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Is this the right choice

By Dr Anjana Kannankara
When addressing major depressive disorder, prescribing antidepressants combined with psychotherapy is the most common way of approach. While suffering from deep, disabling depression, the idea that a medicine can give back normal life and sense of hope is incredibly appealing. But unfortunately, antidepressants do not always bring about the desired results in everyone. Studies show that only four out of 10 people treated with antidepressants improve with the first prescribed medication they try. Sometimes the trial and error method becomes a necessity to find which antidepressant would work for a particular person. Researchers warn that since this would take time, it might worsen the condition at least in some cases as the search for the appropriate medicine might delay the actual treatment.
Experts believe that some people are prescribed antidepressants unnecessarily. Significantly, the fact that more people take antidepressants nowadays is a possible indicator that these medications are sometimes frequently prescribed for milder cases, even though there is doubt regarding how well they work in a specific case.
There are several apprehensions surrounding the use of antidepressants which cannot be dismissed lightly. A discussion about a few concerns may be helpful to understand the pros and cons and decide if an antidepressant would be a right choice.
Concern: Antidepressants help to suppress the symptoms only not the actual problem.
The depressed state can distort a person’s perception of problems and sap him of the energy to address difficult issues. Medication may relieve some symptoms of depression but can’t change the underlying issues and situations in the person’s life that are making him depressed. Antidepressants can surely make it easier to deal with the problems. Many therapists report that when their patients take antidepressants, it helps them make more progress in psychotherapy. These medicines are believed to work by increasing the availability of chemicals like serotonin and dopamine in the brain. However, the theory of chemical imbalance in brain being the cause of depression is disputed by many scientists.
Concern: Antidepressants turn a person into a zombie.
When taken under proper medical directions, antidepressants are not supposed to change anyone’s real character. They are said to be aimed to help improve mood, control anxious feelings and return the previous level of functioning of a person. What needs to be remembered is that medication has an effect on the brain and is not something to be taken lightly. Those who favour use of drugs claim that if a person who isn’t depressed takes antidepressants, the medicine does not seem to improve the person’s mood or functioning. Rarely, people do experience apathy or loss of emotions while on certain antidepressants. When this happens, lowering the dose or switching to a different antidepressant may help.
Concern: Antidepressants have severe side effects.
Like all drugs, antidepressants have side effects, and weight gain can be a common one of many of them. Some antidepressants may be more likely than others to cause weight gain; others may actually cause to lose some weight. Side effects of antidepressants vary from one medication to another and from person to person. Bothersome side effects, such as dry mouth, nausea, tremors, restlessness, weight gain or sexual side effects, can make it difficult to stick with treatment.
Concern: Antidepressants once started have to be taken lifelong.
When antidepressants are prescribed for a primary episode of depression, the goal in the first few weeks and months is to relieve the symptoms and if possible, make the depression go away. Once that goal is attained the patient may need to take the medication continuously for six to nine months for clinical effectiveness and to prevent relapse. Towards the end of the treatment, the dose is gradually reduced over the course of several weeks before stopping the drug completely. Discontinuing them suddenly or abruptly may cause severe withdrawal symptoms which might be difficult to control.
While antidepressants are believed to be quite effective at relieving depression in severe cases, it is possible that some patients, in particular young people, may temporarily feel worse when they first begin taking an antidepressant or when they make changes in their dosage.
Concern: Antidepressants tag the person with social stigma.
It’s high time that people learnt to overcome the stigma attached with seeking help for any kind of mental discomforts unlike in other medical conditions. The fact remains that majority of people these days are stressed out but do not hesitate to get treatment because they understand how treatment can help them lead a normal productive life. When depression interferes with the ability to function normally, seeking treatment is not a sign of weakness. It’s a sign of good self-care when a person decides to seek timely help to alleviate stress, anxiety or sadness even in the initial stages so that the condition doesn’t worsen or ruin the life altogether.
Concern: Antidepressants increase the risk of suicide.
Studies in recent years have raised concerns that antidepressants may raise the risk of suicidal thoughts or behaviours among children, adolescents, and young adults. For example, a 2009 review in the British Medical Journal (BMJ) looked at 372 studies involving nearly 100,000 people who were taking antidepressants. It was found that, antidepressants were associated with a slightly high risk for suicidal thoughts in some children and young adults, have no effect on suicide risk among those 25 to 64, and reduce the risk in those 65 and older.
A 2006 study published in PLoS Medicine suggests that antidepressants have saved thousands of lives. However, people who are taking antidepressants should be watched closely to detect any worsening symptoms and alleviate possible danger.
Concern: Antidepressants cause addiction
Unlike sleeping pills and some anxiety medications, antidepressants are less addictive. Having said this, one should never just stop a course of antidepressants without the supervision of a treating physician. Though body may not crave for the medicine, it will be certainly affected by a sudden stop, particularly at higher doses or might cause the symptoms to return.
Concern: Antidepressants can be quite expensive
The cost of antidepressants varies widely, depending on the dosage, the drug taken and whether it is available as a generic. Some antidepressants can be expensive, so it’s important to enquire if there’s a generic version available which would be equally effective. Informing the medical practitioner about the concerns can help devise a treatment plan without burning a hole in the pocket.
(The author is director,
TGL Foundation, and senior director, FWO)
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