Depression, Risk of Suicide, & Treatment Options
What is Major Depressive Disorder (MDD)?
Depression is not just feeling blue occasionally. Depression affects daily feelings, thoughts, and actions over a longer period of time. Medical conditions such as arthritis, cancer, and diabetes may worsen, too. The good news is that depression is treatable with a high rate of success using treatment options such as prescription medications and psychotherapy (talk therapy).
What Are the Symptoms of Depression?
Could I Be at Risk for Depression?
Depression does not play favorites. Anyone from any age group, socioeconomic status, or ethnic background is subject to depression. Some groups that tend to have a higher incidence of depression include:
- People between 45 to 64 years
- Blacks, hispanics, and non-hispanics of other color
- Education less than high school degree
- Those who are divorced
- People without health insurance
Do We Know What Causes Depression?
Depression may involve multiple factors, such as:
- Genetics or family history
- Chronic or acute health conditions
- Situations like job loss, workplace stress, or physical or mental abuse
- Severe grief due to death of a loved one
- Prescription drug side effects
- Abuse of alcohol or drugs
- Hormonal changes in women
Are There Different Types of Depression?
- Major Depression (or Major Depressive Disorder)
- Seasonal Affective Disorder
- Depressive Psychosis
- Postpartum Depression
- Premenstrual Dysphoric Disorder (PMDD)
If you suffer from symptoms resembling depression, please talk to a trusted friend and a healthcare provider.
What Kind of Treatments Are Available for Depression?
Often, these two approaches are effectively used together. There are different types of psychotherapy and this treatment can help you to:
- Set realistic and daily goals
- Work through a crisis situation
- Develop coping and problem solving skills
- Learn to develop positive relationships
- Replace negative thoughts with positive ones
Antidepressants: What's Used?
Examples of antidepressant classes include:
Antidepressants: Coping With Side Effects
If your side effects seem intolerable, do not stop taking your antidepressant without speaking to your doctor. Abruptly stopping some antidepressants may cause withdrawal-like symptoms or worsen your depression and mood. Speak with your doctor. You may just need a dose adjustment.
Managing Side Effects: Nausea and Vomiting
For those who do have side effects, coping mechanisms can help until the side effect subsides. Nausea can start fairly quickly after beginning treatment with an antidepressant, usually within the first week, but it may go away within a month. If you experience nausea or vomiting, check with your doctor or pharmacist to see if you can take your medicine with food, or if you can use an antacid or Pepto Bismol.
Be sure to drink plenty of noncarbonated fluids, and eat smaller but more frequent meals. If your nausea does not subside, talk to your doctor about a temporary dose reduction.
Managing Side Effects: Sexual Problems
Consult with your doctor; some strategies to cope with sexual side effects include:
Managing Side Effects: Weight Gain
Managing Side Effects: Drowsiness, Insomnia, Headaches
If your antidepressant causes insomnia, ask if you can take it in the morning or add a low dose of a sedating antidepressant (like trazodone) at bedtime. Avoid caffeine. Be sure to engage in regular exercise which can boost your mood and help with insomnia, too. Mild headaches are common with initial therapy and should subside in a few weeks; if not, contact your doctor.
The Selective Serotonin Reuptake Inhibitors (SSRIs): Pros and Cons
Paroxetine has been associated with more weight gain and more sexual side effects than the other options. Fluoxetine is linked with lower rates of withdrawal-type side effects, and sertraline may lead to diarrhea in some patients. With long-term (> 24 month) use of paroxetine or venlafaxine, studies have shown an increased risk for diabetes. As a class, SSRIs can increase the risk for stomach bleeding, so caution should be advised in patients with a history of ulcers or taking a blood thinner.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Pros and Cons
The SNRIs can usually be given once-a-day, and venlafaxine may be useful in patients who have hard-to-treat depression. Duloxetine is also used for painful conditions like osteoarthritis, neuropathic pain, and fibromyalgia, but may increase blood pressure and worsen sweating.
Miscellaneous (Atypical) Antidepressants: Pros and Cons
Bupropion has been added to SSRIs to help reverse sexual dysfunction; it can also help boost patients who feel fatigued. Bupropion must be avoided in patients with a risk for seizures, and higher doses of bupropion can increase this risk.
Monoamine Oxidase Inhibitors (MAOIs): Pros and Cons
Side effects such as lightheadedness (especially when standing up), weight gain, drowsiness, headache, insomnia, nausea, constipation, dry mouth, or sexual dysfunction may occur. MAOIs are not used as first-line depression treatment as there are more tolerable antidepressants with fewer food and drug interactions.
Tyramine found in dried fruit, aged cheeses, pickles, smoked meats, fava beans, and red wine can lead to a spike in blood pressure, headache, nausea, and other serious effects.
Tricyclic Antidepressants (TCAs): Pro and Cons
Like the MAOIs, TCAs are rarely used first-line; however, they may be used in adults for other indications, including nerve pain and migraine headache prevention. A TCA overdose can be fatal. Heart rhythm disturbances, seizures, and depressed breathing are serious overdose complications.
Brintellix: A Newer Serotonergic Antidepressant
Fetzima: A Newer SNRI
In Phase III studies of adults with MDD, a significant improvement in depression was seen with Fetzima given once daily compared to placebo. Common side effects occurring in greater than 5 percent of patients included nausea (>10%), constipation, and sweating. Patent protection for Fetzima runs until 2023.
An Add-On Option: Rexulti
Common side effects seen in the depression studies included restlessness, diarrhea, nausea, weight gain, headache and somnolence. Rexulti is not approved for use in psychotic conditions related to dementia. In addition, healthcare providers should see the label for significant drug interactions that can affect the dose of Rexulti. Rexulti is co-marketed by Lundbeck and Otsuka.
Serious Class Effect: Risk of Suicide
However, it is important to remember that untreated depression itself is also linked with suicide. Caregivers and healthcare providers should closely monitor patients for suicidal signs and symptoms within the first few months of treatment initiation and with dose changes.
SSRI Use in Children: The FDA's Overview
Some studies suggest that the benefits of antidepressants may outweigh the risks to children with major depression and anxiety disorders. Only fluoxetine is currently approved to treat depression in children ages 8 and older.
How to Manage the Risk of Suicide
It is not known if any one antidepressant is more or less likely to result in suicidal thoughts or action. Do not hesitate to call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255) or the Suicide Hotline: 1-800-SUICIDE (1-800-784-2433) for trained help.
Do Not Abruptly Stop Taking Antidepressants
Your doctor may recommend that the antidepressant be slowly discontinued to help prevent withdrawal side effects, and will tell you how you can best taper the medication dose.
Serotonin Syndrome: A Rare But Serious Effect
- Rapid heart rate
- High fever
Drug Interactions Can Lead to Serotonin Syndrome
Antidepressants and Cost Concerns
What if My Antidepressant Does Not Work?
If you prefer to stop your antidepressant, speak with your doctor FIRST so that a tapering schedule can be started. Finally, consider talk therapy with a trained professional who can offer methods to help lessen your depression and increase your quality of life.
Finished: Depression, Risk of Suicide, and Treatment Options
- Centers for Disease Control and Prevention (CDC). CDC Features. An Estimated 1 in 10 U.S. Adults Report Depression. April 20, 2012. Access May 25, 2014 at http://www.cdc.gov/features/dsdepression/.
- Second-Generation Antidepressants for Treating Adult Depression: An Update. Clinician Research Summary. AHRQ Publication No. 12-EHC-012-3. Updated July 2012. Accessed May 27, 2014. Available at: http://effectivehealthcare.ahrq.gov/ehc/products/210/1143/sec_gen_anti_dep_clin_fin_to_post.pdf
- Mayo Clinic. Depression (Major Depressive Disorder). Antidepressants: Get tips to cope with side effects. Last updated July 9, 2013. Accessed May 25 at http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20049305.
- Drugs.com. Winter Depression May Require Plan. December 26, 2012. Accessed May 29, 2014 at http://www.drugs.com/news/winter-depression-may-require-plan-42227.html.
- U.S. Food and Drug Administration (FDA). Antidepressant Use in Children, Adolescents and Adults. Last updated 8/10/2010. Accessed 5/27/2014. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273
- National Institute of Mental Health. Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers. Accessed May 28, 2014 at http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml.
- Mayo Clinic. Depression (Major Depressive Disorder). Antidepressants: Selecting one that's right for you. Last updated November 8, 2011. Accessed May 24, 2014 at http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273