Buspirone is marketed as an antianxiety medication; however, it may have antidepressant effects at doses above 45 mg/day. The antidepressant effects may increase when buspirone is used in combination with SSRIs and TCAs in patients with treatment-resistant depression. Buspirone is a partial 5-HT1A agonist with serotonergic and some dopaminergic effects in the CNS. It has anxiolytic effects but may take up to 2-3 weeks for full efficacy.

A person’s personality characteristics are an important factor. When people are depressed, they usually have a very negative view of themselves and the world. They do not appreciate good things, and bad things seem overwhelming. Some people have a tendency to view things this way even when they are not depressed. In other words, they may have a depressive personality style.
When you’re depressed, it can feel like there’s no light at the end of the tunnel. But there are many things you can do to lift and stabilize your mood. The key is to start with a few small goals and slowly build from there, trying to do a little more each day. Feeling better takes time, but you can get there by making positive choices for yourself.
Another possible cause of depression that should not be overlooked is physical illness or medications. Glandular fever, influenza, hepatitis, thyroid hormones, anaemia, diabetes, birth control pills, alcohol and other substances of abuse, or other medications such as those for heart or blood pressure conditions, may all cause symptoms of depression.
It is normal to experience feelings of sadness and despair in response to adverse life events. Such events could include loss, major life changes, stress, or disappointment. In most cases, the sad feelings resolve as you come to terms with the changes in your life. In situations such as bereavement, these feelings may persist for months and return at significant times, such as birthdays and anniversaries related to the lost loved one. Provided you have times when you can enjoy things, however, this sadness is not a sign of depression.
Stay Socially Engaged. The core symptoms of depression push people to stop participating with others socially and emotionally and motivate them to isolate. It is important to work to resist these urges to isolate as best you can. Let your family, friends and associates help you. Accept invitations to social events and maintain your typical social schedule as best you can even if you are not enjoying your participation as much as you used to. Staying socially engaged provides you with social support, offers you a distraction from the repetitive negative ruminations you are otherwise going to be prone to experiencing, may offer some pleasure even if that feeling is fleeting for a while, and can provide you with opportunities for reality testing (so that you don't take your depressive ideas about how worthless you are too seriously).
Monoamine oxidase inhibitors (MAOIs) are the earliest developed antidepressants. Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate). MAOIs elevate the levels of neurochemicals in the brain synapses by inhibiting monoamine oxidase. Monoamine oxidase is the main enzyme that breaks down neurochemicals, such as norepinephrine. When monoamine oxidase is inhibited, the norepinephrine is not broken down and, therefore, the amount of norepinephrine in the brain is increased.

People from different cultures—Depending on your cultural background, you may have certain beliefs about depression that can affect the way you deal with it. For example, people from some cultures notice more of the physical symptoms of depression and only think of the emotional ones when a professional asks them. Attitudes from our cultures can also affect who we may ask for help. For example, in one BC study Chinese youth were twice as reluctant to talk to their parents about depression as their non-Chinese counter parts. Aboriginal people, on and off-reserve, may also have higher rates of depression, from 12–16% in a year, or about double the Canadian average.


Depression is different from anxiety. Rather than feeling anxious and nervous, feelings of gloom and melancholy overwhelm. Feeling sad or down after experiencing a loss or disappointment is an emotion that everyone feels at one time or another. But when low mood and sadness is severe and lasts for long periods of time, it could be due to depression.
Older adults—Around 7% of seniors have some symptoms of depression. This can be brought on by the loss of a spouse, a shrinking circle of friends or the onset of an illness. It’s also much more common among seniors living in care homes or who have dementia. Depression in people 65 and over appears to be less common than in younger groups, but researchers aren’t sure if this is a real difference or an issue with the research questions. It’s likely that depression is at least somewhat under-recognized in seniors. Some symptoms like changes in sleep or activity levels may be mistaken as signs of aging instead of depression.
Antidepressants can have central and peripheral anticholinergic effects, as well as sedative effects, and can block the active reuptake of norepinephrine (NE), serotonin (5-HT), and dopamine. SSRIs are metabolized via the cytochrome P-450 system and may have drug interactions on that basis. The degree of enzyme inhibition varies among SSRIs. Effects on blood levels and bioavailability of coadministered drugs, as well as pharmacodynamic interactions, account for most clinically significant SSRI-drug interactions.

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Some of these side effects are believed to be a direct consequence of the medication's effect on the brain and are relatively similar among various drugs of the same group. Patients who are taking antidepressants sometimes have a dry mouth, headaches, feel faint, anxious, and have a decreased sex drive. These kinds of symptoms are often perceived to be a side effect of the medications. But some of them may be caused by the depression itself.
If you have such thoughts, and find them disturbing, it's a good idea to discuss them with a qualified therapist. People often want to keep these thoughts to themselves, because they feel ashamed of them, and worry that a therapist will over-react and want to hospitalize them. However, these thoughts are a common part of anxiety disorders, and a therapist who is well versed in the treatment of anxiety disorders will probably be able to evaluate these thoughts and come to a realistic understanding of what they mean and don't mean. So review these with a therapist, in the same way you would review all the other symptoms you experience.

Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, often when other medications haven't worked, because they can have serious side effects. Using an MAOI requires a strict diet because of dangerous (or even deadly) interactions with foods — such as certain cheeses, pickles and wines — and some medications, including birth control pills, decongestants and certain herbal supplements. Selegiline (Emsam), an MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs. These medications can't be combined with SSRIs.
Bear in mind that while effective treatment for anxiety or depression need not be a long-term commitment, it is likely to require regular, ongoing appointments at least in the short-term (e.g., 6-12 months). Therefore, it is critical to find a professional you trust and with whom you feel comfortable speaking about your symptoms. It is equally important to make sure that you find a clinician that you can afford. Before making the commitment for ongoing care, you may want to meet with a couple of providers to get a feel for therapeutic styles/approaches and their treatment recommendations; you can then use this information to determine which path forward feels best to you.

The presence of maternal-fetal stress is another risk factor for depression. It seems that maternal stress during pregnancy can increase the chance that the child will be prone to depression as an adult, particularly if there is a genetic vulnerability. Researchers believe that the mother's circulating stress hormones can influence the development of the fetus' brain during pregnancy. This altered fetal brain development occurs in ways that predispose the child to the risk of depression as an adult. Further research is still necessary to clarify how this happens. Again, this situation shows the complex interaction between genetic vulnerability and environmental stress, in this case, the stress of the mother on the fetus.
Self-help—For mild depression, or when moderate or severe depression begins to improve with other treatments, there are some things you can do on your own to help keep you feeling better. Regular exercise, eating well, managing stress, spending time with friends and family, spirituality, and monitoring your use of alcohol and other drugs can help keep depression from getting worse or coming back. Talking to your doctor, asking questions, and feeling in charge of your own health are also very important. Always talk to your doctor about what you’re doing on your own.
The birth of a baby can trigger mood swings or crying spells in the following days or weeks, the so-called baby blues. When the reaction is more severe and prolonged, it is considered postpartum depression, a condition requiring treatment because it can interfere with the ability to care for the newborn. Depression can also occur seasonally, primarily in the winter months when sunlight is in short supply. Known as seasonal affective disorder, or SAD, it is often ameliorated by daily exposure to specific types of artificial light.
Antidepressants. A variety of antidepressants are prescribed for both anxiety and depression. Some of these also help alleviate nerve pain. The research most strongly supports the use of serotonin and norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs) as double-duty drugs that can treat both psychiatric disorders and pain. The findings are more mixed about the ability of selective serotonin reuptake inhibitors (SSRIs) to alleviate pain.
Sticking to your treatment plan is one of the most important things you can do. It’s easy to get discouraged in the first few weeks of treatment. You may not want to continue. All types of treatment can take a few months before you notice a difference. It’s also easy to feel like you’re doing much better and stop treatment all together. Never stop treatment without consulting your doctor first.
Parents may need to provide more comfort and support than usual for their children. It is not unusual for a child to regress to an earlier stage of development following a traumatic event. Children may find it hard to separate from parents, become clingy or emotionally needy during a hospital stay. Children usually show signs of greater independence by the time of discharge. Please talk to your physician if these problems do not improve.

Bipolar disorder, also known as manic depression, involves serious shifts in moods, energy, thinking, and behavior. Because it looks so similar to depression when in the low phase, it is often overlooked and misdiagnosed. This can be a serious problem as taking antidepressants for bipolar depression can actually make the condition worse. If you’ve ever gone through phases where you experienced excessive feelings of euphoria, a decreased need for sleep, racing thoughts, and impulsive behavior, consider getting evaluated for bipolar disorder.
Women are twice as likely to become depressed as men. However, scientists do not know the reason for this difference. Psychological factors also contribute to a person's vulnerability to depression. Thus, persistent deprivation in infancy, physical or sexual abuse, exposure to community violence, clusters of certain personality traits, and inadequate ways of coping (maladaptive coping mechanisms) all can increase the frequency and severity of depressive disorders, with or without inherited vulnerability.
Cognitive-behavioral therapy (CBT) is one form of psychotherapy that has been shown to be successful in treating depression and anxiety disorders. CBT combines the fundamental concepts of behavioral therapy and cognitive therapy. The term “cognitive” refers to our thought process and reflects what we think, believe and perceive. Put together, CBT focuses on our behaviors and thoughts and how they are contributing to our current symptoms and difficulties.
National Institute of Mental Health: "Mental Health Medications," "Antidepressants.", Mayo Clinic: "Antidepressants: Selecting one that's right for you.", The New York Times: "Meditation Plus Running as a Treatment for Depression," "To Treat Depression, Drugs or Therapy?"; Pond5; Guido Vrola; Rocketclips, Inc.; pertusinas; Andrey Popov; Thinkstock; EpicStockMedia; AudioJungle.
The main aim of treatment with antidepressants is to relieve the symptoms of depression, such as feeling very sad and exhausted, and prevent them from coming back. The medications are designed to restore emotional balance and help people to get on with everyday life. They are also taken to relieve symptoms such as restlessness, anxiety, sleep problems and suicidal thoughts.
Maybe. Some medicines, such as some types of antidepressants, may make it more difficult for you to get pregnant, but more research is needed.15 Talk to your doctor about other treatments for depression that don’t involve medicine if you are trying to get pregnant. For example, a type of talk therapy called cognitive behavioral therapy (CBT) helps women with depression.16 This type of therapy has little to no risk for women trying to get pregnant. During CBT, you work with a mental health professional to explore why you are depressed and train yourself to replace negative thoughts with positive ones. Certain mental health care professionals specialize in depression related to infertility.
When we see a friend or family member in distress, most of us want to reach out and offer a hand. But when it comes to this kind of mental illness, all too often we remain silent, fearful of the stigma associated with the diagnosis. There is nothing to be ashamed of, and no reason not to offer to help out someone who is going through the challenges of living with this disorder.
National Institute of Mental Health: "Mental Health Medications," "Antidepressants.", Mayo Clinic: "Antidepressants: Selecting one that's right for you.", The New York Times: "Meditation Plus Running as a Treatment for Depression," "To Treat Depression, Drugs or Therapy?"; Pond5; Guido Vrola; Rocketclips, Inc.; pertusinas; Andrey Popov; Thinkstock; EpicStockMedia; AudioJungle.
Thyroid disease and disorder symptoms and signs depend on the type of the thyroid problem. Examples include heat or cold intolerance, sweating, weight loss or gain, palpitations, fatigue, dry skin, constipation, brittle hair, joint aches and pains, heart palpitations, edema, feeling bloated, puffiness in the face, reduced menstrual flow, changes in the frequency of bowel movements and habits, high cholesterol, hoarseness, brittle hair, difficulty swallowing, shortness of breath, a visible lump or swelling in the neck, tremors, memory problems, depression, nervousness, agitation, irritability, or poor concentration.
Education for people with depression is extremely valuable. Education provides a knowledge base that potentially gives the person greater control over his or her disorder. Greater control in turn may lead to reduced feelings of helplessness and an increased sense of well-being. Providing education for families or carers is also very important to help increase the support and assistance they provide to the person.
The ADAA 2020 40th Annual Conference (March 19-22, San Antonio, Texas) will bring together clinicians and researchers who want to improve treatments and find cures for anxiety, depression and related disorders. Join more than 1,400 peers from across the US and around the world. Connect, share and collaborate. Choose from 160+ sessions, hear engaging keynotes, learn about cutting-edge thinking in research and clinical practice, and earn continuing education credits (CEs and CMEs). Find your professional home and leave more connected to your peers, and better able to integrate research, practice, and community. #ADAA2020
355 million people are affected by depression, making it one of the most common disorders in the world. Over 40 million American adults are affected by anxiety, making anxiety disorders the most common mental health conditions in the United States. At McLean Hospital, we are committed to providing support for individuals with depression and anxiety through world-class treatment, innovative research into causes and cures, and robust education for patients and families, clinicians, and the broader community.
When taking these medications‚ it is important to follow the instructions on how much to take. Some people start to feel better a few days after starting the medication‚ but it can take up to 4 weeks to feel the most benefit. Antidepressants work well and are safe for most people‚ but it is still important to talk with your doctor if you have side effects. Side effects usually do not get in the way of daily life‚ and they often go away as your body adjusts to the medication.
Play is natural and fun for children and an important part of learning and development. Play therapy is a therapy used by licensed mental health professionals to help children to better express their thoughts and emotions and to address a variety of problems. When children are unable to put into words their feelings or concerns, play can help them express themselves and learn ways to cope.  
Patients generally tolerate SSRIs well, and side effects are usually mild. The most common side effects are nausea and other stomach upset, diarrhea, agitation, insomnia, and headache. However, these side effects generally go away within the first month of SSRI use. Some patients experience sexual side effects, such as decreased sexual desire (decreased libido), delayed orgasm, or an inability to have an orgasm. Sexual side effects occur less often with newer SSRIs like vortioxetine and vilazodone, compared to the older medications in this category. For those patients, especially for whom anxiety is a prominent symptom of depression, the addition of buspirone may help enhance the effectiveness (augment) the effect of the SSRI while decreasing or eliminating sexual side effects. Uncommonly, some patients experience tremors, hair loss, or gradual weight gain with SSRIs. The so-called serotonergic (meaning caused by serotonin) syndrome is a serious neurologic condition associated with the use of SSRIs, usually when given in high doses or in combination with another SSRI. High fevers, seizures, and heart-rhythm disturbances characterize serotonergic syndrome. This condition is very rare and tends to occur only in very ill psychiatric patients taking multiple psychiatric medications.
Depression and anxiety treatment begins first with recognizing if you have symptoms. Both often appear as physical symptoms, some of which are similar to those seen in migraine. For example, problems with sleep and appetite changes, being easily upset, trouble concentrating, and low energy are all symptoms of migraine, depression, and anxiety. As a result, it is better to pay attention to thoughts and feelings. Depression usually involves strong feelings of sadness or hopelessness that last two weeks or more. Some migraine patients who are depressed do not feel sad or down, but are simply not as interested in activities that they normally enjoy. Others include feeling worthless, guilty, or thoughts of suicide.

Many medications and therapies help with symptoms of depression and anxiety. Antidepressants reduce symptoms of depression and anxiety because they change how the brain sends chemical signals. Sometimes a single method can help both symptoms of depression/anxiety and headache. However, many patients require two different drugs or behavioral treatments for a period of time. They need one to treat depression/anxiety and another to prevent migraines.


Crisis lines aren’t only for people in crisis. You can call for information on local services or if you just need someone to talk to. If you are in distress, call 310-6789 (do not add 604, 778 or 250 before the number) 24 hours a day to connect to a BC crisis line, without a wait or busy signal. The crisis lines linked in through 310-6789 have received advanced training in mental health issues and services by members of the BC Partners for Mental Health and Addictions Information.
Depressive disorders are mood disorders that have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Literature and the arts have portrayed depression, also referred to as clinical depression, for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, people thought of depression as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his becoming clinically depressed.
Depression drains your energy, hope, and drive, making it difficult to take the steps that will help you to feel better. But while overcoming depression isn’t quick or easy, it’s far from impossible. You can’t just will yourself to “snap out of it,” but you do have more control than you realize—even if your depression is severe and stubbornly persistent. The key is to start small and build from there. Feeling better takes time, but you can get there by making positive choices for yourself each day.
Encourage the person to get a clinical evaluation. You can start by helping them to fill out our Depression and Bipolar Test. When finished, you can print the results so that the person can bring them to a clinician for further evaluation. Mention that depression and bipolar disorder are both treatable medical conditions. Often, people feel relieved to learn that they are suffering from a medical condition. Ask the person to see a medical professional, offer to make an appointment, and go with the person or call the doctor in advance to state the person’s symptoms.
Your GP will have suggestions for alternative things you can try to help manage your depression from day to day, and will be able to assess if you need medication or further help. Treatments such as cognitive behavioural therapy and medication, and having a good relationship with a GP, psychologist and/or psychiatrist, can be effective in treating depression and improving mood.
Many medications and therapies help with symptoms of depression and anxiety. Antidepressants reduce symptoms of depression and anxiety because they change how the brain sends chemical signals. Sometimes a single method can help both symptoms of depression/anxiety and headache. However, many patients require two different drugs or behavioral treatments for a period of time. They need one to treat depression/anxiety and another to prevent migraines.
Compared to women, men with depression are more likely to experience low energy, irritability, and anger, sometimes to the point of inflicting pain on others. Men with depression are also more likely to exhibit sleep problems, a loss of interest in work or hobbies, and substance abuse. They may work excessively and engage in more risky behaviors when struggling with depression, committing suicide four times as often as women with this condition. Despite these difficulties, men tend to be much less likely to receive treatment for any condition, particularly depression.

Bennabi D, Yrondi A, Charpeaud T, Genty JB, Destouches S, et al. Clinical guidelines for the management of depression with specific comorbid psychiatric conditions French recommendations from experts (the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental). BMC Psychiatry. 2019 Jan 30. 19 (1):50. [Medline].


TCAs have been in use since the 1950s when imipramine (Tofranil) was shown to be effective for treating depression. TCAs primarily work by increasing the level of norepinephrine in the brain and to a lesser extent serotonin levels. Some TCAs also are antihistamines (block the action of histamine) or anticholinergic (block the action of acetylcholine, a neurotransmitter), and these additional actions allow for uses of TCAs other than for treating depression as well as additional side effects.
Although many people are fearful of ECT, this technique is arguably the safest and most effective medical treatment for severe depression although there can be some memory related side effects. ECT is more rapid in its effect than antidepressant drugs, and CBT and antidepressants remain useful adjuncts to treatment since they can help prevent relapse after ECT is completed.
Tricyclic antidepressants – Tricyclics are known for causing more side effects than other types of antidepressants, so they are unlikely to be prescribed unless other medications are ineffective. Examples include amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil).
Hypnosis. During this therapy, a clinician helps a patient achieve a trance-like state and then provides positive suggestions — for instance, that pain will improve. Some patients can also learn self-hypnosis. One study showed that hypnosis training reduced both gastrointestinal distress and levels of depression and anxiety in 71% of those studied.
If the patient is taking MAOIs, he or she must avoid certain aged, fermented, or pickled foods, like many wines, processed meats, and cheeses. The patient should obtain a complete list of prohibited foods from the doctor and keep it available at all times. The other types of antidepressants require no food restrictions. It is also important to note that some over-the-counter cold and cough medicines can also cause problems when taken with MAOIs.

Many migraine patients suffer from symptoms of depression and anxiety. Migraine patients are between two to five times more likely to have these symptoms than patients without migraine. About 25% of patients with migraine have depression, and about 50% have anxiety. Some patients have symptoms of these disorders after living with migraine for years. Others develop them before migraine. At this time, scientists don’t know the exact answer why all are so common. One of the brain chemicals involved in all these conditions is called serotonin. Hormone changes in women can also trigger both conditions.
All patients are unique biochemically. Therefore, the occurrence of side effects or the lack of a satisfactory result with one SSRI does not mean that another medication in this group will not be beneficial. However, if someone in the patient's family has had a positive response to a particular drug, that drug may be the preferable one to try first.
It may be dangerous to take St. John’s wort if you also take other medicines. St. John’s wort can make many medicines not work at all or may cause dangerous or life-threatening side effects. The medicines used to treat heart disease, HIV, depression, seizures, certain cancers, and organ transplant rejection may not work or may have dangerous side effects if taken with St. John’s wort. St. John’s wort may also make birth control pills not work, which increases the chance you will get pregnant when you don’t want to.12 It is crucial that you tell your doctor or nurse if you take St. John’s wort.
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