The SSRI antidepressants can cause sexual dysfunction. SSRIs reportedly decrease sex drive (libido) in both men and women. SSRIs reportedly cause inability to achieve orgasm or delay in achieving orgasm (anorgasmia) in women and difficulty with ejaculation (delay in ejaculating or loss of ability to ejaculate) and erections in men. Sexual dysfunction with SSRIs is common though the exact incidence is unknown. Newer SSRIs like vortioxetine and vilazodone have little to no negative impact on sexual functioning. Furthermore, patients have reported sexual side effects with the use of other antidepressant classes such a MAOIs, TCAs, and dual-action antidepressants.
^ Jeronimus BF, Kotov R, Riese H, Ormel J, et al. (October 2016). "Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants". Psychological Medicine. 46 (14): 2883–2906. doi:10.1017/S0033291716001653. PMID 27523506.
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.
Even in the most severe cases, depression is highly treatable. The condition is often cyclical, and early treatment may prevent or forestall recurrent episodes. Many studies show that the most effective treatment is cognitive behavioral therapy, which addresses problematic thought patterns, with or without the use of antidepressant drugs. In addition, evidence is quickly accumulating that regular mindfulness meditation, on its own or combined with cognitive therapy, can stop depression before it starts by effectively disengaging attention from the repetitive negative thoughts that often set in motion the downward spiral of mood.

Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake and also has a weak effect on norepinephrine and dopamine neuronal reuptake. It has slight anticholinergic effects and may cause more weight gain than other SSRIs. Paroxetine is sometimes prescribed for indications that are not FDA approved, such as eating disorders and the relief of vasomotor symptoms of menopause.


Depression is a common and debilitating mood disorder. More than just sadness in response to life’s struggles and setbacks, depression changes how you think, feel, and function in daily activities. It can interfere with your ability to work, study, eat, sleep, and enjoy life. The feelings of helplessness, hopelessness, and worthlessness can be intense and unrelenting, with little, if any, relief.
Kessler RC, Birnbaum HG, Shahly V, Bromet E, Hwang I, McLaughlin KA, Sampson N, Andrade LH, de Girolamo G, Demyttenaere K, Haro JM, Karam AN, Kostyuchenko S, Kovess V, Lara C, Levinson D, Matschinger H, Nakane Y, Browne MO, Ormel J, Posada-Villa J, Sagar R, Stein DJ. Age Differences in the Prevalence and Co-Morbidity of DSM-IV Major Depressive Episodes: Results From the WHO World Mental Health Survey InitiativeExternal. Depression and Anxiety 2010;27(4):351–64 [accessed 2018 Mar 22].

Many people living with high-functioning anxiety and depression are described as Type-A personalities or overachievers. They often excel at work or appear to be “super mom/dad” and seem to have it all under control. Other people may notice signs of high-functioning anxiety and depression but characterize the behaviors as “anal retentive” quirks or bad habits. And, many times, signs and symptoms of high-functioning depression and anxiety that others observe are given positive attributes, rather than being seen for what they are. For instance, anxiety and worry may be expressed as dwelling on minor details and viewed as perfectionism. What observers generally do not see are the private struggles with stress, sleeplessness, digestive issues, self-criticism, or feelings of sadness and gloom that had to be overcome to attain achievements.


Of people diagnosed with major depressive disorder, who are treated and recover, at least half are likely to experience a recurrent episode sometime in their future. It may come soon after or not for many years. It may or may not be triggered by a life event. After several episodes of major depression, a psychiatrist may suggest long-term treatment. More
MAOIs also impair the ability to break down tyramine, a substance found in aged cheese, wines, most nuts, chocolate, certain processed meats, and some other foods. Tyramine, like norepinephrine, can elevate blood pressure. Therefore, the consumption of tyramine-containing foods by a patient taking an MAOI drug can cause elevated blood levels of tyramine and dangerously high blood pressure. In addition, MAOIs can interact with over-the-counter cold and cough medications to cause dangerously high blood pressure. The reason for this is that these cold and cough medications often contain drugs that likewise can increase blood pressure. Because of these potentially serious drug and food interactions, MAOIs are usually only prescribed for people who are thought to be willing and able to manage the many dietary restrictions required by these medications and after other treatment options have failed.
It's often difficult to come to grips with the confusion and uncertainty that characterize the problems of anxiety and depression when you keep them to yourself and try to figure it out on your own. A consultation with a professional therapist can often help you through that doubt and uncertainty. If you are in need of a therapist, there are several good national organizations which can help you find a professional in your area.

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 with substance use problems—There is a direct link between depression and problem substance use. Many people who are experiencing depression turn to drugs or alcohol for comfort. Overuse of substances can actually add to depression in some people. This is because some substances like alcohol, heroin and prescription sleeping pills lower brain activity, making you feel more depressed. Even drugs that stimulate your brain like cocaine and speed can make you more depressed after other effects wear off. Other factors, like family history, trauma or other life circumstances may make a person vulnerable to both alcohol/drug problems and depression.
Symptoms of depression and anxiety are most common among people with chronic migraine, which is when headache attacks occur on 15 or more days a month. For people with fewer headaches, depression or anxiety puts them at risk for more headaches over time. Symptoms of depression and anxiety also impact other areas of health. Migraine patients with depression or anxiety have higher medical costs, are at increased risk for suicide, and have higher levels of disability than migraine patients without depression or anxiety. Also, and perhaps most importantly, headache treatments don’t work as well when the depression or anxiety is not also being treated. Untreated patients are less likely to follow medicine or behavior treatment plans. They also show less response to headache medications, and are more likely to relapse. For these reasons, treating all these conditions is very important.
The new world of pharmacogenetics holds the promise of actually keeping the genes responsible for depression turned off so as to avoid the illnesses completely. Also, by studying genes, we are learning more about the matching of patients with treatment. This kind of information can tell us which patients do well on which types of drugs and psychotherapy regimens.
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.
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.
People who are depressed will usually show a style of thinking that focuses on negative views of the world. They often think of themselves as worthless and of the world as being a bad or unfair place, and they are without hope that their lives will improve in the future. When something bad happens, they blame themselves, but when good things happen, they tell themselves they are just lucky. Furthermore, people with depression are less likely to recognize and appreciate positive events when they happen; rather, they tend to be more tuned into the bad things in their lives and brood over those events.
Stressful life events play a part in the onset or relapse of depression. Ongoing conflicts with others can take their toll on our well-being, as can other social and environmental stressors such as financial difficulties, retirement, unemployment, childbirth, loneliness, or loss of someone or something important. In vulnerable people, these unpleasant life events may be enough to cause or worsen a depressive illness.
The nerve cells in our brain use various chemicals to pass on impulses. Even though not all details are known, experts believe that depression is caused by an imbalance of certain chemicals like serotonin which then affects some nerve connections. Antidepressants aim to increase the availability of these chemicals. The various drugs do that in different ways.
Patience is required because the treatment of depression takes time. Sometimes, the doctor will need to try a variety of antidepressants before finding the medication or combination of medications that is most effective for the patient. Sometimes, it's necessary to increase the dosage to be effective or decrease the dosage to alleviate medication side effects.
Generally, people who have anxiety or depression disorders display significant disruptions in their ability to work, go to school, or participate in social functions. But with high-functioning anxiety and depression, although those disruptions are not as apparent, they still can occur. The signs and symptoms are often overlooked, because sufferers are able to manage daily activities, but they are suffering in silence. To the outside world, people living with high-functioning anxiety and depression seem fine and often excel at accomplishing tasks and goals.
The signs of high-functioning anxiety and depression can get hidden within seemingly reasonable justifications. Even though one might be holding down a job, going to school, or in a healthy relationship, he or she experiences disruptions in life activities that may not be necessarily obvious. Some of these hidden disruptions can be seen in behaviors such as declining social invitations with the excuse that work has been busy or stressful, sleeping more or sleeping less, and an overreliance on coping mechanisms like excessive exercise, overeating, or overindulging in alcohol or illicit substances.
People with substance use problems—There is a direct link between depression and problem substance use. Many people who are experiencing depression turn to drugs or alcohol for comfort. Overuse of substances can actually add to depression in some people. This is because some substances like alcohol, heroin and prescription sleeping pills lower brain activity, making you feel more depressed. Even drugs that stimulate your brain like cocaine and speed can make you more depressed after other effects wear off. Other factors, like family history, trauma or other life circumstances may make a person vulnerable to both alcohol/drug problems and depression.
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.
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.
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).
Behavioral activation is the practice of gradually increasing activity to experience more pleasure and mastery in life, according to Joel Minden, Ph.D., a clinical psychologist at the Chico Center for Cognitive Behavior Therapy. The therapeutic technique is relatively new, so it has a limited amount of research backing it. Nonetheless, it did spring from cognitive behavior therapy [CBT], which has mountains of research to support its efficacy.
Suicidal behavior is defined as a preoccupation or act that is focused on causing one’s own death voluntarily. Suicidal ideation refers to thoughts of suicide or wanting to take one’s own life. Suicidal behavior refers to actions taken by one who is considering or preparing to cause his or her own death. Suicide attempt usually refers to an act focused on causing one’s own death that is unsuccessful in causing death. Suicide refers to having intentionally caused one’s own death. Talking about suicide is the best way to prevent it. Although it is not possible to predict suicide with any certainty, our best tool is recognition of the signs that many people exhibit when contemplating suicide. These three behaviors should prompt you to seek immediate help for you or a loved one: talking about wanting to die or to kill oneself; looking for a way to kill oneself, such as searching online or obtaining a gun; talking about feeling hopeless or having no reason to live. See the Resources section below for actions to take if you or someone you know needs help.
Try to notice good things. Depression affects a person's thoughts, making everything seem dismal, negative, and hopeless. If depression has you noticing only the negative, make an effort to notice the good things in life. Try to notice one thing, then try to think of one more. Consider your strengths, gifts, or blessings. Most of all, don't forget to be patient with yourself. Depression takes time to heal.

It's also common for people who are having a difficult time with an anxiety disorder to feel depressed as a result of the way anxiety is interfering with their lives. It's my experience that most patients who experience this will find that their depression lifts naturally as a result of doing better with anxiety, and no special treatment for the depression is necessary.


Reminiscence of old and fond memories is another alternative form of treatment, especially for the elderly who have lived longer and have more experiences in life. It is a method that causes a person to recollect memories of their own life, leading to a process of self-recognition and identifying familiar stimuli. By maintaining one’s personal past and identity, it is a technique that stimulates people to view their lives in a more objective and balanced way, causing them to pay attention to positive information in their life stories, which would successfully reduce depressive mood levels.[38]
Trazodone is effective in the treatment of major depression. It inhibits reuptake of serotonin and modulates serotonergic neurotransmission. It also significantly blocks histamine (H1) receptors. Its most common side effect is sedation, and thus, it has an off-label indication as a hypnotic. It can be very rarely associated with priapism, a medical emergency and a dangerous side effect of this drug in men. It is often used at a low dosage (25 to 50 mg) as an adjunct to SSRIs to treat insomnia.
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.
When you’re suffering from deep, disabling depression, the idea that a pill can give you back your life—and sense of hope—is incredibly appealing. But are antidepressants always the best treatment option? What are the potential side effects and safety concerns? And are there any truly effective non-drug alternatives? These are some of the important questions to think about when considering antidepressant treatment. Learning about what antidepressants can (and can’t) do will enable you to weigh the benefits against the risks, make a more informed decision, and find the depression treatment that’s right for you.
For some people, the reduced daylight hours of winter lead to a form of depression known as seasonal affective disorder (SAD). SAD can make you feel like a completely different person to who you are in the summer: hopeless, sad, tense, or stressed, with no interest in friends or activities you normally love. No matter how hopeless you feel, though, there are plenty of things you can do to keep your mood stable throughout the year.
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:
Additionally, the symptoms must last for two or more weeks and cause significant disruption of life functions. But to be diagnosed with dysthymia, a person need only have two of the recognized diagnostic symptoms, one of which is a mood that is persistently dark or gloomy, and the symptoms must be present on most days for at least two years. It is possible to have periods of time that are “symptom free,” but the break cannot last longer than two months.
Although no one knows exactly why, depression and anxiety often occur together. In one study, 85% of those with major depression were also diagnosed with generalized anxiety disorder and 35% had symptoms of panic disorder. Other anxiety disorders include obsessive-compulsive disorder and post-traumatic stress disorder (PTSD). Because they so often go hand in hand, anxiety and depression are considered the fraternal twins of mood disorders.
Jacobsen PL, Mahableshwarkar AR, Serenko M, Chen Y, Trivedi M. A randomized, double-blind, placebo-controlled study of the efficacy and safety of vortioxetine 10 mg and 20 mg in adults with major depressive disorder. Program and abstracts of the 166th Annual American Psychiatric Association Meeting; May 18-22, 2013; San Francisco, California. Poster NR9-06.
Anxiety disorders involve more than common nervousness and worry. They can cause terrifying fear about things other people wouldn’t think twice about. Many people with anxiety disorders fully comprehend that their thoughts are irrational. But they still can’t stop them. Feelings of losing inner control haunt them. This angst is one of the entry ways for depression.2

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Focus on behaviors. If the person is reluctant to seek help, then don’t try to convince the person that a mood disorder is causing the problems. Instead, talk about their behaviors and the ways in which treatment can help. For example, after you have listened and sympathized with the person’s feelings, try to agree on wellness goals (e.g., consistent sleep and feeling less irritable). Then, try to assign some action steps that you can agree on to reach these goals (e.g., after two weeks, if the person does not improve, you will set up a medical evaluation).
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.

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.
Whether or not someone has side effects, which side effects they have, and how frequent they are will depend on the drug and on the dose used. And everyone reacts slightly differently to drugs as well. The risk of side effects increases if other medication is also being taken. One of the drugs may make the side effects of the other worse. These kinds of drug interactions are common in older people and people with chronic illnesses who are taking several different kinds of medication.
Depression, a state of low mood and aversion to activity, can affect a person's thoughts, behavior, tendencies, feelings, and sense of well-being. Symptoms of the mood disorder is marked by sadness, inactivity, difficulty in thinking and concentration and a significant increase/decrease in appetite and time spent sleeping. A great deal of people also have feelings of dejection, hopelessness, and sometimes suicidal tendencies. It can either be short term or long term depending on the severity of the person's condition.[1] A depressed mood is a normal temporary reaction to life events, such as the loss of a loved one. It is also a symptom of some physical diseases and a side effect of some drugs and medical treatments. Depressed mood may also be a symptom of some mood disorders such as major depressive disorder or dysthymia.[2]

Towards the end of the treatment, the dose is gradually reduced over the course of several weeks. You may experience temporary sleep problems, nausea or restlessness while coming off the medication. These problems are especially common if you stop taking antidepressants suddenly. Sometimes people stop taking their medication as soon as they start feeling better. But doing so increases the likelihood of the depression returning. Unlike many sleeping pills and sedatives, though, antidepressants do not cause physical dependence.

The causes of SAD are unclear, says NIMH, but research suggests it may be due to seasonal fluctuations in levels of serotonin, a brain chemical that helps regulate mood, or to an overproduction of melatonin, the hormone that regulates sleep. Scientists also posit that people with SAD may produce too little vitamin D, which impacts serotonin activity.
Problem-focused coping leads to lower level of depression. Focusing on the problem allows for the subjects to view the situation in an objective way, evaluating the severity of the threat in an unbiased way, thus it lowers the probability of having depressive responses. On the other hand, emotion-focused coping promotes depressed mood in stressful situations. The person has been contaminated with too much irrelevant information and loses focus on the options for resolving the problem. They fail to consider the potential consequences and choose the option that minimizes stress and maximizes well-being.
Venlafaxine and its active metabolite inhibit neuronal serotonin and norepinephrine reuptake. They are weak inhibitors of dopamine reuptake. In addition, it causes beta-receptor down-regulation. Venlafaxine is sometimes prescribed for non–FDA-approved indications, such as obsessive-compulsive disorder, hot flashes, neuropathic pain, attention-deficit/hyperactivity disorder, and posttraumatic stress disorder.
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.

I'm 12 years out from my TBI,and am here now reading for a recently injured friend. My heart goes out to you, those fighting through this darkness. I almost gave up. My healing really turned the corner for the better when I made exercise and slow flow, meditative yoga a daily priority. Please, please make movement a part of every single day! I'm only one voice, but research agrees: aerobic exercise reduces anxiety and depression. Group yoga was the hardest to join, but I believe it was the most beneficial. All good yoga teachers will offer modifications to help you practice safely and within any limitations. I also started daily morning walks and some gentle swimming. Sometimes I hated it, but i stuck to a routine, invited those closest to me to join sometimes, and fought to stay with it. I could feel I slept better. I now run or lap swim 5 days a week. Always. Its not about speed ( I'm super slow!) it's about brain oxigenation and cell renewal - essential for your brain's recovery, and your very soul's happiness. Yoga emphasizes rhythmic breathing, stretch, positive self acceptance, and quiet social interaction. At my lowest, I forced myself to go. Sometimes my husband even walked me in to class. We laugh about that now! No matter how low the day, I was always glad AFTERWARDS that I had gone. Believe, this will get better! Eat only healthful food, lots of fresh veggies, and add yoga and walking/running at any speed. Trust, no one is watching! I was afraid to look disabled in front of my neighbors. Really, most folks just didn't care... and now I know some are just like me: rooting for you every step of the way. There are more silent suffers of all kinds out there than we admit. My compassion for other humans grew because of the understanding this struggle forced upon me. Trust, with healthy living our brains do slowly heal. I may never be quite the same, but by golly I am plenty good enough. <3 I now run with a group too once or twice a week, and those folks have become the very best medicine I've ever encountered. Shared endorphins and sweat bring out the best in people - we were made for teamwork . Whether it's a walking group at the mall or a yoga class at the Y, please gift yourself the medicine of exercise. Namaste and love. You're going to make it past this. Lynn- TBI, 07/03/2002
Premenstrual dysphoric disorder is another manifestation of depression which is a severe and sometimes disabling extension of premenstrual syndrome (PMS). Although regular PMS and Premenstrual dysphoric disorder (PMDD) both have physical and emotional symptoms, the mood changes in PMDD are much more severe and can disrupt social, occupational, and other important areas of functioning. In both PMDD and PMS, symptoms usually begin seven to 10 days before the start of a menstrual period and continue for the first few days of the period. Both PMDD and PMS may also cause breast tenderness, bloating, fatigue, and changes in sleep and eating habits. PMDD is characterized by emotional and behavioral symptoms that are more severe, such as sadness or hopelessness, anxiety or tension, extreme moodiness, irritability or anger.
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