Side effects: TCAs affect several neurotransmitters in the brain and, as a result, cause numerous side effects. The most common side effects include dry mouth, constipation, blurred vision, urinary retention, dizziness, tachycardia, memory impairment, and delirium. Other side effects include orthostatic hypotension, weight gain, seizures, bone fractures, sexual dysfunction, increased sweating, and increased or irregular heartbeats.
Strengthen your social support. Although you cannot control your depression diagnosis, there are some things you can control. You can seek or create a positive support system for yourself. Whether your social network stems from your spouse, family members, close friends, co-workers, religious organizations, or community groups, support is available.

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.
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).
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.
Strengthen your social support. Although you cannot control your depression diagnosis, there are some things you can control. You can seek or create a positive support system for yourself. Whether your social network stems from your spouse, family members, close friends, co-workers, religious organizations, or community groups, support is available.

Pregnancy or breast-feeding. A decision to use antidepressants during pregnancy and breast-feeding is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is low. Still, certain antidepressants, such as paroxetine (Paxil, Pexeva), may be discouraged during pregnancy. Work with your doctor to find the best way to manage your depression when you're expecting or planning on becoming pregnant.
When psychotherapy and antidepressants don’t work, clinicians may turn to other treatment options. Usually the first is to try and adjunct medication to the existing antidepressant medication. In more serious or treatment-resistant cases, additional treatment options may be tried (like ECT or rTMS). Ketamine infusion treatments also appear to be effective, but are generally not covered by insurance and the long-term risks are unknown.
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.
But there’s more to the story. There are medications that help people feel better a lot faster than today’s antidepressant pills. And feeling better sooner means that people can take helpful actions sooner, developing helpful habits for long-lasting change and lifting themselves out depression. And there are other medications that might not work any faster, but have antidepressant effects without some of the most troubling side effects associated with medications like Zoloft (sertraline) or Paxil (paroxetine).
Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the amount of the neurochemical serotonin in the brain. (Remember that brain serotonin levels often are low in depression.) As their name implies, the SSRIs work by selectively inhibiting (blocking) serotonin reuptake in the brain. This block occurs at the synapse, the place where brain cells (neurons) connect to each other. Serotonin is one of the chemicals in the brain that carries messages across these connections (synapses) from one neuron to another.

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.


Monoamine oxidase inhibitors (MAOIs) – MAOIs have more serious side effects, so they are rarely prescribed unless other medications do not work. MAOIs have many interaction effects with foods and other medications, so people who take them may have to change their diet and other medications. SSRIs and many other medications taken for mental illness cannot be taken with MAOIs.

Another type of depression is called Persistent depressive disorder (dysthymia). The essential feature of this mood disorder is a low, dark or sad mood that is persistently present for most of the day and on most days, for at least 2 years (children and adolescents may experience predominantly irritability and the mood persist for at least 1 year). For the individual to receive the diagnosis of persistent depressive disorder they should also have two of the diagnostic symptoms which include poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, or feelings of hopelessness. During this period, any symptom-free intervals last no longer than two months. The symptoms are not as severe as with major depression. Major depression may precede persistent depressive disorder, and major depressive episodes may also occur during persistent depressive disorder.
Exercise and pleasurable activities are natural ways to improve mood. Exercise increases the levels of endorphins which can elevate mood. Foods high in omega-3-fatty acids may increase serotonin levels in the brain and contribute to relieving depression. During winter months some people may suffer from seasonal depression. Increasing exposure to light alleviates seasonal depression.
ECT involves the application of a brief electric current to carefully selected sites on the scalp. These electric currents, which are administered by a psychiatrist and anaesthetist, produce a minor seizure in the brain. Prior to the procedure, the person is given a short-acting general anaesthetic and a muscle relaxant to reduce awareness of the procedure and to prevent a physical seizure.
When you’re depressed, just getting out of bed can seem like a daunting task, let alone working out! But exercise is a powerful depression fighter—and one of the most important tools in your recovery arsenal. Research shows that regular exercise can be as effective as medication for relieving depression symptoms. It also helps prevent relapse once you’re well.

Everyone experiences a range of emotions over the course of days and weeks, typically varying based on events and circumstances. When disappointed, we usually feel sad. When we suffer a loss, we grieve. Normally these feelings ebb and flow. They respond to input and changes. By contrast, depression tends to feel heavy and constant. People who are depressed are less likely to be cheered, comforted or consoled. People who recover from depression often welcome the ability to feel normal sadness again, to have a “bad day,” as opposed to a leaden weight on their minds and souls every single day. More
Several specific antipsychotic medications have been shown to enhance the effects of an antidepressant when an initial response is poor. These include aripiprazole (Abilify), brexpiprazole (Rexulti), and quetiapine (Seroquel). Symbyax, a combination of the antipsychotic drug olanzapine (Zyprexa) and an SSRI (Prozac, or fluoxetine), is approved for treatment-resistant depression or depression in people with bipolar disorder.

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Depressive disorders are mood disorders that come in different forms, just as do other illnesses, such as heart disease and diabetes. However, remember that within each of these types, there are variations in the number, timing, severity, and persistence of symptoms. There are sometimes also differences in how individuals express and/or experience depression based on age, gender, and culture.
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
When you’re depressed, just getting out of bed can seem like a daunting task, let alone working out! But exercise is a powerful depression fighter—and one of the most important tools in your recovery arsenal. Research shows that regular exercise can be as effective as medication for relieving depression symptoms. It also helps prevent relapse once you’re well.

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.
Mahableshwarkar AR, Jacobsen PL, Serenko M, Chen Y, Trivedi M. A randomized, double-blind, parallel group study comparing the efficacy and safety of 2 doses of vortioxetine 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 NR9-02.
During the holidays, our thoughts may gravitate to memories of our youth, growing up and time spent with family and friends. But as often happens when we age, family members and friends pass away. Loved ones move far away because of family and job obligations. Feelings of isolation and loneliness can take hold, especially during the holidays, a time that in the past was filled with activities and traditions with family and friends.
Express yourself. With depression, a person's creativity and sense of fun may seem blocked. Exercise your imagination (painting, drawing, doodling, sewing, writing, dancing, composing music, etc.) and you not only get those creative juices flowing, you also loosen up some positive emotions. Take time to play with a friend or a pet, or do something fun for yourself. Find something to laugh about — a funny movie, perhaps. Laughter helps lighten your mood.
Not to be disrespectful of the good work you are providing here, but please don't say that medications help with the relief of depression and anxiety. It simply is not a true statement. These drugs cause severe damage to the human brain, nervous system, organs and are neurotoxins. I was severely damaged by them and now have a form of TBI caused by these drugs. In the online forums I'm in we call this a chemical brain injury. Psych meds should never be used to treat mental health disorders. There are alternative holistic treatments out there. The statement made that meds are not addictive is incorrect. Please do in depth research outside of mainstream websites. Contact me if you need valid true information about medications. Please don't go down the rabbit hole of psych meds. Please. They will cause you severe harm as they did me.
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.
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.
Serotonin syndrome: Serotonin syndrome is a serious medical condition that can occur when medications that alter the concentration of serotonin in the brain are taken together. Symptoms of serotonin syndrome may include anxiety, restlessness, sweating, muscle spasms, shaking, fever, rapid heartbeat, vomiting, and diarrhea. Examples of medications that can cause serotonin syndrome include antidepressants, some pain relievers such as meperidine (Demerol) or tramadol (Ultram), St. John's wort, medicines used to treat migraine headaches called triptans, and some street drugs such as cocaine.
Depressed mood may not require professional treatment, and may be a normal temporary reaction to life events, a symptom of some medical condition, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition which may benefit from treatment. The UK National Institute for Health and Care Excellence (NICE) 2009 guidelines indicate that antidepressants should not be routinely used for the initial treatment of mild depression, because the risk-benefit ratio is poor.[36] Physical activity can have a protective effect against the emergence of depression.[37]

Another type of depression is called Persistent depressive disorder (dysthymia). The essential feature of this mood disorder is a low, dark or sad mood that is persistently present for most of the day and on most days, for at least 2 years (children and adolescents may experience predominantly irritability and the mood persist for at least 1 year). For the individual to receive the diagnosis of persistent depressive disorder they should also have two of the diagnostic symptoms which include poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, or feelings of hopelessness. During this period, any symptom-free intervals last no longer than two months. The symptoms are not as severe as with major depression. Major depression may precede persistent depressive disorder, and major depressive episodes may also occur during persistent depressive disorder.
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:
Spend Time With Pets. Many depressed people find that it is comforting to spend time with their pets. Pets offer unconditional love and do not make complicated demands on depressed people. They are often great listeners (even though they don't really understand what you are saying). Feeding pets is a loving act. Taking pets for a walk (if that is appropriate) can become a regular exercise routine with multiple benefits for both pet and owner.
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.
Talk therapy involves discussing your problems and how you feel with a trained therapist. Your therapist can help you detect patterns of thought or behavior that contribute to your depression. You may be given homework, such as tracking your moods or writing in journals. This will help you to continue your treatment outside of appointments. Your therapist can also teach you exercises to reduce stress and anxiety, and help you understand your illness.

Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings Cdc-pdf[PDF – 2.37MB]External. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2014 [accessed 2018 Mar 22].

See a psychiatrist, not a family physician. Your family physician might help you or your loved one first realize that you need depression treatment. But although any medical doctor can prescribe medications, psychiatrists are doctors who specialize in mental health treatment. They are more likely to be familiar with the newest research on antidepressants and any safety concerns. Your health depends on your doctor’s expertise, so it’s important to choose the most qualified physician.


People living with high-functioning anxiety and depression may appear fine, but they are far from being as emotionally and mentally healthy as they could be. Seeking treatment is an important step to improving overall emotional and mental health to its potential level. High-functioning anxiety and depression is very treatable, but often the difficulty is in identifying the signs and symptoms and realizing there is a problem.
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:
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.
One reason is that while the medication may ultimately help you, your depression might also naturally lift over the course of a few weeks or months. That doesn’t happen for everyone, but it is surprisingly common. Another is that it can take awhile for “antidepressant effects” to kick in — but more on that below. Finally, these medications often treat symptoms of depression — like trouble sleeping, or not eating enough. When those symptoms improve a bit, you can take more positive actions — like exercising, getting back to your hobbies, working, and being social. And a rise in your mood often follows from those actions. Talk therapy often works in the same way: helping you take action first, leading to you feeling better later.

Doctors often use one of the SSRIs initially because of their lower severity of side effects compared to the other classes of antidepressants. It's possible to further minimize side effects of SSRI medications by starting them at low doses and gradually increasing the doses to achieve full therapeutic effects. For those patients who do not respond after taking a SSRI at full doses for six to eight weeks, doctors often switch to a different SSRI or another class of antidepressants. For patients whose depression failed to respond to full doses of one or two SSRIs or whom could not tolerate those medications, doctors will usually then try medications from another class of antidepressants. Some doctors believe that antidepressants with dual action (action on both serotonin and norepinephrine), such as duloxetine (Cymbalta), (Cymbalta), mirtazapine (Remeron), venlafaxine (Effexor), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima), may be effective in treating patients with severe depression that is treatment resistant. Other options include bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban), which has action on dopamine (another neurotransmitter).
Desipramine inhibits the reuptake of serotonin and, more potently, norepinephrine at the presynaptic neuronal membrane. It is a commonly used TCA that is relatively less sedating and tends to have fewer anticholinergic and antihistaminic adverse effects than other TCAs. It is sometimes used for off-label indications such as peripheral neuropathy and attention-deficit/hyperactivity disorder.

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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.
A mental health specialist is the type of professional best equipped to make a reliable diagnosis for this condition. These kinds of professionals include psychologists, psychiatrists, and clinical social workers. While a general practitioner or family doctor may be able to make an initial diagnosis, further followup and treatment should be done by a specialist for the best treatment results.
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.
Even though depression isn’t simply a matter of having too little serotonin, that doesn’t mean that antidepressants don’t work. Going back to our aspirin analogy: headaches aren’t caused by an aspirin deficiency, but they still go away when you pop a couple of pills. Is the same true with antidepressants and depression? Again, the evidence may surprise you.
Amitriptyline inhibits the reuptake of norepinephrine and, more potently, serotonin at the presynaptic neuronal membrane, which increases concentration in the CNS. It has a high affinity for histamine H1 and muscarinic M1 receptors. Amitriptyline can cause weight gain, sedation, and anticholinergic side effects. It is often used for non–FDA-approved indications, such as chronic pain management, diabetic neuropathy, migraine prophylaxis, and posttraumatic stress disorder.

Concerns about long-term use of the benzodiazepines led many doctors to favor tricyclic antidepressants (amitriptyline, imipramine, and nortriptyline). Although effective in the treatment of some anxiety disorders(but not Social Anxiety Disorder), they can cause significant side effects, including orthostatic hypotension (drop in blood pressure on standing), constipation, urinary retention, dry mouth, and blurry vision.
High scores on the personality domain neuroticism make the development of depressive symptoms as well as all kinds of depression diagnoses more likely,[10] and depression is associated with low extraversion.[11] Other personality indicators could be: temporary but rapid mood changes, short term hopelessness, loss of interest in activities that used to be of a part of one's life, sleep disruption, withdrawal from previous social life, appetite changes, and difficulty concentrating.[12]
All antidepressants can have side effects, but some may be more problematic than others. Guided by your doctor, you may need to try several different drugs before you find the one that’s best for you. Keep in mind that they do not work immediately and usually take at least several weeks for maximal benefit. Combining the right medication with psychotherapy or another intervention, like a support group, might be what you need to feel better.

TCAs are safe and generally well tolerated when properly prescribed and administered. However, if taken in overdose, TCAs can cause life-threatening heart-rhythm disturbances. Some TCAs can also have anticholinergic side effects, which are due to the blocking of the activity of the nerves that are responsible for control of the heart rate, gut motion, visual focus, and saliva production. Thus, some TCAs can produce dry mouth, blurred vision, constipation, and dizziness upon standing. The dizziness results from low blood pressure that occurs upon standing (orthostatic hypotension). Anticholinergic side effects can also aggravate narrow-angle glaucoma, urinary obstruction due to benign prostate enlargement (hypertrophy), and cause delirium in the elderly. Patients with seizure disorders or a history of strokes should avoid TCAs.


We know it can be tough take on any of these depression self help tips when you’re feeling really bad. Also, when it comes to self-help, strategies for feeling better are very individualistic. That is, different things work for different people. Not everyone will want to start doing yoga, for example, so keep trying different ideas even if the first thing you try doesn’t help.
Track your thoughts. Writing down your thoughts is a good way to identify those that are contributing to making you feel down and depressed; these might include thoughts like ‘I’m useless’ or ‘no one cares about me’. Just because we think something, it doesn’t mean it’s true, so learn how to challenge negative thinking. If your mood is really low and you have difficulty challenging your thoughts, avoid writing them down on your own and instead seek help from a mental health professional.
ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
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