More on Medication for Depression

There is a third class of antidepressants known as MAO Inhibitors, or MAOI’s.  You can read all about them here: http://pharmacist.hubpages.com/hub/What-Are-MAO-Inhibitors.

As with the others, the targets of this class of medication include serotonin, dopamine, epinephrin–all the so-called “feel-good” chemicals that the brain produces.

The question I’d like to address today is, “If depression can be treated without medication, then why take the pills?  Wouldn’t it be better to get to the root of the problem instead of just masking it?”

There are some assumptions in those questions.  I hear the questions a lot, because unfortunately, there is still stigma attached to taking medication for “nerve problems,”  or “emotional problems.” People of faith worry about depending on medication instead of God, believing that if they could just pray enough, read the Bible enough and deal with whatever their lack of faith is, they’d get better.  What follows is how I answer all that in my office, usually in a first or second visit with someone who is typically depressed, anxious, and embarrassed to be sitting in a “shrink’s” office.  This could take several posts to really get the job done, I’m not sure.  We’ll see!

So, let’s pretend you’re sitting in my office, we’re getting to know each other, and I’m seeing clear indications of depression.  The first thing I’m going to do is reassure you that you’ve made a good choice to find some help; that you certainly are not alone in your misery, and that it WILL get better. About this time, I will point out that there’s a box of tissues sitting right behind you on the back of the little sofa you’re sitting on.

Once you’ve told me your story, or at least enough to get us started, I’m going to ask you about the stressors in your life.  That question always gets me a wide variety of responses, from floods of tears to anger to uproarious–but sad–laughter. The reason I ask that question is that more and more clinical evidence is pointing to the reality that anxiety comes first, then depression.  Anxiety is just another word for fear.  Every single one of us deals with some level of anxiety at some point or points in our lives. It can stem from marital relationships, extended family, an obnoxious neighbor, illness, financial stress, job stress– to just about anything else you can think of. These are anxious times we live in, but that’s nothing new.  The folks who lived through World War I  thought it was Armageddon.  It was supposed to be the war to end all wars.  Those who endured through the Holocaust thought nothing could ever be worse, and then the atom bomb and nuclear warfare became something new to fear.

On a much smaller, but far more personal scale, most of us experience anxiety just in the routine of our daily lives, rarely thinking about the predictions of world-wide disaster.  The disasters at home are far more consuming. So you, sitting in my office, begin to tell me that you can’t sleep, that you often have sweaty, heart-pounding moments when you think you’re going to die; you can’t get a deep breath, you feel buzzy and faint, and then it passes and you’re terrified of the next attack.

Which takes us to a conversation about anxiety, panic attacks, anti-anxiety meds, and whether or not to use those meds. Please understand that not everyone who experiences depression will experience extreme anxiety and panic attacks.  It can be a part of the total picture, but it doesn’t have to be.  Sometimes, people who live with panic attacks have some deep trauma that has never really been addressed.  This can be Post-Traumatic Stress Disorder, common among military veterans and victims of childhood sexual abuse and/or rape; victims of natural disasters like tsunamis, hurricanes, and so on.  There are special treatments for this type of problem, including EMDR, which is a specialty of mine.  You can google it to find out more about it.

All right.  Just a quick note about anti-anxiety meds and then we’re done for today.  Here is a list of the most common medications:

• Alprazolam (Xanax) – approved for GAD, panic disorder; used off-label for agoraphobia with social phobia
• Chlordiazepoxide (Librium) – approved for anxiety (in general)
• Clonazepam (Klonopin) – approved for panic disorder; used off label for anxiety (in general)
• Diazepam (Valium) – approved for anxiety (in general)
• Lorazepam (Ativan) – approved for anxiety disorders (in general)
• Oxazepam (Serax) – approved for anxiety (in general)

GAD, by the way, stands for General Anxiety Disorder.   These medications are almost always prescribed “as needed” and can be helpful in calming you down if you suffer from panic attacks. Also, several of the common antidepressants are considered anti-anxiety as well.  Sometimes a physician will prescribe both, suggesting the anti-anxiety be used only when absolutely necessary.

And yes, I know there’s a lot of controversy about all this.  Be patient.  I’ll get there eventually!