Top Mistakes People Make with Antidepressant Medication What to Know When Taking Medication for Depression

Americans prefer medication for depression, with 80% popping a pill for the condition, according to a Consumer Reports poll. But using antidepressants correctly will help your recovery, according to one Harvard-trained psychiatrist. Read on for his expert advice on the top mistakes people make with antidepressant medication… Antidepressants are among the most commonly prescribed drugs in the U.S., with up 118 million prescriptions are written each year. Of these, more than 10% of women older than 18 take them, according to the Centers for Disease Control and Prevention (CDC). But treating depression is more complicated than just swallowing a little pill every day. Mistakes and misuse of antidepressants can hamper recovery for people with depression. To find out the top blunders to avoid, we spoke with mood-disorder expert Michael Banov, M.D., a triple-board-certified, Harvard-educated psychiatrist and author of Taking Antidepressants: Your Comprehensive Guide to Starting, Staying On, and Safely Quitting (Sunrise River Press). Banov is also director of Northwest Behavioral Medicine and Northwest Behavioral Research Center in Atlanta, Ga, which tests new drugs to treat psychiatric disorders, including depression. In this exclusive Lifescript interview, Banov discusses how to make the most of your antidepressant. Read on for his advice. What’s the biggest mistake people make with antidepressants? Taking medicine too early – before you’ve tried to pull yourself out of depression with other methods, such as counseling and lifestyle changes. Exercise, for example, boosts serotonin and endorphins, which have an antidepressant effect. It has been shown to work well for mild to moderate depression, but it’s best when done with sufficient intensity. One 2005 study showed improvement with 35 minutes of fast walking five times a week, or 60 minutes three times a week. You can make changes to your diet too. Fast food, refined sugars, soft drinks, white bread and unrefined carbohydrates have been associated with higher rates of mood disorders. So have deficiencies in vitamin B, magnesium and omega-3 (as found in fish). The herbal supplement St. John’s Wort can improve mood, although it can also interfere with other medications. Talk with a doctor before trying it. Yoga has been shown to increase GABA (gamma-aminobutyric acid), a brain neurotransmitter that improves mood and anxiety. Other nontraditional healing practices, such as meditation and acupuncture, may work for some. For example, women may find hormonal supplements useful during menopause. For Seasonal Affective Disorder (SAD), light therapy may be helpful. And let’s not forget psychotherapy. In moderate depressions, medication and therapy can be equally effective. Can you wait too long to get on antidepressants? The earlier you treat depression, with medicine or not, the better. But some people get angry, confused or concerned when antidepressants are recommended. Women tend to be resistant because they fear weight gain or loss of sexual appetite. But not all antidepressants have these side effects. Some types of depression may not get better without drugs. You need to stop the chemical changes in the brain. Situations such as not doing well at work, a broken relationship or loss of a family member will worsen depression. How can delaying antidepressant treatment harm us? A potential consequence of not seeking treatment is that it can get so bad that you may end up in the hospital or hurting yourself. Untreated depression can cause physical changes that can impact physical and mental health – including depleting brain neurotransmitters, such as serotonin, norepinephine and dopamine. People with certain types of depressions absolutely need antidepressants immediately. For example, postpartum depression that turns into psychosis (hearing and seeing things that aren’t there) is a psychiatric emergency. With other types of depression, it’s not as clear. People with melancholic depression – where you can’t sleep, aren't eating and lose weight – tend to need drugs more than people with other forms. Obviously, you want to make sure the medication is safe, effective and the best for you. Your doctor should be able to answer questions and explain what you need and why. Do other illnesses mimic depression? Yes, another mistake people make is not checking for other medical reasons [for their blues]. Anyone diagnosed with depression should have a thorough physical examination to rule out viruses, thyroid disorders, diabetes, infections, autoimmune diseases, stroke, even some cancers. All can have depression-like symptoms. Your doctor also should review prescription medicines you’re taking, as well as over-the-counter drugs and herbal products, because some can [mimic] depression. Should I worry about side effects? When starting an antidepressant medication, educate yourself and be open-minded. Understand what to expect. There may be mild, short-term side effects in the first few weeks. Some people say the antidepressant makes them too drowsy or unable to sleep, that they feel agitated or nauseous, or have headaches. If you’re concerned about side effects, call your doctor. A lowered dose or taking the drug at a different time of day may make the experience a lot better. Also, understand that antidepressants don’t work immediately. Some people expect them to work within days, but it can take 4-6 weeks to feel their full effect. And if one drug doesn’t work, consider taking another. There are 30 commonly used antidepressants on the market, and none has been shown conclusively to work better than another. Patients often ask, ‘What’s the best medication to treat my depression?’ The answer is, ‘Whatever works best for you.’ What happens if I miss doses? If you don’t take your antidepressant medication consistently from the beginning, you won’t get a good result. Over time, your depression will get worse. People who miss doses may experience withdrawal symptoms. If you’re not going to take your medicine or choose to stop shortly after starting, tell your doctor. He or she will address concerns and offer alternatives. What if I continue having good and bad days? You may be having a partial response to the drug. If you have residual symptoms, your depression is more likely to return. Many people feel so much better with medication that they dismiss such symptoms as just having a ‘little’ trouble sleeping or a ‘slight’ energy problem. But ignoring these symptoms is a mistake. You need to be open with your doctor about any problem. I advise patients to keep a mood chart or diary to track feelings. There’s also a free iPhone application called “Mood Reporter.” Write down whether you’re having a good or bad day, rates of depression and sleep [patterns]. This will help you and your doctor monitor where you are [in the recovery process]. If the first antidepressant isn’t showing the desired improvement, there may be other options. Research funded by the National Institute for Mental Health (NIMH) has shown that those who didn’t do well with their first drug often did better when they switched to a second one. Do I need to see a therapist if I’m taking an antidepressant? Not all people need therapy, but everyone should do more than just take a pill. Most often, people do best with a combination of medication and non-drug treatment, such as lifestyle changes and therapy. If you’re in therapy, continue it. If you’re not, take care of yourself with a good diet, exercise and stress reduction. Don’t depend on medicine alone. You may feel so much better on the drug that you feel like you’ve found the answer. But you may find the depression eventually returns and even worsens if you don’t include other forms of treatment. I’m feeling better. Can I stop taking the antidepressant? Don’t make that mistake. The decision to stop taking medication must be made with your doctor and under their supervision. Even if you feel better after a few months, the rate of depression returning is very high if you stop your antidepressant before 9-12 months. Are antidepressants addictive? No, but you can have withdrawal symptoms. Some antidepressants need to be gradually stopped so your body can adjust. For most people, 4-6 weeks is needed to slowly and gradually wean off an antidepressant. How do I know if I’m ready to stop my antidepressant? The length of time someone needs to stay on antidepressants varies widely by person. The generally recommended time for antidepressant treatment for a single depression episode is 9-12 months. Getting on antidepressants isn’t a life sentence, but if you have chronic depression – repeated episodes – you may need to stay on maintenance medication indefinitely, often at lowered doses. Three good reasons to discontinue medication are: You no longer need antidepressants to stay well. The side effects outweigh the benefits. The drug never really helped you get better.