Monday, 10 September 2018

Midlife drugs you should not combine: Antidepressants

For many people, midlife is the happiest time of life.  They do not have the uncertainties of youths. They do not have the weaknesses of old age.  They have gained the comforts of life that they aimed and strived for. For some other people, midlife is a disappointment and a time in which they are prone to depression.  Depression may come transiently every now and then or it may be stubbornly sustained and chronic.  It may be mild and of little consequence or it may become a major depressive disorder requiring clinical attention.
Clinical experience tells us that depression is twice as common in women as it is in men but the real figures may be far from that as men are more prone to not disclosing their feelings.
A ®Livescience documentation says that women aged 40-59 have the highest rate of depression.  Americans (The Center for Disease Control and Prevention) are very good at keeping records and we know that about 1 in 10 Americans have depression.  Annually, more than 23 million people in the USA and about 350 million people globally say they have depression.  People aged 45-65 may be more likely to get major depression for which a drug may be prescribed.
The causes or underlying problems differ according to age, sex, socio-economic and political environments, family conditions, religious experience or inexperience, education, etc.  In Nigeria for example, 20% of Nigerians have chronic depression according to the Nigerian General Household survey panel and out of these, two in five persons have been affected by a negative event or conflict.  Heads of household are ready victims of depression.  So are people who lack jobs, money, family, or good health.
Treatment of depression can be self-contained or clinical.  A person may pull himself or herself out of depression in various ways. The dispositions of faith, hope, and love are the human best dispositions against experiences of life.  Virtues such as courage, endurance, resilience, tact, daring, tenacity, and hard work can help one through obstacles and to achieve breakthroughs.   Mild depression can be overcome by exercise, improving sleep, change of diet (to include psycho-positive treats), change of activities (to include psycho-positive occupations), religious influence, change of environment or improvement of environment with psycho-positive components, and by detaching oneself from psycho-negative and psycho-toxic persons or experiences. Personal analysis and examination of one’s own feelings, action, and reactions can help one recognize one’s defective way of thinking.  These personal efforts can condition one to release brain hormones (such as dopamine) that are involved in learning, pleasure, and a sense of fulfilment, thus boosting the ego.
Some people, however, may fail in personal response to depression and may sink into major depression or chronic depression. They may be helped through cognitive behavior therapy(CBT), psychodynamic psychotherapy, interpersonal therapy, and counselling.  Online CBT is available for those who do not want to attend a clinic or therapy. Others person may be prescribed medication.
There are several dozen types of antidepressants that are being used for moderated to severe depression.  Doctors sometimes try one or two different drugs one a patient before sticking to one drug as individual responses and side effects tend to be unpredictable.

The major groups of antidepressants commonly used include the selective serotonin reuptake inhibitor (SSRIs) such as paroxetine (Seroxat, Paxil), citalopram (Cipramil, Celexa), vortioxetine (Lundbeck), fluoxetine (Prozac, Sarafem), escitalopram (Cipralex, Lexapro), and sertraline (Zoloft).  They increase the level of the good mood chemical, serotonin, in the brain. Another group of antidepressant drugs is the tricyclic antidepressants (TCAs) e.g. imipramine (Imipramil) and amitriptyline (Elavil, Endep).  Newer drugs are venlafaxine (Efexor), duloxetin (Cymbalta, Ventreve ), and mirtazapine (Daltab, Zispin).  The herbal medicine, St John’s Wort is also used as an antidepressant.
Most antidepressants are used to treat depression and behavioural disorders such as panic disorders, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder which are all common in today’s society.
Pain is a common experience and we easily reach out for a painkiller drug when we think we need it.  Pain killer drugs, both the major groups of opioids (morphine-like) and NDSAIDs (aspirin-like) painkillers affect serotonin levels in the brain.  Do not take them if you are on an SSRI antidepressant without first consulting your doctor.  Such drug combinations can lead to serotonin syndrome, internal bleeding, and mental changes that precipitate suicide.
Sometimes people with clinical depression hang out in clubs or even just at home doing drugs. Do not smoke cannabis if you are on a TCA. You may end up with severe tachycardia (racing of the heart beats). Do not take Ecstasy, a recreational drug, if you are on an SSRI.  This combination can produce serotonin syndrome, shock, coma, and death.  Doctors know other drugs that should not be combined with antidepressants but most of these are prescription drugs and they would not prescribe them together.  If you are on an antidepressant always consult your doctor before taking any other medication.



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