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FAQ: Depression and Manic-Depressive Illness




Excerpted from
How to Cope with Depression
By Raymond Depaulo, Jr., M.D.

Should I stop my medication as soon as I think the depression has lifted?

Absolutely not. Antidepressants may relieve the symptoms of depression while the illness runs its course over months or years. Stopping medication prematurely could cause a relapse; discontinuing it should be done only with the close guidance of your physician.

Do I need to stay on medication for life?

The need for lithium and/or antidepressant medication is specific to a person's illness. For people who experience severe or frequent exacerbations of major affective disorders, medications may always be needed. For those who experience long, symptom-free time periods in between recurrences, medications may be needed only intermittently.

It is important for anyone with a major affective disorder to maintain close contact with a psychiatrist, who will monitor his or her moods and decide on appropriate therapy.

Why do I need to have blood drawn while I am on an anti-depressant or lithium?

Blood sampling allows your physician to monitor the blood concentrations of medications you are taking. In very high concentration, lithium and other antidepressant and antimanic medications can be dangerous. In addition to guarding against toxicity, blood testing allows for optimal dosing of medications with a "therapeutic window. " These medications work best within a specific range of concentrations, above which and below which they are less effective.

Can I become addicted to antidepressants?

Antidepressant medications and lithium are not addictive. People do not develop cravings for them. Some antidepressants should, however, be tapered, rather than stopped abruptly, when no longer needed. This allows the body to adjust to their absence.

What is postpartum depression?

Postpartum depression refers to depression occurring after childbirth. While some women experience severe major depression following childbirth, many others experience only transient mood changes (apparently due to the hormonal changes). Many of those who suffer more severely have experienced a major affective illness before pregnancy or will experience one at some point (possibly unrelated to childbirth) later in life. The treatment of the persistent severe depressive episodes following childbirth is no different from that for episodes occurring at other times. The biggest problem related to these disorders is delayed recognition and treatment, which affects not only the depressed mother, but her infant and the rest of her family.

Does affective illness occur in children and adolescents?

It is clear that children and adolescents have substantial rates of serious depression and manic-depressive illness. These conditions are painful and can result in social, familial, and educational problems. They also carry the risk of suicide.

There has been a worrisome increase in suicides among adolescents and young adults in recent years. The reasons for this are not known, but it may be related to increased use and abuse of alcohol and other drugs. This, in turn, may be related to affective illness.

It is important that the signs and symptoms of affective illness in children and adolescents be identified by parents and taken seriously. Loss of appetite, fatigue, lethargy, unusual irritability or sadness (possibly reflected only in facial expression), and new difficulties in school may be clues.

When depression or manic-depressive illness is suspected, parents should seek the help of their family physician or, if possible, a psychiatrist experienced in diagnosing and treating affective disorders.

Are the elderly especially prone to depression?

Depression in our growing elderly community can be extremely severe and is fairly common. Symptoms such as decreased mood, decreased self-esteem, loss of interest in pleasurable activities, and loss of appetite are not "normal" parts of aging. The likelihood of concurrent medical conditions that can cause or complicate depression makes medical diagnosis and treatment of affective illness in the elderly essential. About a third of depressed patients over the age of 60 experience memory and other intellectual impairments that will improve when the depression is successfully treated.

Can a poor diet cause depression?

Although appetite often wanes during depression, there is no evidence that eating the wrong foods will cause major affective illness. Alcohol, of course, can play a role in making depression much worse.

Can vitamins relieve depression?

While the amino acid L-tryptophan may be of some usefulness in helping to treat some depressions, it is probably not effective alone. Therefore, it is usually used (if at all) with standard antidepressants or lithium. Uncommonly, vitamin deficiencies can be associated with depression, but there is no good evidence that they cause it. There is no evidence that vitamins, minerals, or nutritional supplements alone are useful in the treatment of major depression.

Is there any difference between generic and trade brands of a drug?

While the same chemical is found in generic and trade brands of a particular drug, the pills (even when the same size and weight) may differ in bioavailability - the amount of the drug that is free to enter the circulation and reach the brain. For this reason, it is sometimes wise to continue with a single brand throughout a treatment course. This decision should be made by your doctor or your doctor and pharmacist together.



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