy

Note: Persistent pulmonary hypertension of the newborn is a rare condition. Even if you take an SSRI during pregnancy, the ultimate risk remains extremely low.

 If you take antidepressants throughout pregnancy or during the last trimester, your baby may experience temporary withdrawal symptoms — such as jitters or irritability — at birth.
A preliminary 2007 study associated the use of antidepressants during pregnancy with preterm birth. However, the evidence wasn’t strong enough to consider antidepressants a consistent risk for preterm birth. Generally, antidepressants aren’t considered a risk factor for preterm birth.
If you stop taking antidepressants during pregnancy, you risk a depression relapse. In fact, in a 2006 study, pregnant women who stopped taking antidepressants were five times more likely to experience a depression relapse than were pregnant women who continued taking the drugs.

In addition, stopping an SSRI abruptly may cause various signs and symptoms, including:

  • Headache
  • Nausea and vomiting
  • Chills
  • Dizziness
  • Fatigue
  • Insomnia
  • Irritability
  • Vivid dreams

If you have depression and are pregnant or thinking about getting pregnant, consult your doctor. Sometimes mild depression can be managed with support groups, counseling or other therapies. If your depression is severe or you have a recent history of depression, the risk of relapse may be greater than the risks associated with antidepressants.
It’s not an easy decision. As researchers continue to learn more about antidepressants, the risks and benefits of taking the drugs during pregnancy must be weighed carefully on a case-by-case basis. Work with your doctor to make an informed choice that gives you — and your baby — the best chance for long-term health.