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Depression
Video transcripts reprinted with permission from Dr. Allison Jorgensen, RP
"Hi, welcome to Health Wise. I'm Ally Jorgensen.
Today we're going to be talking about depression. When we talk about depression, there are a couple of words that we use that we need to be careful we understand. The first word is 'disease.' A disease is an illness or condition that the patient has no control over. Not the patient's fault, it just happens, and it either makes them feel ill, or sometimes it makes them feel sad, like depression. Depression is a disease when you cannot find a way to get happy. Again, it is not your fault, it is a disease. Insomnia is one of the problems sometimes that we have with depression.
Insomnia is either an inability to fall asleep or an inability to stay asleep. That is kind of an important word, especially when we are talking about depression. And the last word, is the opposite of insomnia, and that is hypersomnia. Hyper always means 'big'' so hypersomnia means you sleep all of the time, and you just cannot seem to wake up. It is important when we're talking about depression to remember depression is a disease. It is not your fault, you didn't do it. And when people say things to you like 'snap out of it,' 'get happy,' 'do something,' you cannot. It is a disease and it needs medical help. So, when you suffer from things like insomnia, which could mean you have depression, or hypersomnia, you sleep all the time which could mean you have depression, or you just know something doesn't feel right, 'I haven't been happy in a long time...,' then you know that it is time to seek medical care. Because depression, just like high blood pressure or diabetes, is a disease and you cannot do anything about it all alone. You did not cause it and pharmacist and doctors and medical professionals can help fix the problem. Most often, when we are treating depression, we are using drugs. That is the best way that we can rearrange the chemicals in your brain that cause the depression in the first place.
There are a number of different kinds of drugs that we can use to treat depression. It is important to know a little bit about those different kinds, because those are the decisions we make when we decide which drug is best for you. The first group of antidepressants, the oldest ones, they have been around in the United States for more than 50 years, are called MAO inhibitors. Sometimes, we just say 'MAOI' and we do not even finish the word 'inhibitor.' The big long words are monoamine oxidase inhibitor. No one ever writes those. The problem is if you do not know what these drugs are, when you read warning labels on drugs that you would take for a cough, or a cold, it will just say 'if you are taking an MAO.' If you do not know that you are, you could get into trouble.
There are only three monoamine oxidase inhibitors and they work very well. In fact, every antidepressant we will talk about today works just as well as every other antidepressant. We sort of pick between the side effects. The MAOs do not have a bunch of side effects, they just have a problem. They do not like other drugs. They do not even like some foods. So, if you are using an MAO inhibitor, you cannot drink beer. You cannot drink wine, you cannot eat aged pickles. And they have problems with certain old flavorful cheese, and there is even some sour dough bread that MAO inhibitors do not like. There are a wide of variety of drugs that the MAO inhibitors do not play with either. You cannot take St. John's Wort, you cannot take any other antidepressant. You cannot take any drugs for coughs, or colds; you cannot even take Alka-Seltzer® when you feel poorly. All of those drugs interact with MAO inhibitors. If you are taking one of these three drugs, please do not even buy vitamins without talking to your pharmacist or your doctor first. You will get used to the dietary restrictions and the special needs that these drugs will cause for you. And, when they begin to treat your depression, you will feel better too. That is the only problem with these drugs. Other than that, they work very well.
The second group of drugs that we often use to treat depression are called tricyclic antidepressants. What that really means is if we ask the chemistry teacher to draw them, they have three circles in the middle. And those are rings of carbon that help us change the chemicals in your brain to help get rid of the depression. The tricyclic antidepressants are the most widely used group of antidepressants for about the last 30 years. They are falling out of fashion just a little bit, because people do not like their side effects. But, they are relatively inexpensive and they are very good antidepressants. Most of the tricyclic antidepressants make you sleepy. So, if insomnia is a problem for you in addition to depression, the tricyclic antidepressants work wonderfully. We give them to you at bed, and we use that side effect that makes you sleepy to get rid of one of the symptoms of your depression which is you could not sleep in the first place.
The tricyclic antidepressants also do some things that we wish that they did not do. They tend to make your eyes dry. So, if you wear contact lenses, sometimes it is difficult to take tricyclic. They tend to make your mouth a little bit dry. So, if you sing in the church choir or you run a radio show, or even if you wear dentures, sometimes your mouth gets so dry that it is very uncomfortable for you and you would rather that the drug went away. And lastly, in our gentleman friends, if they take tricyclics and they already have a problem called benign prostatic hypertrophy, or BPH, the tricyclic antidepressants can make that worse. And we need to be careful. The cost, however, of the tricyclics, or the fact that they do not cost very much, makes them a really good drug to choose when people have to decide where they are going to spend their limited money.
The next class of antidepressant is the one that is growing very quickly. They are called the selective seratonin reuptake inhibitor, and just like everything else in pharmacy and medicine, we shorten that down and we call them the SSRIs. You have read about the SSRIs in numbers of public magazines and newspapers because they were such a change from the things that happened before. These drugs do not dry out your eyes, they do not dry out your mouth. They do not have the food problems that some of the MAO inhibitors have. But, the SSRIs sometime make you too alert. That is, they sometimes make you feel a little jumpy, and it is hard to sleep. So, if you are one of those folks who has depression and just wants to sleep all of the time, these drugs are great. If you are one of those folks who has depression and insomnia, that is, you cannot sleep, sometimes we cannot try the SSRIs because you would never sleep at all! It is one of the side effects of the drugs.
There are a number of other antidepressants that do not really fit into a good class like the first three groups that we have. And we use them for all kinds of things. We have a drug called Welbutrin. It is not really any of the three things we talked about, but it works wonderfully for depression. In fact, every drug for depression works as well as every other drug for depression. We just have to pick between the side effects. There is one very important exception to that rule. St. John's Wort, that little yellow flower medicine that you can buy at the gas station and at the health food store and at most pharmacies, that is an antidepressant too. But it does not work as well as the others. In fact, people with serious depression cannot take St. John's Wort because it is not strong enough to help them. That is why it is not a prescription.
It is important that you know if you are taking any of the antidepressants, any of the classes that we talked about, or some of those unusual antidepressants that do not fit in any class, you may not take St. John's Wort at the same time. Even though you can buy it without a prescription, you should never mix antidepressants unless the same doctor and the same pharmacy filled all of them and everybody knows what you are doing. Mixing antidepressants is a very, very bad idea.
I know that some of you are saying 'I take those drugs, and I do not take them for depression.' And that is true. We sometimes use the antidepressants for other problems. The [tricyclic] antidepressants, the ones that make your eyes dry and your mouth dry up, are wonderful if you have bad, sore muscles. They are also pretty good if you just need a little help for awhile falling asleep. The seratonin reuptake inhibitors, the SSRIs, work very well for some other issues. We use them to treat migraine headaches. Sometimes we use them to help people who panic when they have to go out in public, or they have to give a speech. Those people are not depressed, but they are getting some very important benefits from the antidepressant drugs.
When we think about treating depression, there are a couple of things that we need to remember. Depressed patients do not always know that they are depressed. That is, they have become so sad, and so withdrawn and it is been so long since they were happy, they do not remember that they ever felt any other way. It is important that if you have a friend, or family member, who you think is depressed, that you get them to the doctor so that we can see if they need help.
It is also important to remember, that the drugs we use to treat depression always take three weeks to work their very best. If you starting taking these drugs today, it will take 21 days from now until we know if that drug is going to work as well as we want it to. So, it will take 21 days before we know how much the drug has helped you. You may feel better in a week, you may feel much better in two weeks, but it will take us three full weeks to know how well this drug works for you.
Unfortunately, if the drug is going to cause side effects, it is going to dry out your mouth, it is going to make you sleepy, that will happen tomorrow. So, when you are taking the antidepressant drugs, please remember, the side effects happen the very next day. The help doesn't happen for three weeks. And that is true with every one of these drugs. It does not matter which drug class we pick; it does not matter which dose we pick, it always takes three weeks to do its very best job.
So, after you have the time to go to the doctor and get a good diagnosis, after you have discovered there is nothing wrong with you except you have depression, it is not your fault, you did not do anything wrong, you need to take a prescription to help. You still have to wait three more weeks to see how well this drug is going to work. At the end of those three weeks, we may change the dose or we may change the drug. Sometimes, when we move between drug classes, you have to take no drugs at all for two weeks. That is so we are sure you are safe. Remember, we cannot take them together, and sometimes it takes two whole weeks to get the drug out of your blood, so that I can put a different one in there.
Please do not take St. John's Wort when you are taking antidepressants. Please do not treat your own coughs and colds when you are taking any of the antidepressants for any reason. Even if you are taking a drug like Prozac for migraine headaches; do not treat your own coughs and colds without talking to your pharmacist or your doctor. The problem is these drugs have some serious drug interactions - not very many, but the few that they do have are very serious. If you are taking one of the MAOI inhibitors, please remember, you need to watch your diet. And if you have any questions, do not eat it until you have called somebody who can help. We always know...no beer, no wine, no cheddar cheese, no pickles. Beyond that, you will probably have to call and get some people to help you.
If you are taking the tricyclics and your only problem is your mouth gets dry, try sucking on a lemon drop. That works beautifully and you can continue to take the less expensive drug. If you are taking one of the seratonin inhibitors and it just makes you so awake you have a hard time sleeping, start taking it in the morning, then you will be happy that you are awake and you will be able to fall asleep at night. If you are taking any of the other drugs, if you are having any other side effects, please remember to talk to your doctor and your pharmacist.
When we treat depression, most of our patients take their drugs between one and three years. This is not going to get fixed quickly, but it is going to get fixed well. Also, remember, if you start taking your drugs today to treat depression, it is going to be three weeks before we know how well it works. Your doctor and your pharmacist understand that. And they will be right beside you to support you. The most important part is recognizing that you, or someone you love, may have this disease and getting to the doctor so that you can get some help.
For Health Wise, I'm Ally Jorgensen. Thanks for listening."
Posted July 22nd, 2007
"Hi, welcome to Health Wise. I'm Ally Jorgensen.
Today we're going to be talking about depression. When we talk about depression, there are a couple of words that we use that we need to be careful we understand. The first word is 'disease.' A disease is an illness or condition that the patient has no control over. Not the patient's fault, it just happens, and it either makes them feel ill, or sometimes it makes them feel sad, like depression. Depression is a disease when you cannot find a way to get happy. Again, it is not your fault, it is a disease. Insomnia is one of the problems sometimes that we have with depression.
Insomnia is either an inability to fall asleep or an inability to stay asleep. That is kind of an important word, especially when we are talking about depression. And the last word, is the opposite of insomnia, and that is hypersomnia. Hyper always means 'big'' so hypersomnia means you sleep all of the time, and you just cannot seem to wake up. It is important when we're talking about depression to remember depression is a disease. It is not your fault, you didn't do it. And when people say things to you like 'snap out of it,' 'get happy,' 'do something,' you cannot. It is a disease and it needs medical help. So, when you suffer from things like insomnia, which could mean you have depression, or hypersomnia, you sleep all the time which could mean you have depression, or you just know something doesn't feel right, 'I haven't been happy in a long time...,' then you know that it is time to seek medical care. Because depression, just like high blood pressure or diabetes, is a disease and you cannot do anything about it all alone. You did not cause it and pharmacist and doctors and medical professionals can help fix the problem. Most often, when we are treating depression, we are using drugs. That is the best way that we can rearrange the chemicals in your brain that cause the depression in the first place.
There are a number of different kinds of drugs that we can use to treat depression. It is important to know a little bit about those different kinds, because those are the decisions we make when we decide which drug is best for you. The first group of antidepressants, the oldest ones, they have been around in the United States for more than 50 years, are called MAO inhibitors. Sometimes, we just say 'MAOI' and we do not even finish the word 'inhibitor.' The big long words are monoamine oxidase inhibitor. No one ever writes those. The problem is if you do not know what these drugs are, when you read warning labels on drugs that you would take for a cough, or a cold, it will just say 'if you are taking an MAO.' If you do not know that you are, you could get into trouble.
There are only three monoamine oxidase inhibitors and they work very well. In fact, every antidepressant we will talk about today works just as well as every other antidepressant. We sort of pick between the side effects. The MAOs do not have a bunch of side effects, they just have a problem. They do not like other drugs. They do not even like some foods. So, if you are using an MAO inhibitor, you cannot drink beer. You cannot drink wine, you cannot eat aged pickles. And they have problems with certain old flavorful cheese, and there is even some sour dough bread that MAO inhibitors do not like. There are a wide of variety of drugs that the MAO inhibitors do not play with either. You cannot take St. John's Wort, you cannot take any other antidepressant. You cannot take any drugs for coughs, or colds; you cannot even take Alka-Seltzer® when you feel poorly. All of those drugs interact with MAO inhibitors. If you are taking one of these three drugs, please do not even buy vitamins without talking to your pharmacist or your doctor first. You will get used to the dietary restrictions and the special needs that these drugs will cause for you. And, when they begin to treat your depression, you will feel better too. That is the only problem with these drugs. Other than that, they work very well.
The second group of drugs that we often use to treat depression are called tricyclic antidepressants. What that really means is if we ask the chemistry teacher to draw them, they have three circles in the middle. And those are rings of carbon that help us change the chemicals in your brain to help get rid of the depression. The tricyclic antidepressants are the most widely used group of antidepressants for about the last 30 years. They are falling out of fashion just a little bit, because people do not like their side effects. But, they are relatively inexpensive and they are very good antidepressants. Most of the tricyclic antidepressants make you sleepy. So, if insomnia is a problem for you in addition to depression, the tricyclic antidepressants work wonderfully. We give them to you at bed, and we use that side effect that makes you sleepy to get rid of one of the symptoms of your depression which is you could not sleep in the first place.
The tricyclic antidepressants also do some things that we wish that they did not do. They tend to make your eyes dry. So, if you wear contact lenses, sometimes it is difficult to take tricyclic. They tend to make your mouth a little bit dry. So, if you sing in the church choir or you run a radio show, or even if you wear dentures, sometimes your mouth gets so dry that it is very uncomfortable for you and you would rather that the drug went away. And lastly, in our gentleman friends, if they take tricyclics and they already have a problem called benign prostatic hypertrophy, or BPH, the tricyclic antidepressants can make that worse. And we need to be careful. The cost, however, of the tricyclics, or the fact that they do not cost very much, makes them a really good drug to choose when people have to decide where they are going to spend their limited money.
The next class of antidepressant is the one that is growing very quickly. They are called the selective seratonin reuptake inhibitor, and just like everything else in pharmacy and medicine, we shorten that down and we call them the SSRIs. You have read about the SSRIs in numbers of public magazines and newspapers because they were such a change from the things that happened before. These drugs do not dry out your eyes, they do not dry out your mouth. They do not have the food problems that some of the MAO inhibitors have. But, the SSRIs sometime make you too alert. That is, they sometimes make you feel a little jumpy, and it is hard to sleep. So, if you are one of those folks who has depression and just wants to sleep all of the time, these drugs are great. If you are one of those folks who has depression and insomnia, that is, you cannot sleep, sometimes we cannot try the SSRIs because you would never sleep at all! It is one of the side effects of the drugs.
There are a number of other antidepressants that do not really fit into a good class like the first three groups that we have. And we use them for all kinds of things. We have a drug called Welbutrin. It is not really any of the three things we talked about, but it works wonderfully for depression. In fact, every drug for depression works as well as every other drug for depression. We just have to pick between the side effects. There is one very important exception to that rule. St. John's Wort, that little yellow flower medicine that you can buy at the gas station and at the health food store and at most pharmacies, that is an antidepressant too. But it does not work as well as the others. In fact, people with serious depression cannot take St. John's Wort because it is not strong enough to help them. That is why it is not a prescription.
It is important that you know if you are taking any of the antidepressants, any of the classes that we talked about, or some of those unusual antidepressants that do not fit in any class, you may not take St. John's Wort at the same time. Even though you can buy it without a prescription, you should never mix antidepressants unless the same doctor and the same pharmacy filled all of them and everybody knows what you are doing. Mixing antidepressants is a very, very bad idea.
I know that some of you are saying 'I take those drugs, and I do not take them for depression.' And that is true. We sometimes use the antidepressants for other problems. The [tricyclic] antidepressants, the ones that make your eyes dry and your mouth dry up, are wonderful if you have bad, sore muscles. They are also pretty good if you just need a little help for awhile falling asleep. The seratonin reuptake inhibitors, the SSRIs, work very well for some other issues. We use them to treat migraine headaches. Sometimes we use them to help people who panic when they have to go out in public, or they have to give a speech. Those people are not depressed, but they are getting some very important benefits from the antidepressant drugs.
When we think about treating depression, there are a couple of things that we need to remember. Depressed patients do not always know that they are depressed. That is, they have become so sad, and so withdrawn and it is been so long since they were happy, they do not remember that they ever felt any other way. It is important that if you have a friend, or family member, who you think is depressed, that you get them to the doctor so that we can see if they need help.
It is also important to remember, that the drugs we use to treat depression always take three weeks to work their very best. If you starting taking these drugs today, it will take 21 days from now until we know if that drug is going to work as well as we want it to. So, it will take 21 days before we know how much the drug has helped you. You may feel better in a week, you may feel much better in two weeks, but it will take us three full weeks to know how well this drug works for you.
Unfortunately, if the drug is going to cause side effects, it is going to dry out your mouth, it is going to make you sleepy, that will happen tomorrow. So, when you are taking the antidepressant drugs, please remember, the side effects happen the very next day. The help doesn't happen for three weeks. And that is true with every one of these drugs. It does not matter which drug class we pick; it does not matter which dose we pick, it always takes three weeks to do its very best job.
So, after you have the time to go to the doctor and get a good diagnosis, after you have discovered there is nothing wrong with you except you have depression, it is not your fault, you did not do anything wrong, you need to take a prescription to help. You still have to wait three more weeks to see how well this drug is going to work. At the end of those three weeks, we may change the dose or we may change the drug. Sometimes, when we move between drug classes, you have to take no drugs at all for two weeks. That is so we are sure you are safe. Remember, we cannot take them together, and sometimes it takes two whole weeks to get the drug out of your blood, so that I can put a different one in there.
Please do not take St. John's Wort when you are taking antidepressants. Please do not treat your own coughs and colds when you are taking any of the antidepressants for any reason. Even if you are taking a drug like Prozac for migraine headaches; do not treat your own coughs and colds without talking to your pharmacist or your doctor. The problem is these drugs have some serious drug interactions - not very many, but the few that they do have are very serious. If you are taking one of the MAOI inhibitors, please remember, you need to watch your diet. And if you have any questions, do not eat it until you have called somebody who can help. We always know...no beer, no wine, no cheddar cheese, no pickles. Beyond that, you will probably have to call and get some people to help you.
If you are taking the tricyclics and your only problem is your mouth gets dry, try sucking on a lemon drop. That works beautifully and you can continue to take the less expensive drug. If you are taking one of the seratonin inhibitors and it just makes you so awake you have a hard time sleeping, start taking it in the morning, then you will be happy that you are awake and you will be able to fall asleep at night. If you are taking any of the other drugs, if you are having any other side effects, please remember to talk to your doctor and your pharmacist.
When we treat depression, most of our patients take their drugs between one and three years. This is not going to get fixed quickly, but it is going to get fixed well. Also, remember, if you start taking your drugs today to treat depression, it is going to be three weeks before we know how well it works. Your doctor and your pharmacist understand that. And they will be right beside you to support you. The most important part is recognizing that you, or someone you love, may have this disease and getting to the doctor so that you can get some help.
For Health Wise, I'm Ally Jorgensen. Thanks for listening."
