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Do anti- depressants really stop the sadness?

While talk therapy is apopular way of overcoming depression in the West, here anti- depressants are still being prescribed despite the evidence mounting against their usefulness

SANJEEV SHARMA was the life of every party. Young, exuberant and successful, he believed he had everything a man could possibly dream of. Suddenly things changed. Activities he earlier found pleasurable no longer appeared worthwhile. He started losing sleep and was often distracted at work. At the insistence of some colleagues, he sought help from a therapist.

During a session, it emerged that Sanjeev's recent divorce had taken a toll on his nerves. The psychiatrist concluded that his divorce coupled with a destructive thought pattern had triggered his depression. He was put on a course of antidepressants and psychotherapy.

Depressive disorders claim 1 lakh lives in India annually, and this figure is expected to spiral upwards: The World Health Organisation has concluded that by 2020 depression will be the second highest killer after heart disease. A dysfunctional family life, stress, chemical imbalances in the brain and genetic makeup can trigger depression.

Sometimes there is no reason for sadness. Serious depression is different from periodic sadness, and affects a person's mood and thought patterns in a more persistent way. It's tough to snap out of it without counselling and medical intervention.

In India the first choice of treatment by psychiatrists are antidepressants, typically prescribed for moderate and severe depression. These are intended to restore the chemical balance in the brain but they actually achieve this end is still a mystery. As Diksha Sawhney says, "When I asked my psychiatrist how exactly Prozac would help me she said the exact mechanism was still hazy. I took the drug but was not mentally satisfied. If they don't even know how it works then I have my doubts about its efficacy."

WHAT ' HAPPY PILLS' CONTAIN

ALL ANTIDEPRESSANTS or " happy pills" as they are popularly known as, are not alike. The four main categories of antidepressants are SSRI's, SNRI's, Tricyclics and MAO Inhibitors. All of these boast of different mechanisms through which they alter brain chemistry. Antidepressants target various chemicals to restore the chemical balance in the brain. A chemically balanced brain is indicative of cure from depression. Almost all antidepressants have adverse side effects. These range from anxiety, weight gain, tremors and drowsiness to rapid heart beat and low blood pressure.

The MAO Inhibitors have an additional side effect of an adverse reaction with tyramine.

Tyramine is present in food items such as cheese and pickles. Anybody on a course of MAO Inhibitors will have to follow a restricted diet.

MONITORING IS IMPORTANT

A NUMBER of leading scientists and psychiatrists believe that antidepressants can effectively treat depression. Dr Stan Kutcher, head of the department of psychiatry at Dalhousie University and a leading expert in depression says medication can help 60 to 80 per cent of people suffering from the condition.

But what needs to be borne in mind is that each person is different and reactions to medications also vary. Patience and perseverance is the key to finding what works. Monitoring the mood of the depressed individual is important. If there is no change, the psychiatrist can be asked for another antidepressant or an increase in dosage. Vinay Sharma says, " I cooperated with my psychiatrist right from the beginning.

During my meetings, I gave him regular updates about any changes in my mood and behaviour. Finally after six months we were able to hone in on a drug cocktail which pulled me out of the depression and was well tolerated by my system." Taking antidepressants in conjunction with psychotherapy is a powerful tool to combat depression. A depressed individual might benefit from ' talk therapy'. The therapist tries to resolve the problems which are exacerbating the depression through talking.

Cognitive Behavioural Therapy is another approach which helps the individual to break free from the thought pattern that produces depression.

ADVERSE SIDE- EFFECTS

THE PRIMARY reason that antidepressants aren't as effective as they could be is their side- effects. " I expected to feel better once I started the antidepressant medication. Instead I became nauseous and gained tons of weight. The pills didn't help me feel better, so I stopped taking them," says Shalini Ahuja, who went onto drug therapy for a few weeks before abandoning it. The perception of antidepressants as magic pills allows a person taking them to believe that their depression will just melt away once they begin. This misconception also results in poor treatment compliance.

Misconceptions about depression also come in the way. Many believe that depression is a sign of mental weakness rather then a real illness. Some people who opt for treatment, stop because of stigma and other negative social perceptions. " Nobody in my family has ever suffered from depression and I felt awkward going to the psychiatrist and finally stopped as their comments put me off," says Neha Solanki. Abrupt discontinuation of medication just when a person starts feeling better can lead to a relapse. Medication should only be discontinued under psychiatric supervision.

THEY MAY NOT WORK AT ALL

Some people suffer from " treatment resistant depression." The nature of their depression is such that they do not respond to antidepressant medication. It had been a matter of debate for several years that pharmaceutical companies which manufacture antidepressants overemphasise their benefits and any research that shows the drugs in an unfavourable light is not made public. This has been confirmed by a recent study conducted by Irving Kirsh Department of Psychology, University of Hull. " Given these results there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed," concludes Kirsh.

It is imperative that depression be combated in a proactive manner.

The choice of treatment should, however, be left to the depressed individual. One can opt for antidepressants, psychotherapy or alternative remedies.

If a person is not mentally comfortable with a treatment option they are not going to benefit from it. The reality is that antidepressants occupy a nebulous area, though most psychiatrists would disagree with this fact.

goodhealth@ mailtoday. in

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Publication:Mail Today (New Delhi, India)
Date:Nov 24, 2009
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