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My doctor recommends medication for my depression. Should I wait to see whether my depression will go away without treatment?

Depression often occurs in cycles, and if an individual waits long enough, it may in fact remit without treatment. This may take months or longer, however. The risks of this approach are great: a loss of productivity in school/work, impaired relationships, family conflicts, financial problems, delays in development in children, and, most significantly, suicide. Treatment of the depressive episode greatly shortens its duration and enables you to participate in the community again sooner. In addition, research suggests that depression itself can have harmful effects on the brain. These effects may make you more susceptible to future depressive episodes, possibly more severe, in the future.

Untreated depression can have harmful effects on your physical health as well. Under stress, the body is less able to fight infection. Recovery from some physical illnesses may be adversely affected. Problems with sleep also impair the body's functioning, resulting in further loss of energy and difficulties in concentrating.

Depressed persons are at higher risk for drug and alcohol abuse, which can further worsen depressive symptoms and result in disability and problems with the law. Depressed persons are at risk of having problems in their relationships and getting a divorce. They may have difficulty developing strong attachments with their children.

Depressed children can have problems in their social and emotional development, making them at risk for further emotional problems in the future. Most significantly, untreated depression may increase the risk for suicide. Suicidal thoughts can gradually lead up to suicide attempts if the depression does not remit and feelings of hopelessness persist.

Treatment of depression is important for many reasons. A delay of its treatment may be as risky as delaying treatment for a multitude of medical conditions, such as heart problems, diabetes, high blood pressure, and cancer.

Can I take other medicines while I am on an antidepressant?

It is always important to inform any doctor you see of all medications you are taking, including any herbal or over-the-counter supplements. Although many medications can be taken concurrently, the potential for reactions exists between many medications as well; thus consideration must be given for this. Sometimes the potential reaction is minimal and may be due to additive side effects (e.g., sedating effects may combine). Other times, the presence of one medication can influence the elimination of the other medicine from the body, either allowing excessive accumulation or causing too rapid a depletion. Consequences can thus be toxicity or a lack of efficacy. The SSRIs are metabolized[1] by specific liver enzyme groups that eliminate the medication. Each SSRI has a slightly different profile as to the enzymes involved in its own metabolism. MAOIs are generally contraindicated in combination with all other antidepressants because of the risk for serotonin syndrome, which can be fatal (although there are certain combinations that skilled clinicians can prescribe in a methodical way to minimize the risks). Serotonin syndrome[2] occurs when an excess of serotonin exists in the central nervous system. Symptoms include tremor, confusion, incoordination, sweating, shivering, and agitation. Most SSRIs are contraindicated in combination with thioridazine (Mellaril) as well because of a risk of cardiac toxicity[3]. SSRIs should be used cautiously in combination with sibutramine (Imitrex), commonly prescribed for migraine, because of a risk for serotonin syndrome. St. John's wort, an herbal preparation used for depression, should be avoided when on a prescribed antidepressant, also because of a potential risk for serotonin syndrome. Again, there are some circumstances when a psychiatrist will combine two SSRIs or an MAOI with a TCA, for example, but this is typically done cautiously and under his or her guidance.

As described in Question 42, MAOIs have very specific guidelines on foods to be avoided (see Table 4). Likewise, MAOIs can have significant interactions with other medications. As noted previously here, they are not to be combined with most other antidepressants. In fact, MAOIs have to be discontinued 2 weeks before a trial of another antidepressant, or the other antidepressant is to be discontinued for 2 weeks before initiating an MAOI (5 weeks for fluoxetine). There are many over-the-counter medications to be avoided, such as pseudoephedrine and oxymetazoline; thus it is important to check with your doctor and pharmacist before taking an over-the-counter medication while on an MAOI. This is sound policy with all medications, not just psychotropics.

Certainly, if the depression is not responding to a prescribed treatment, consultation with a specialist is warranted as well.

  • [1] the process of breaking down a drug in the blood.
  • [2] an extremely rare but life-threatening syndrome associated with the direct physiologic effects of serotonin overload on the body. Symptoms include flushing, high fever, tachycardia, and seizures.
  • [3] damage that occurs to the heart or coronary arteries as a result of medication side effects.
 
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