Beware of drug interactions. You should avoid drinking alcohol when taking SSRIs since it can lessen the effects of the medication. Dangerous drug interactions can occur when SSRIs are taken with antihistamines, found in many over-the-counter cold and allergy medicines and sleep aids, or with prescription painkillers. Always talk to your doctor or pharmacist before combining medications.
Do your best to not be this way. Instead, choose to accept your diagnosis and to take the medications and other therapies that have been prescribed for you regularly. Make it a point to talk with your doctor when you are not getting relief as expected or new symptoms develop so that your doctor has a chance to address these concerns. Tell the people that you are close to that you are clinically depressed and ask for their help in overcoming the problem. For instance, your friends can help you resist the urge to withdraw and isolate, and give you feedback as to how you appear to be doing both physically and emotionally. Allow the time necessary for medication therapies to pass before you decide that they aren't working. In general, accept your diagnosis and cooperate as best you can with the people who are trying to help you recover.
While the majority of individuals with depression have a full remission of the disorder with effective treatment,only about a third (35.3%) of those suffering from severe depression seek treatment from a mental health professional.[2]  Too many people resist treatment because they believe depression isn't serious, that they can treat it themselves or that it is a personal weakness rather than a serious medical illness.
Depression can affect anybody; young or old, rich or poor, man or woman. While depression can affect anyone, at anytime, it does seem to strike most often when a person is going through changes. Changes can be negative life changes such as the loss of a loved one or a job, regular life changes such as starting university or a big move, or physical changes such as hormonal changes or the onset of an illness. Because depression can be linked to change, certain groups of people are at risk more often than others:
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.
There is no single known cause of depression. Rather, it likely results from a combination of genetic, biologic, environmental, and psychological factors. Major negative experiences—trauma, loss of a loved one, a difficult relationship, or any stressful situation that overwhelms the ability to cope—may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger. Depression is not an inherent consequence of negative life events; research increasingly suggests that it is only when such events set in motion excessive rumination and negative thought patterns, especially about oneself, that mood enters a downward spiral.
When your doctor recommends an antidepressant to fight depression—such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)—it's about more than just boosting your mood. Depression has many potential physical effects. "Most people aren't aware that depression can lead to other health problems," says Dr. Amanda Hernandez, a geriatrician at Harvard-affiliated Massachusetts General Hospital.
Social abuse, such as bullying, are defined as actions of singling out and causing harm on vulnerable individuals. In order to capture a day-to-day observation of the relationship between the damaging effects of social abuse, the victim’s mental health and depressive mood, a study was conducted on whether individuals would have a higher level of depressed mood when exposed to daily acts of negative behavior. The result concluded that being exposed daily to abusive behaviors such as bullying has a positive relationship to depressed mood on the same day.

Scientists have some evidence that depression susceptibility is also related to diet, both directly—through inadequate consumption of nutrients such as omega-3 fats—and indirectly, through the variety of bacteria that populate the gut. Of course, depression involves mood and thoughts as well as the body, and it causes pain for both those with the disorder and those who care about them. Depression is increasingly common in children.


Some people find that herbal remedies, such as St. John’s Wort, help with their depression symptoms. Remember that even herbal remedies can have side effects and may interfere with other medications. Dosages can also vary depending on the brand you use. Talk about the risks and benefits of herbal or other alternative treatments with your health care provider and make sure they know all the different treatments you’re trying.
Sometimes people have prejudices about physical disability that make them feel like “second class citizens” when they become disabled themselves. Sometimes people with a disability get into the habit of letting other people do things for them and as a result they start to feel helpless. Sometimes people with a disability start to avoid situations that make them nervous (for example going out in public where others can see that they look or act differently). This makes those situations much more scary or upsetting when they can no longer be avoided.
Another type of depression is related to changes in the length of days or seasonality. This type of depression is called Seasonal affective disorder (SAD). People with SAD suffer the symptoms of a Major Depressive Disorder only during a specific time of year, usually winter. This appears to be related to the shorter days of winter, and the lack of sunlight in many parts of the country.
For treatment with antidepressants to work, a careful diagnosis has to be made first. Experts believe that some people are prescribed antidepressants unnecessarily. The fact that significantly more people take antidepressants nowadays suggests that. These medications are sometimes already prescribed for milder cases, even though there is doubt about how well they work in mild depression.
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.
One reason depression is difficult to identify is that its symptoms can vary depending on age and sex. Adults with depression generally feel overwhelmed by sadness, while depression in adolescents tends to express itself mainly as irritability. Women with depression are more likely to note symptoms like anxiety and indecisiveness, while men are more likely to report anger and aggression.

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.


Although depressive disorder can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and treatment plan. Safety planning is important for individuals who have suicidal thoughts. After an assessment rules out medical and other possible causes, a patient-centered treatment plans can include any or a combination of the following:


Another type of depression is bipolar disorder, which encompasses a group of mood disorders formerly called manic-depressive illness or manic depression. These conditions often show a particular pattern of inheritance. Not nearly as common as the other types of depressive illnesses, bipolar disorders involve cycles of mood that include at least one episode of mania or hypomania and may include episodes of depression, as well. Bipolar disorders are often chronic and recurring. Sometimes, the mood switches are dramatic and rapid, but most often they are gradual, in that they usually take place over several days, weeks, or longer.
Clinical depression is different from normal sadness — like when you lose a loved one, experience a relationship breakup, or get laid off from work — as it usually consumes a person in their day-to-day living. It doesn’t stop after just a day or two — it will continue for weeks on end, interfering with the person’s work or school, their relationships with others, and their ability to just enjoy life and have fun. Some people feel as if a huge hole of emptiness has opened inside when experiencing the hopelessness associated with this condition. In any given year, 7 percent of Americans will be diagnosed with this condition; women are 2 to 3 times more likely to be diagnosed than men (American Psychiatric Association).
Antidepressants, sometimes in combination with psychotherapy, are often the first treatment people get for depression. If one antidepressant doesn't work well, you might try another drug of the same class or a different class of depression medicines altogether. Your doctor might also try changing the dose. In some cases, your doctor might recommend taking more than one medication for your depression.
A type of mild to severe depression that typically sets in as the hours of daylight wane in the fall, seasonal affective disorder (SAD) afflicts as many as 6 percent of Americans. Women are particularly at risk, experiencing SAD four times more often than men, as are people who have a relative with depression. People who live far from the equator tend to experience SAD in greater numbers — 9 percent of Alaskans versus 1 percent of Floridians, according to the National Institute of Mental Health (NIMH).
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.
Understanding the underlying cause of your depression may help you overcome the problem. For example, if you are depressed because of a dead-end job, the best treatment might be finding a more satisfying career rather than simply taking an antidepressant. If you are new to an area and feeling lonely and sad, finding new friends will probably give you more of a mood boost than going to therapy. In such cases, the depression is remedied by changing the situation.
Sadness can be a difficult emotion to deal with, not only due to the pain it causes, but also because of the factors that caused the sadness in the first place. Sadness can be the result of loss, helplessness, or disappointment, among many other things. It is important to remember, though, that sadness is one of the most common and natural human emotions, and is something that will ultimately help us appreciate our happy times.
But with all three of these treatments, there is the promise of alternative medications to treat depression that might help people feel better — sometimes faster — and hopefully with fewer troubling side effects. No one treatment is right for everyone (that’s why we made our iPhone app called Start, to help people figure out if their antidepressant works), so better research into safe alternatives is important.
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
For example, abruptly stopping an SSRI such as paroxetine can cause dizziness, nausea, flu-like symptoms, body aches, anxiety, irritability, fatigue, and vivid dreams. These symptoms typically occur within days of abrupt cessation, and can last one to two weeks (up to 21 days). Among the SSRIs, paroxetine and fluvoxamine cause more pronounced discontinuation symptoms than fluoxetine, sertraline, citalopram, escitalopram, vortioxetine, and vilazodone. Some patients experience discontinuation symptoms despite gradual tapering of the SSRI. Abrupt cessation of venlafaxine, duloxetine, desvenlafaxine, or levomilnacipran can cause discontinuation symptoms similar to those of SSRIs.
Remember, antidepressants aren’t a cure. Medication may treat some symptoms of depression, but can’t change the underlying issues and situations in your life that are making you depressed. That’s where exercise, therapy, mindfulness meditation, social support and other lifestyle changes come in. These non-drug treatments can produce lasting changes and long-term relief.
In addition to becoming more irritable, teens might lose interest in activities they formerly enjoyed, experience a change in their weight, and start abusing substances. They may also take more risks, show less concern for their safety, and they are more likely to complete suicide than their younger counterparts when depressed. Generally, acne increases the risk of teen depression.
Clomipramine potently inhibits the reuptake of serotonin at the presynaptic neuronal membrane. It has strong affinities to both H1 and M1 receptors, which results in sedation, weight gain, and anticholinergic side effects. Although clomipramine is FDA approved only for obsessive-compulsive disorder, it has also been prescribed for depression, panic attacks, and chronic pain.

Once diagnosed, a person with depression can be treated a number of ways. The most common treatments are medication and psychotherapy. Many studies show that cognitive behavioral psychotherapy is highly effective, alone or in combination with drug therapy. Psychotherapy addresses the thinking patterns that precipitate depression, and studies show that it prevents recurrence. Drug therapy is often helpful in relieving symptoms, such as severe anxiety, so that people can engage in meaningful psychotherapy.
This class of drugs is frequently used for short-term management of anxiety and as an add on treatment, in treatment resistant anxiety disorders.They are not recommended as a treatment for Post Traumatic Stress Disorder. Benzodiazepines (alprazolam, clonazepam, diazepam, and lorazepam) are highly effective in promoting relaxation and reducing muscular tension and other physical symptoms of anxiety. Long-term use may require increased doses to achieve the same effect, which may lead to problems related to tolerance and dependence.
Obsessive Compulsive Disorder (OCD) is when a person has unwanted, intrusive, persistent or repetitive thoughts (whakaaro), feelings, ideas, or sensations (obsessions) which cause anxiety. So they then carry out actions to reduce the anxiety or get rid of those thoughts. For example, the person may be afraid of germs and try to relieve the anxiety through repeated hand washing or avoiding touching things like door knobs. They may know these thoughts (whakaaro) are unreasonable but be unable to stop them. When OCD is severe and left untreated, it can be very distressing, and get in the way of work (mahi), school (kura) and normal life at home. 

As a matter of fact, many researchers think that antidepressant medications should work more quickly — that people shouldn’t have to take a medication for weeks before they see some improvement. Especially because the most common antidepressants cause short- and long-term side effects — all antidepressants can produce psychological side effects, tricyclic antidepressants (TCAs) can cause heart problems, and SSRI and SNRI medications cause issues ranging from nausea to weight gain and low sex drive, among others. Alternatives and better options are a good thing.


Common treatments for anxiety disorders include individual and group therapy, and medications as appropriate. Other treatments may include TMS (transcranial magnetic stimulation) and ECT (electroconvulsive therapy), both of which have been found to have profound effects on individuals with depression or anxiety, especially for those who have not found relief in symptoms through other treatment methods.


Websites run by organizations like the National Institute of Mental Health (NIMH) provide copious background information as well as updates on clinical trials. Grassroots groups like the National Alliance on Mental Illness connect you with support and services, offer education, and let you know that you are not alone. Personal blogs share the struggle and the wisdom of lived experience. And numerous online depression tests can help those who aren’t sure whether or not they need help get started on the pathway to a healthier life.

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
Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.
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