Do you know any albino black Jewish lesbians on Zoloft? J That?s the
name of an off-broadway play written by a friend of mine. It
illustrates how much drugs for depression have woven into all of our
lives. I?m not here today to tell you that you need these drugs, but I
certainly won?t discourage their use because frankly I make a living
prescribing them. Instead I?m here to do three things: 1) to help you
know when you might need these drugs, 2) to explain how these drugs
work, and 3) to show how a doctor might pick the best drug for you.
Deciding to take a drug for depression can be hard for some people.
It?s easy for me to tell someone they should take a drug, but in the
end the patient decides for himself and I can?t force him. Some reasons
I might recommend someone to take a drug for depression are: 1) missing
work, 2) being suicidal, 3) having no energy or motivation, and 4)
being blue for no apparent reason.
Like many things in life, it?s a judgment call. You have to weight
the risk of not taking the drug against the possible benefits of being
on it.
If someone?s life drags to the point of missing work, using a drug
could mean a big difference. For those who are able to work and care
for their family, taking a drug can give them enough of a boost to keep
their heads above water. Other people may only be mildly depressed, but
they either won?t or can?t find other ways to deal with their
depression without medicine. Of course, other options exercise,
meditation, finding a new hobby or interest, or just eating better.
The bottom line goes back to the pros and cons for using or not
using a drug. You know like deciding on whether you want to be married
or not. J
How do drugs for depression work? The theory hinges on what is
called a neurotransmitter. This is a chemical that carries a message
from one nerve cell to another. In the brain, three main chemicals
paint the picture of depression in a person?s life. Today we are going
to talk about serotonin, and call it the S chemical, because it is the
most popular target of depression drugs.
Let’s look at how Prozac works. Let?s take that door to be the
entrance to this room. Let?s say that the S chemical, a few humans like
us, need to come in from this entrance and exit this other door to get
a message across to the brain to "Be Happy". These messengers are
blindfolded and groping around for the exit, bumping into walls in the
meantime. J What?s more is they are also being constantly pulled back
out the door by a rope around their necks.J If their message to "Be
Happy" is not sent enough times out this exit, then depression occurs.
Prozac stops the S chemical from being pulled back out the entrance.
This leaves more of the S chemical to exit and convey the message to
"Be Happy". Don?t worry, use Prozac! J
A common question asked by a patient is, "Which is the best drug for
depression?" This is not an easy question. I am sorry to inform you
that there is no way for a doctor to know for sure which drug is best
for any given person. Everyone?s body and brain are different and each
drug has a different effect on each person. Even if statistics show a
drug had less side effects than another, we don?t know if that would
hold true for that one person because his unique reaction is still
unpredictable.
In general, most doctors today use drugs from a group that Prozac is
in. Other drugs in this class are: Zoloft, Celexa, and Paxil. After
prescribing medicine for over twenty years, drugs have taken on
personalities for me. Knowing these traits helps a doctor decide which
drug would fit a person?s kind of depression.
Prozac is like a tall, distinguished gentlemen, dressed in a tuxedo,
who is quite the life of the party. Prozac has been around the longest
and still is the most popular. Its effect in the body also lasts long
and in general it has an activating effect on a person. It is known as
the "gold" standard to which all others are compared.
Zoloft and Celexa are like a clean and neat professor and his prot?,
both of them medium built — Zoloft is the older and Celexa is the
newer. I?ve put them together because they share similarities Neither
activates or sedates too much. They also both have what is called
linear pharmacokinetics: this means when you take more of each drug,
you will find more in the blood stream; they are predictable. The other
SSRI?s don?t act this way. Both Zoloft and Celexa also are felt to have
fewer side effects and rare reactions when mixed with other drugs.
Paxil is like a short, mellow fellow that drifts around. It stays
the shortest in the body and has been noted to have some withdrawal
effects when stopped. Paxil has tended to be more sedating and has been
indicated for a number of anxiety disorders.
Any of the drugs I’ve discussed can be used to begin a course of
treatment for depression. All of them work at about the same rate —
about 70% of all patients treated will get better.
Having the blues is no fun for anyone, but just know that drugs are
out there to help if you ever need them. I?ve talked about some of the
reasons to use drugs for depression. Each of us has to decide when we
feel enough of a need to take them. I?ve talked about how these drugs
work. I?ve talked about the traits of some of the more popular drugs.
We have no reason the sing the blues. Let?s be assured we can beat the
blues if they ever come around!