An Essential First
Step in Treating Depression: A Medical Evaluation
Visit Your Doctor
Depression can actually be caused by
several illnesses. The flu, various other viruses, anemia, substance abuse, diabetes, and thyroid disease are just some things that
produce depression as a 'side effect,' or mimic its symptoms.
Some prescription and over-the-counter medications can produce depression.Your first step in managing
your depression would be to visit your doctor to check for these
things. Get a complete physical, including a blood glucose test,
thyroid test (T3/T4 test AND increased TSH test--ask for the results)
and a blood count. These three tests will help your doctor rule
out three major medical causes of depression.
You've probably been exposed to lots
of advertisements about anti-depressant medication. You will want
your depression diagnosed by a professional mental health practitioner before making any decision about medications. Unfortunately, 80% of antidepressant prescriptions in the U.S. are written by family physicians, who may have little or no training at all in psychopharmacology or in psychological diagnosis, who feel pressured by patients who've seen pervasive drug company advertisements for antidepressants, and are heavily courted by pharmaceutical reps. Because depression and anxiety are often symptoms of an underlying psychological condition, it's important not to medicate the symptom without the diagnosis and, if necessary, monitoring of side effects by a psychiatrist or psychologist. This is why most physicians require a patient receiving medication to be seeing a psychologist at the same time.
- If your depression is severe, your
psychologist may ask you to consider antidepressant medication.
After a period of being depressed, your brain's neurotransmitters
(responsible for normal brain activity) are depleted. Antidepressant
medications restore them to their normal levels. They won't help
you feel happy, but they might eliminate the physical symptoms
(fatigue, slowness, agitation, sleep disturbance, and so on)
so that you will have more energy to do the emotional work of
therapy. Antidepressants work for about 60% of people. Antidepressant
medications take 2-4 weeks to produce their full effect.
- Antidepressants should only be prescribed
by a psychiatrist, since they make some conditions much worse,
can be dangerous in interaction with other drugs (including alcohol),
and because they have side effects. Psychiatrists receive extensive
training in psychopharmacology, in contrast to general practictioners (physicians),
who can prescribe them, but receive little, if any, training
specific to antidepressants.
- Consider an over-the-counter preparation.
In the most recent metanalysis of 22 randomized, controlled studies
comparing it to a placebo (Whiskey, et al., 2001), St. John's
Wort was found (at 1800 mg/day, 600 mg. three times per day)
to work as well in reducing depression as do prescription antidepressants,
with no side effects (900 mg/day taken in three doses of 300
mg each was sufficient for mild depression). St. John's Wort
must not be taken with any other antidepressant, and must be
stopped 5 days before taking any other drug with which it might
interact. You should always check with your pharmacist for possible
interactions before you start taking it (or any other medication).
St. John's Wort takes 4 to 6 weeks to produce its full effect.
Sam-e (400-1600 mg/day, plus vitamin B supplements) is the most
often used antidepressant in Italy (and has been for 20 years).
It is a naturally occurring product in the body. It has not been
tested as extensively as St. John's Wort, and it is much more
expensive. It is unwise to begin taking either of these without
first being diagnosed by a professional, as some forms of depression
may be made worse by taking them.
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