Different approaches doctors use to switch antidepressant medications plus taking antidepressants during pregnancy - is it safe.

Gold Standard for Treating Depression (part 10)

According to Dr. John Preston, board certified neuropsychologist and co-author of several books on depression, healthcare professionals will use one of three approaches when switching from one antidepressant to another.

1. Stop the first drug and immediately start the second drug. The advantage to this method is a decreased chance that depression symptoms will return- as they might if a drug is stopped with no replacement. The problem is that there is a risk for drug interactions or increased side effects. FYI: Prozac is one drug that can suddenly be discontinued without severe withdrawal symptoms due to the fact that it stays in the body much longer than most antidepressants. It has its own built-in taper effect that is the equivalent of reducing the medications slowly. Thus, as compared to other antidepressants, it may be safer to quit Prozac and immediately try a new antidepressant.

2. Do a "washout" by taking a week or two with no medications at all. The advantages are that drug-drug interactions are less likely as the first drug is completely eliminated from the body before starting the next. The disadvantage is that there can be strong antidepressant withdrawal symptoms and or break-through depressive symptoms.

3. Reduce the dose of the first drug while starting on a low dose of the second drug: this is a conservative approach often used that may avoid the problems of the other two strategies. In any event, gradual dose reduction will almost always work to avoid withdrawal symptoms.

4. Augment the current drug. This involves a healthcare professional deciding what new drug will best work with a current medication.

Are Antidepressants Safe If I'm Pregnant?

Every antidepressant is different regarding safety before and after pregnancy. This is a topic that must be discussed thoroughly with a medical professional. You can also do your own research on the web to bring into a consultation with your healthcare professional.

The FDA ruled that Paxil can produce birth defects and warned other antidepressants should be used cautiously and judged by risk to mother vs. baby. Women with depression regularly have healthy babies. You will need to research your antidepressant medications carefully and speak with your doctor about your options.

video: Depression Treatment Interviews w/Julie Fast

Find out what causes antidepressant side effects and what you can do about the side effects from antidepressants.

Gold Standard for Treating Depression (part 8)

When a person has cancer, we are used to hearing that the person has been nauseous or has lost their hair due to medication side effects, and yet, when a person is on psychiatric medications, similar side effects are often unexpected and scary; simply because they are not explained ahead of time. The reality is that drugs for depression have side-effects. That is part of the territory when you put something into your body to change your brain chemistry.

Medications for depression work by regulating brain chemicals such as serotonin, norepinephrine and dopamine. The problem with medications for depression is that they cannot be sent directly to your brain; they have to go through your body first and this can lead to many physical complications.

Some side-effects are tolerable; such as a dry mouth or a mild restlessness. Others are impossible to live with, such as extreme fatigue, irritation and anger, suicidal thoughts, erectile dysfunction or not being able to have an orgasm.

It can be extremely difficult to stick to a treatment plan when a drug has strong side-effects with seemingly very little results. It gets even more frustrating when your healthcare professional says, "Let's just give this time." But the reality is that it sometimes does take much longer for the medications to work than you want them to.

It's always a trade off when you take an antidepressant and it's up to you to decide what side effects you can and can't tolerate. When you're depressed, having to deal with medication side-effects often feels intolerable, but you do have some options.

1. Start with a small dose and then increase the dose to an optimum level over time. This is called microdosing and can work well for some people.

2. Give your body time to deal with the side effects. If the antidepressants are helping, there is a chance that the side effects can considerably lessen over time as your body acclimates to the dose.

3. Change medications with the help of a prescribing medications healthcare practitioner before deciding that antidepressants are not for you. There are many classes of antidepressants and one of them may work for you with no significant problems.

4. Change the times you take the antidepressant. If it causes drowsiness, take the drug before bed. If it is agitating or increases your energy, take it upon waking up in the morning.

5. Side effects that lower sex drive, cause impotence or make a person unable to have an orgasm can often be eliminated by adding another drug like Viagra, Levitra or Cialis or changing the antidepressant. For some, depression itself lowers sex drive and antidepressants can help restore it.

6. Find a therapist to help you manage depression more successfully while you explore your different medication options. The role of therapy in depression treatment is covered in more detail in the next section.

7. Make lifestyle, behavior and thought changes that decrease depression so that you may need less medications. This can include removing yourself as best as possible from situations (triggers) that are contributing to your depression. This topic is covered in detail in a later section.

Side effects are the main reason people stop taking their medications. By trying a variety of medications and treatment techniques, you can reduce side-effects so that you can find the right medications for you. If the side-effects of your medication are simply too strong to tolerate, it cannot be emphasized enough how important it is that you don't just decide to stop the medications yourself. Even if you feel you can't take another day of the side effects, decisions regarding medications need to be discussed with your healthcare professional.

video: Depression Treatment Interviews w/Julie Fast

Detailed information on antidepressants, medications for treatment of depression. How to find the right antidepressant, side-effects, more.

Gold Standard for Treating Depression (part 7)

You've been just diagnosed with clinical depression. What's the best initial approach to take?

Although some depressive symptoms are often the same for depressed people: lack of pleasure, hopelessness, suicidal thoughts, lethargy, irritation, anxiety, changes in appetite and a general reduction in the quality of life, the treatment for each person can differ significantly due to medications tolerance and symptom relief.

How Do I Find an Antidepressant That Works for Me?

Choosing the best antidepressant is usually a trial and error process. The most important part of this choice is working with a healthcare professional who understands the type of depression you have as well as how your body may react to the medication. As mentioned before, this is done through the healthcare professional asking you the right questions as well as helping you monitor your progress and adjusting your treatment as necessary.

Once your healthcare professional decides on an initial medication, the dosage will depend on your ability to tolerate any accompanying side-effects as well as the effectiveness of the medications. As seen in the Star*D research, this dose may be much higher than usually prescribed. Once you have started the antidepressant, it can take, on average, about six weeks for the medication to work. This can be a difficult time. You may feel that the medications are not giving you enough relief or that the side-effects are too strong. That's why it's so important that you and your healthcare professional work closely together.

Common Antidepressant Side Effects

• Dry mouth
• Nausea
• Increased appetite and weight gain
• Lack of appetite and weight loss
• Sexual side effects
• Fatigue, drowsiness
• Insomnia
• Waking up too early and unable to go back to sleep
• Blurred vision
• Constipation/diarrhea
• Dizziness
• Agitation, restlessness, anxiety
• Irritation and anger
• Aggressiveness
• Suicidal thoughts

Antidepressant side effects can feel overwhelming at first. While some people experience few drug side effects and are able to find relief from their first antidepressant, others may have to work on dosage and/or try other medications before finding one that can be tolerated. It's often true that side effects can end or lessen over time. This is why it's so important for you to give your drug a chance before deciding it will not work.

It's also true that different antidepressants have different side effects. Because of this, it is often possible that one antidepressant may work better for you than another. There are certainly situations where side-effects such as suicidal thoughts and severe stomach problems are too overwhelming- and a new drug must be tried. However, for many, giving the medication time to work may be the answer.

video: Depression Treatment Interviews w/Julie Fast

Learn about all the options for treating depression.

Gold Standard for Treating Depression (part 6)

Instead of relying solely on medications for depression, by combining all of your options, you can significantly increase your chances of managing depression successfully. The following suggestions offer an optimal treatment plan that not only takes into account the Star*D research but also uses complimentary treatments that increase your chances of managing depression successfully and achieving the quality of life you desire.

• Medications
• Psychotherapy
• Lifestyle, behavior and thought modifications
• Alternative and Complementary Treatments

Although these therapies can be used individually, a combination of all four offers you a variety of ways that can give you much more control over your treatment than you previously thought possible.

video: Depression Treatment Interviews w/Julie Fast

Besides, or in addition to antidepressant medications, there are other effective treatments for depression.

Gold Standard for Treating Depression (part 5)

The goal of medication treatment for depression is a complete remission of symptoms. You may be one of the lucky people who do respond very favorably to antidepressant medications at first try. Unfortunately, this is not the case for all people who try antidepressants either due to side-effect intolerance or less than significant symptom relief from the medications. Because of this, the overall treatment proven most effective for depression is one that uses antidepressant medications along with other comprehensive treatments such as lifestyle changes; including:

• bright light exposure
• regulated sleep
• diet and exercise

and behavioral changes including:

• looking for and managing the triggers of depression
• learning your personal symptoms of depression so that you can determine what part of your behavior comes from the illness and what represents your real emotions

and finally, taking an active role in your own treatment.

It's also very important that you surround yourself with people who understand depression and have the tools to help you when you get sick, including healthcare professionals, family and friends.

video: Depression Treatment Interviews w/Julie Fast

The Star D depression research project and how the results can help treat your depression.

Gold Standard for Treating Depression (part 4)

The Star*D (Sequenced Treatment Alternatives to Relieve Depression) research project addressed the fact that only some 30% of people who are initially treated with an antidepressant for depression receive significant symptom relief while others often struggle to find a plan that works for them. The researchers asked the question: What are the options for the 70% of the people treated for

depression who do not respond to their initial antidepressant medication? This seven year study, sponsored by the National Institute of Mental Health (NIMH), followed 2876

patients in order to find the best course of medication treatment and in what sequence the treatment should unfold if the first chosen antidepressant was not successful.

What Were the Results?

The initial phase of the research found that aggressively increasing the antidepressant dose (often a significantly higher dose than usually prescribed) of a person's first choice medication provided remission usually within 8-12 weeks for 30% of participants. For those who did not experience remission with the higher doses, a second treatment plan was implemented where a new drug was added to the original drug (augmentation) or the original drug was changed to a different class of antidepressants.

The results of these changes showed that up to an additional 30% of participants in the second phase experienced remission with the help of another medication added to the first or through switching to a new antidepressant medication completely. This is good news for those resistant to initial antidepressant treatment. Psychotherapy was added to this phase of the treatment and the results are pending. Past research into the role of psychotherapy in the treatment of depression is discussed later in this article. The final research phases explored additional treatment options for those who did not respond to the first two treatments and results are pending.

The Importance of Regular Antidepressant Side-Effect and Depression Symptom Monitoring

During all phases of the Star*D project, participants monitored the level of their depression, as well as the side effects caused by the medications, on a regular basis. Researchers found that filling out these weekly charts was one of the major factors in successful treatment. There were two reasons for this:

1. When participants were clear on their specific medication side-effects, they were better able to tell a researcher how well they tolerated a medication dose. This led to either reducing or increasing the dosage, switching to a different class of antidepressants, or augmenting a medication.
2. The second step of rating the level of depression a client felt on a weekly basis not only helped the researcher measure the effectiveness of the treatment, it also helped the participant see that their depression was often significantly better; even though they did not feel a change.

This self-monitoring, along with antidepressant treatment, showed that when participants are involved in their own care, treatment outcomes are much more positive. The study also found that frequent contact with a researcher helped participants feel more positive about their treatment.

Getting a depressed person through the first weeks of treatment can be very challenging as the hopelessness felt with depression can make a person loose faith in a medication before it has had time to work. Another problem occurs when a person who is already feeling pessimistic about the chance of recovery ends antidepressant medication treatment due to minor side-effects. The conclusion is that people with depression must give their medications time to work before ending treatment.

Dr. John Rush, principal investigator of the Star*D project tells HealthyPlace.com, "Ideally, in treatment, visits should be as often as required- when severely depressed, weekly or every two weeks contact is optimum. When a person is less symptomatic, contact can be every three weeks to three months as needed." This contact can be with the healthcare professional who monitors the depression. If this contact is not realistic, a person can use the self-monitoring forms to determine when more care is needed. It's also a great way for a person with depression to participate in his or her own healthcare and become more realistic about the impact depression and medications for depression have on daily life.

Download copies of these self monitoring charts and share the results with your doctor:

• Antidepressant Side-Effect Monitoring Chart
• Depression Symptoms Monitoring Chart

How Can the Star*D Findings Help Relieve My Depression?

The Star*D findings can greatly impact the way you are treated for depression. First of all, just knowing that a different course of treatment that you may not have experienced in the past could work for you, offers hope for the future. Also, you can have more control over your treatment by monitoring antidepressant side-effects and your level of depression. This will help you work more closely with a healthcare professional to decide your best treatment path.

To Review:

1. When initial antidepressant treatment is not successful, doses typically need to be much higher than currently prescribed as long as the side- effects are tolerable.

2. If the first drug doesn't work, there are some good results with augmenting or switching drugs.

3. Weekly monitoring of drug side-effects and severity of depression symptoms increases a person's role in their own healthcare and improves the chance of successful antidepressant treatment.

4. And though it is not always realistic, regular contact with a healthcare professional can have a significant impact on successful medication treatment.

Dr. Rush notes, "Tools used in research settings (depression rating scales, etc.) are not routinely used in practice, which may contribute to the high rates of inadequate treatment with antidepressant medications in routine care. Our results also suggest that the use of depressive symptom and side-effect ratings to guide treatment is feasible in "real world" practices as well as effectiveness trials and can be used to monitor patient progress, to adjust the treatment, and to make clinical decisions."

What Should I Tell My Doctor About the Star*D Research?

Keep in mind that most people receive prescriptions for antidepressants from their family doctor. For a variety of reasons, many doctors can't keep up with the latest research in every field. You may have to bring your healthcare professionals up-to-date on the Star*D research so that you can work as a team to find the depression medication treatment that works best for you. Healthcare professionals can also visit https://www.nimh.nih.gov/funding/clinical-research/practical/stard/allmedicationlevels.shtml for more information on the study and how they can use the findings in their own practice.

video: Depression Treatment Interviews w/Julie Fast

Everyone wants to know "what is the best depression treatment for me?" The answer is below.

Gold Standard for Treating Depression (part 3)

Depression is considered a physiological illness caused by imbalanced brain chemicals. As with other physiological illnesses, medications are usually the first line of treatment. As clearly shown by a recent government study explained below, antidepressants are the number one choice for the successful management of depression for those who can tolerate antidepressants. This is an important distinction, as some people find the side-effects intolerable or do not get total relief from medications. This does not mean that antidepressants are the only treatment, or that they cannot or should not be combined with therapy and other lifestyle changes, but it does show that people with depression that does not lessen with time should at least try antidepressants first.

Initial Treatment of Depression May or May Not Work

For some people with depression, an initial treatment with the correct antidepressant can offer immediate and often permanent relief from the illness. For others, initial treatment with antidepressants is not as successful as the medications may only help with some of the symptoms, do not work at all, or have significant side-effects.

Recent research from a government study called the Star*D research project suggests that even when a person does not have an optimum response to his or her initial treatment, by improving the way medications are prescribed, significant relief is possible. When the recommendations of this research are implemented and combined with proven psychotherapy techniques and lifestyle and behavior changes, significant reduction in symptoms and, in some cases, complete remission (the virtual absence of symptoms are possible.

video: Depression Treatment Interviews w/Julie Fast

Gold Standard of Treating Depression (part 2)

As you start to take more charge of managing depression, it's important that you choose professional people who can best support your choices.

Finding the right support can be difficult. The system of managed care in the U.S. often dictates who you can see, but within this system, you do have options. The following can help you find someone who best fits your needs.

• A healthcare professional who knows how to correctly diagnose depression.
• A healthcare professional who understands a wide range of depression medications and knows how to make sure you are prescribed the one that can best treat your illness by using the Star*D research findings described below.
• A healthcare professional who has the time to help with treatments other than medications alone, including one trained in psychotherapy or alternative treatments.

Who Can Prescribe Depression Medications?

Over the past years, depression treatment and management has changed from the realm of psychiatrists towards general family doctors. Depending on your state, physicians (MDs and ODs), nurse practitioners, physician assistants, psychologists, and on some Indian reservations, nurses, are authorized to prescribe psychiatric medications.

Dr. John Preston, the author or The Complete Idiot's Guide to Managing Your Moods says, "People may feel more comfortable seeing someone they already know. However, there are pros and cons to seeing the family doctor. The negative side is that most general doctors have little schooling or experience in the treatment and management of depression. Because of this, antidepressants are often prescribed too quickly without a proper physical assessment and diagnosis." The result is that you may be given a commonly prescribed antidepressant instead of one that fits your personal needs. How a healthcare professional chooses an antidepressant to prescribe depends on a few factors:

1. What is the normal treatment course for people with your type of symptoms
2. Whether or not you have taken antidepressants before and, if so, how well the medication worked for you
3. Which antidepressant will work best for you in terms of minimal side-effects.

The most important part of this choice is working with a healthcare professional who understands the type of depression you have as well as how your body may react to the antidepressant medication. This is determined by asking you questions specifically used to diagnose depression as well as helping you monitor your progress and adjusting your treatment as necessary.

When Treating Depression, Does It Help To Have A Team?

You may find that choosing a healthcare team can be much more effective than seeing just one healthcare professional for all of your needs. This team can include a doctor or nurse practitioner to perform a thorough diagnosis and prescribe medications, a therapist with an understanding of depression treatment, as well as other professionals who can help you manage your physical health including yoga teachers, massage therapists and those trained in complimentary treatment options such as naturopaths.

video: Depression Treatment Interviews w/Julie Fast

Quest for Freedom!

~ An insight into OCD ~ Obsessive Compulsive Disorder

Dear Diary,
My name is Sandra - Sani for short, and this is the first page of what I hope will be an interesting Diary for people to read. I'm married, live in England and have been suffering with the illness OCD (Obsessive Compulsive Disorder) for about the last 12 years, although actually I've probably had the Disorder all my life in one form or another, but not as seriously or life interfering.

I remember as a child sometimes being frightened of things but not always knowing why. My friends would quite happily do things and go to places without any fear whilst I would sometimes be anxious or nervous. As a teenager, I went through a phase of turning light switches on and off again - hoping that nobody saw me! My mum did occasionally see this strange behavior, but OCD wasn't as well heard of then. When I was 19 several traumatic things happened in my life at about the same time, and these plus stress in my work, I believe, triggered the OCD more seriously. In my work, I sometimes had to work with some nasty chemicals and I became increasingly more afraid of them - to the point of having to wash & shower constantly before I'd feel clean of them - even if I had hardly been in contact with any of them! Eventually I had to give up my work. In the 12 years since, I have been living in what I have felt to be a very contaminated world, sometimes going for months without going out of the house - so strong was the fear. I think very often you have to reach rock bottom before you can rise up again, and I did!

The strain of living with the illness was affecting every part of my life - including my marriage! I was getting depressed and so was my husband. It was at this time that I started talking to someone regularly on a chatline. We would talk for hours, had loads in common, and I found this person to be one of those rare types of people in life: unselfish and wanting to do anything to help. Anyway, to cut a long, 12 month story short, this person gave me confidence and belief in myself, plus the motivation to believe that I could ACTUALLY get well! So, with this new found belief, I started along the path of trying to get free from this illness. I first went to a Doctor - I can't begin to tell you how frightening that first visit was, or how vulnerable I felt opening up my fruitcake mind to a stranger! I was referred to a Psychiatrist, a really nice man who put me at ease straight away, and a Psychologist who I expect I'll be having Behavior therapy with. I've been put on two types of drug, Fluoxatine (Prozac) and a different kind of antidepressant called Lofepramine. These two taken together seem to be helping and I'm on the waiting list for the Behavior Therapy.

In the meantime, I've been to visit the friend I was telling you about. I see my own home to be very contaminated - even just making a cup of tea is a very difficult task. However, my friend's house feels relatively uncontaminated and I guess that's partly because I'm not aware of the history of it, so I am able to wash dishes, cook, go in and out of rooms, and all kinds of stuff, all by myself for the first time in years and it feels GREAT!! I have been here for several weeks now and I love the freedom I feel I have. Whilst I'm here, my husband has started to change the environment at home so that hopefully it won't feel quite as contaminated to me when I go back. I guess you could say I'm doing some Behavior Therapy of my own! The mind is a very complex thing, isn't it? I spent all those years trying to keep my home contaminate free and all I ended up in doing was creating a prison in my own home for myself and my husband! Hopefully, though, there is a light at the end of what has been a very long and dark tunnel.

I shall update this regularly to let you know how I'm doing. I know how isolating this illness can be, so I just want to say, to anyone reading this who has OCD, you're not alone! There are millions of us out there, and you can get well. At least well enough to function freely and with some normality in the world again - DON'T EVER GIVE UP HOPE! I know how easy it is to do so and to feel that maybe life isn't worth it, but please believe me, it is. Thanks for reading and drop by each month to read update's. Oh! and please visit the other pages on my site!

next: My Obsessively Clean Diary: December, 2000
~ ocd library articles
~ all ocd related disorders articles

What Are The Treatment Options for Attention Deficit Disorder?

A child with attention deficit disorder faces many challenges. It is a chronic condition that can continue into adulthood.

Treatment is geared toward helping the child learn, control behavior and increase his or her self-esteem.

A combination of strategies are usually recommended to help the child learn, to increase his or her ability to deal with the emotional cruelty of other children, and to increase self-confidence.

Special education programs tailored to the child's needs can be effective in helping the child learn. Many technologies and techniques are now available to assist the child with an attention deficit disorder.

Often, the initial focus is on teaching the child to learn how to learn. Special education programs may be provided in the public school setting or in private facilities or clinics. Tutoring and practice at home are usually recommended and can significantly help the child.

A child with an attention deficit disorder is usually referred to a psychiatrist or psychologist for specialized counseling. Usually, the physician also recommends specialized counseling for the parents.

Some medications may be recommended to help the child focus attention. The most commonly prescribed medications include dextroamphetamine and methylphenidate.

In order to make an informed decision about your child's health and medical needs, ask the physician to fully explain the benefits, risks and costs of all treatment alternatives, including medication.