Depression and women

National Women's Health Report, August, 2003

National Foundation for Depressive Illness, Inc.

PO Box 2257

New York, NY 10116

1-800-239-1265

http://www.depression.org

Informs the public about depressive illness and treatment options.

National Institute of Mental Health

6001 Executive Boulevard

Bethesda, MD 20892-9663

1-866-615-6464

http://www.nimh.nih.gov

The premier federal research institution for the study of mood disorders; consumer information available.

National Mental Health Association

2001 N. Beauregard Street, 12th Floor

Alexandria, VA 22311

1-800-969-6642

http://www.nmha.org

Provides information about medication, treatment and patient rights.

Postpartum Support International

http://www.postpartum.net

Offers online support and educational forum, including chat rooms and consumer information.

Depression Treatment Options

The treatment of depression received a huge boost 15 years ago with the introduction of Prozac, or fluoxetine, the first in a class of new drugs called selective serotonin reuptake inhibitors, or SSRIs, that have far fewer side effects than the older antidepressants. The old ones are still around and have their place in depression treatment.

They are not all the same, however, nor are they comparable in terms of their effectiveness or side effects, as the chart below shows. (10)

Drugs, however; are just one part of the treatment puzzle, with studies finding that 10 to 30 percent of patients taking antidepressants are partially or totally resistant to the treatment (although switching to different medications often resolves the resistance). (11) Various forms of therapy, particularly interpersonal psychotherapy (IPT), a less intensive form of traditional psychotherapy, and cognitive behavioral therapy (CBT), in which you learn to alter your perception of the world, are also recommended for treatment of depression, either alone or in conjunction with medication. (10) (These therapies are described in more detail on page 7.) Some studies also find therapy to be as effective as medicine for some mild or moderate depression. (9)

For patients with major depression that doesn't respond to drugs or therapy, electro-convulsive therapy (ECT), commonly referred to as "shock therapy," may be tried. ECT is one of the most misunderstood and feared depression-related treatments despite the fact it is also the best-studied and most effective treatment for this form of severe depression. The most common side effect is short-term memory loss or confusion. (10)

MEDICATION FOR DEPRESSION

Medication Class/Type *              How it Works

Selective Serotonin Reuptake         Blocks reuptake of serotonin,
Inhibitors (SSRIs). Includes         allowing more of this
fluoxetine (Prozac, Sarafem),        neurotransmitter to remain
sertraline (Zoloft), paroxetine      available to the brain
(Paxil), citalopram (Celexa),
escitalopram oxalate (Lexapro)

Monoamine oxidase inhibitors         Inhibits the action of monoamine
(MAOIs). Includes phenelzine         oxidase, an enzyme that breaks
(Nardil), isocarboxazid              down neurotransmitter.
(Marplan), tracylpromine
(Parnate)

Tricyclics (TCAs). Includes          Either inhibits norepinephrine
imipramine (Tofranil),               reuptake or both norepinephrine
desipramine, (Norpramin),            and serotonin reuptake.
nortriptyline (Pamelor),
amitriptyline-HCI (Elavil),
maprotiline (Ludiomil)

Mixed reuptake inhibitors.           Bupropion appears to regulate
Includes bupropion (Wellbutrin)      transmission of both
and venlafaxine (Effexor)            norepinephrine and dopamine,
                                     while venlafaxine appears to
                                     inhibit the reuptake of those two
                                     chemicals as well as serotonin

5-HT modulators. Includes            Strong effects on blocking 5-HT (a
nefazodone (Serzone) and             precursors of serotonin) serotonin
trazodone (Desyrel)                  receptors.

Norepinephrine and 5-HT              Block serotonin receptors.
modulators. Includes mirtazapine
(Remeron)

What Studies Show                    Potential Side Effects & Warnings

During initial stages of taking      Sexual side effects, nervousness,
the medicine, about 10 to 20         nausea, diarrhea, insomia.
percent of patient quit because
of side effects.

Particularly effective for           Dry mouth. Can cause life-
patients who don't respond to        threatening interactions with
more conventional treatments.        aged cheese and meats, and with
                                     common over-the-counter
                                     medications, such as some flu and
                                     cold remedies.

About 30 percent of people stop      Can be lethal with just small
taking TACs due to side effects      overdose and may require blood
such as fainting, weight gain and    tests to monitor levels.
headaches.

Bupropion: Substantially lower       Nausea, headaches. Venlafaxine
incidence of sexual side effects     may results in sexual side effects
compared to SSRIs; may be            as well as a risk of elevated
particularly useful for treatment    blood pressure.
of depressions characterized by
weight gain, loss of energy and
oversleeping. Venlafaxine: Seems
to be better than SSRIs at
treating major depression.

Improves sleep and has a low risk    Sudden drop in blood pressure upon
of sexual side effects.              standing, headaches, daytime
                                     drowsiness. In rare cases,
                                     nefazodone may cause liver damage.

Relieves symptoms sooner than the    Weight gain and daytime
SSRIs.                               drowsiness.

* Not all drugs within a class are listed

Source; Hollon, SA, Michael ET, Markowitz, JC. "Treatment and
Prevention of Depression." Psychological Science in the Public
Interest. Nov. 2003 3(2):39-70.