Depression, also known as clinical or major depression, is a mood disorder that will affect one in eight Canadians at some point in their lives. It changes the way people feel, leaving them with mental and physical symptoms for long periods of time. It can look quite different from person to person. Depression can be triggered by a life event such as the loss of a job, the end of a relationship or the loss of a loved one, or other life stresses like a major deadline, moving to a new city or having a baby. Sometimes it seems not to be triggered by anything at all. One of the most important things to remember about depression is that people who have it can’t just “snap out of it” or make it go away. It’s a real illness, and the leading cause of suicide.
TCAs are associated with a number of cardiovascular (heart and blood vessels) effects such as orthostatic hypotension and abnormal heart rates and rhythms. Orthostatic hypotension may lead to dizziness, falls, and fractures. Orthostatic hypotension may be managed by reducing or discontinuing the TCA dose, increasing salt intake, or treatment with steroids.

Nortriptyline blocks the reuptake of serotonin and, more potently, norepinephrine at the presynaptic neuronal membrane. It has less affinity for H1 and M1 receptors and, thus, is better tolerated than other TCAs. Although nortriptyline is FDA approved only for depression, it has also been prescribed for chronic pain, myofascial pain, anxiety disorders, and attention-deficit/hyperactivity disorder. As with desipramine, there is a therapeutic window for nortriptyline


About Depression:  Feelings of depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. But true clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended period of time.
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.
Mental health medication, including antidepressants, are effective in reducing symptoms of depression. They often work well as a supplement to therapy or short-term solution for symptoms that might initially be severe. Nonetheless, even their short-term effects can take two weeks or more to activate. If you are considering mental health medication, consult a psychiatrist, not only a primary care doctor.
Offidani, E., Fava, G. A., Tomba, E., & Baldessarini, R. J. (2013). Excessive mood elevation and behavioral activation with antidepressant treatment of juvenile depressive and anxiety disorders: A systematic review. Psychotherapy and psychosomatics, 82, 132-141. Retrieved from https://pdfs.semanticscholar.org/467a/0936752c67af496c727d48b6513f3f48d2f3.pdf
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).

In general, the severe depressive illnesses, particularly those that are recurrent, will require antidepressant medications, phototherapy for winter seasonal depression (or ECT or TMS in severe cases) along with psychotherapy for the best outcome. If a person suffers one major depressive episode, he or she has up to about a 75% chance of a second episode. If the individual suffers two major depressive episodes, the chance of a third episode is about 80%. If the person suffers three episodes, the likelihood of a fourth episode is 90%-95%. Therefore, after a first depressive episode, it may make sense for the patient to come off medication gradually. However, after a second and certainly after a third episode, most clinicians will have a patient remain on a maintenance dosage of the medication for an extended period of years, if not permanently.

The relationship between these emotions — and their associated clinical conditions, anxiety disorders and mood disorders — is complex and somewhat idiosyncratic. For one person, anxiety can lead to avoidance and isolation, and isolation, in turn, can result in a lack of opportunity for pleasurable experiences and then, low mood. For another individual, feeling down may zap them of the energy to do things they typically enjoy, and attempts to re-engage with the world after being out of practice may result in some nervousness.
If feeling anxious or depressed, it is important to admit to it and get help. Even when family and friends are around for support, professional attention is best. A good first step is to discuss concerns with your regular doctor. He or she can provide advice about the best treatment and suggest a qualified therapist. There are several types of mental health professionals who can provide psychotherapy (counselors, social workers and psychologists), but any medications must be prescribed by a physician (your regular doctor or a psychiatrist). It is important to select a therapist with whom you fee comfortable and can talk honestly about your feelings. Psychotherapy can be done individually, with other family members, or in a group.
Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions[18] and physiological problems, including hypoandrogenism (in men), Addison's disease, Cushing's syndrome, hypothyroidism, Lyme disease, multiple sclerosis, Parkinson's disease, chronic pain, stroke,[19] diabetes,[20] and cancer.[21]
TCAs have a long record of efficacy in the treatment of depression and have the advantage of lower cost. They are used less commonly because of the need to titrate the dose to a therapeutic level and because of their considerable toxicity in overdose. TCAs are often prescribed for many other psychiatric disorders, such as generalized anxiety disorder and posttraumatic stress disorder. They are also used to treat chronic pain, such as neuropathy, and migraine headaches.
As the name implies, antidepressants are used for the treatment of depression. It is now clear that in addition to improving one’s mood, antidepressants also have an anti-anxiety effect. Antidepressants are believed to affect certain (chemical messengers) in the brain, resulting ​in a better mood and less anxiety. Today, antidepressants are the usual choice of medication intervention for major depressive disorders and anxiety disorders.
If you think you may have depression, describe your symptoms to a doctor. Or, if you’re not able to do that, pull out your cell phone and type “depression” or “clinical depression” into Google; you’ll be able to take a clinically validated depression test, known as the PHQ-9 patient health questionnaire, immediately and see if your scores show that you have depression.
Another potential complication is that chronic high-functioning anxiety and depression can lead to a variety of other medical and mental health issues when left untreated. Research has shown a correlation between mental health disorder and chronic illness. Evidence points toward changes in the way certain body systems function when mental health disorders are present. Some changes include fluctuations in heart rate and circulation, increased inflammation in the body, metabolic changes, and irregularities with stress hormones. There are also increased risks of diabetes, stroke, cardiovascular disease, and substance abuse. Getting treatment quickly can help prevent high-functioning anxiety and depression from getting worse, or developing into additional medical and mental health issues.
Brain and Behavior is a peer-reviewed, open access, interdisciplinary journal, providing rapid publication of scientifically sound research across neurology, neuroscience, psychology and psychiatry. The journal publishes quality research reports that enhance understanding of the brain and behavior. The journal strives to help authors and look for reasons to publish rather than reject.
Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.
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