10 Factors that Every Clinician Should Know – and Share with their Clients – about Antidepressants
– Depression is a real illness, not a character flaw or weakness. In this regard, depression is no different from diabetes or hypertension. Also, depression is highly responsive to appropriate treatments, which may include more than medication alone.
– Antidepressant medications typically work quickly. In fact, at least half of all individuals who will eventually respond to antidepressants begin to demonstrate improvement within the first week of treatment. They will likely first notice an increase in their energy level, followed by a gradual improvement in their mood and overall physical functioning.
– While all antidepressants have similar efficacy, their side effects differ. The prescriber should provide this information to the client when the prescription is generated. If this does not happen, clinicians can turn to countless sources where this information can be found. My book, Psychopharmacology: Straight Talk on Mental Health Medications, discusses the side effects of all widely used antidepressants. Also, because many side effects diminish over time and clients gradually become conditioned to them, they are only minor irritants to continued use.
– Antidepressants are not associated with cravings and are not addictive. If clients express concerns about getting “hooked” on these drugs, explain that this is a non-issue.
– If the first agent prescribed does not help after an adequate trial period, other agents should be tried. Until science unlocks more mysteries of the brain, clients and clinicians alike must learn to live with a “one-size-does-not-fit-all” approach.
– For an antidepressant to be effective, the client must take enough for long enough. In general, clients should continue taking the medication daily unless their prescriber recommends otherwise. Also, clinicians should advise clients to keep a diary of their symptoms. For example, if before starting the medication they felt sad, empty, and were sleeping poorly, these conditions should be noted in the diary. Then, over time, the clinician and client can monitor which symptoms, if any, are improving. This diary can also be used to keep the prescribing physician informed of bothersome side effects and to schedule follow-up appointments.
– Use of an antidepressant should never be abruptly discontinued. Although abrupt discontinuation is not considered dangerous, some people report “shock-like” sensations in their extremities, particularly the hands and feet. To spare the patient this unnecessary upset, it is best that any antidepressant be discontinued gradually.
– Ideally, an antidepressant is taken at the same time each day. If the time is missed, it’s fine for the client to take the medication within one to three hours of the regularly scheduled time. But if more than a few hours pass, then the client should instead wait for the next regularly scheduled time.
– For many clients, too much information can be as detrimental as too little. Information overload may fuel feelings of hyper-vigilance and alarm. Reading (sometimes conflicting) articles on the Internet and devouring every word of information attached to the prescription bag can exacerbate a client’s fears. Most of what appears in print-outs will never happen; that data is mainly for the prescriber, not the consumer.
– Beware of direct-to-consumer advertising. When drug companies advertise their products – particularly on television – they typically glorify the medication’s benefits while the voiceover only casually mentions its risks.
While clients certainly have every right to ask whether a specific antidepressant may be helpful, ultimately, the decision should be made collaboratively by the client and their prescriber. What’s more, this decision should hinge on the patient’s personal and family history of depression, as well as any previous experiences with antidepressants they may have – and not on an advertised message. The good news: Antidepressant treatment has come a long way from the days when debilitating side effects and other complications were sometimes worse than the depression itself.
Joe Wegmann is a licensed clinical social worker and a clinical pharmacist with over 30 years of experience in counseling and medication treatment of depression and anxiety. Joe’s new book, Psychopharmacology: Straight Talk on Mental Health Medications is available at www.pesi.com. To learn more about Joe’s programs or to contribute a question for Joe to answer in a future article, visit his website at www.thepharmatherapist.com, or e-mail him at firstname.lastname@example.org.