I have been diagnosed with severe depression, how long do I need to stay on these medications? I hate the side effects.

Unfortunately, most patients with depression are at a risk for relapse and thus long-term treatment is required. In general, patients with depression are usually assessed each year and the doctor then decides whether to continue the medication.

The current custom of clinically prescribing continuous antidepressant medications is to prevent relapse or recurrence after the third lifetime episode of depression. Other individuals who also require long term anti depressant treatment are those who have had two episodes of depression within a five-year span. If for any reason, the depression was severe enough that you attempted suicide or caused some type of self-injury, then long-term maintenance is required after just one such episode.

In the USA, most psychiatrists continue the medications for life and evaluate the patient regularly. 

You have to understand that if the doctor stops your medication and you hurt yourself or commit suicide, the doctor is in big shit with malpractice lawsuits.

Mother’s depression worsens asthma in children

US researchers say that a mother’s depression can worsen her child’s asthma symptoms. The 6-month study done by researchers at John Hopkins University looked at 262 black mothers and their children. What they observed was that mothers who had severe depression also often had children with frequent asthmatic attacks. On the other hand women who has less depression, has children with fewer asthmatic symptoms.


Says lead investigator Kristin Riekert, a pediatric psychologist and co director of the John Hopkins Adherence Research Center, "Even though our research was not set up to measure just how much a mom's depression increased the frequency of her child's symptoms, a clear pattern emerged in which the latter followed the earlier. “


On the other hand, children who has less asthma did not necessary have mothers with less depression. Based on these observations the researcher say that depression may be an independent risk factor that can predict the severity of child.


"Intuitively, it may seem that we're dealing with a chicken-egg situation, but our study suggests otherwise. The fact that mom's depression was not affected by how often her child had symptoms really caught us off guard, but it also suggested which factor comes first," Riekert said.


Since depression can profoundly affect mental health concentration, causes fatigue, leads to low concentration, it may impair the mother’s inability to mange her child asthma, which often requires daily drug treatment and frequent doctor visits say the researchers.


"Mom is the one who must implement the doctor's recommendations for treatment and follow-up, and if she is depressed she can't do it well, so the child will suffer," study lead investigator Michiko Otsuki said in the news release.


This simple observational study may be true but there are many other factors in African American that have not been looked at. Economy, availability of health care facilities, finances, physical health, obesity, single parent or lack of transport- all these can lead to worsening of not only asthma but also any other medical disorder

I feel down and feel that I am depressed but am afraid to see a doctor, I do not have any desire to live and don’t have any motivation?

I am sorry to hear that. You are right, you are depressed. However, you must know that depression is a treatable disease. 

It is vital that you seek help from a doctor as soon as possible because the symptoms will only get worse. Treatment for depression is a combination of drugs and psychotherapy. 

Your symptoms will resolve rather quickly and you will feel better. Take a chance and see your doctor today. Do not give up. Wish you all the best.

Can vagus nerve stimulation reverse depression?

Many people with depression struggle and are always searching for a treatment that lasts long. While drugs have been the primary therapy for depression, many people do not always respond to them. Even when they respond, the benefits are short lived and plus the drugs also have potent side effects.

Recently vagus nerve stimulation has been introduced as a treatment for depression. Vagus nerve stimulation has been used for the treatment of certain epileptic disorders. Over time, it became obvious that these individuals started to develop an improvement in their mood. So now vagal nerve stimulation is being tried as a therapy for chronic depression.

Vagal nerve stimulation is a small surgical procedure. A thin electrode is placed near the vagus nerve in the neck and the wire is then connected to a pulse generator, which is implanted in the upper chest. The pulse generator emits electrical signals which stimulates the vagus nerve. Vagus nerve stimulation in turn results in mood improvement- at least that is the theory.

Vagus nerve stimulation is not standard therapy and only used in people in whom the standard anti-depressant therapies have failed. In addition, vagus nerve stimulation may be an option for people who are taking multiple drugs and have failed electroconvulsive therapy. Unfortunately, vagus nerve stimulation does not work in all depressed people. The few studies have not always shown convincing results and the result are also variable. Even among psychiatrists, the therapy is not accepted and many health insurance companies do not cover the procedure. In addition, the costs of vagal nerve stimulation are not trivial- considering that it may not even work.

While the procedure is easy to perform, it does have side effects that range from neck pain, infection, damage to the vague nerve, difficulty breathing, nausea and slowing of heart rate. In rare cases, one may develop vocal cord paralysis, voice changes, persistent cough and throat pain. While most side effects are tolerable, many people find the side effects annoying in the long run. However, of more concern is that in a few cases, vagal nerve stimulation may also lead to worsening of depression, suicidal thoughts and anxiety.

The surgery for implantation of the device is done as an outpatient and done under local anesthesia. After implantation, the device is programmed to deliver electrical impulses at various frequencies. Most people are started at low electrical current, which is gradually increased to get the desired result. Each stimulation lasts 30 seconds and occurs every 5 minutes. During this period, the side effects are most common. All individuals are given a small hand-held magnet to control the device. The machine has to be turned off while eating or speaking.

The results of vagus nerve stimulation are not immediate and often take months before the desired electrical impulse is obtained. As soon as the stimulation stopped, the depressive symptoms return. The decision to undergo vagal nerve stimulation is difficult. The procedure is very costly and there is no guarantee it will work. So before you decide to get the procedure, speak to people who have had it done. Remember even after vagal stimulation, you may still need to take anti depressant medications and continue with psychotherapy.

Is there an anti depressant which won’t cause weight gain?

Unfortunately weight gain is a universal problem with all anti depressants. The longer one uses them, the greater the likelihood of gaining weight. So far, every anti depressant, save for bupropion (wellbutrin), has been found to cause weight gain. Even the newer SSRIs can cause profound weight gain.

Bupropion does cause an initial weight loss but this is only a transient phase and with time, one starts to regain weight. There are some anecdotal reports that effexor may not cause as much weight gain as the other antidepressants, but it can induce sleepiness. 

All patients who do take anti depressants should be advised to  change their dietary habits and enter into an exercise program if they want to prevent the weight gain.  Unfortunately, the world of depression is not easy and there is no other way out of this dilemma.

Can a change in neuroticism improve depression? Part 2

Tang and colleagues looked to see if the SSRI, Paxil (brand name Seroxat), had effects beyond just treating depression symptoms. In their study they noticed dramatic changes not only in depression but a significant drop in neuroticism and marked increases in extroversion. "Patients taking paroxetine reported 6.8 times as much change on neuroticism and 3.5 times as much change on extroversion as placebo patients matched for depression improvement," said Tong Tang

"Those are very dramatic, notable changes. At the beginning of the treatment, they were way out there. Their neuroticism was abnormally high. By the end of treatment, they moved back into the boundary of the normal range." Tang mentioned that all SSRI would possibly have a similar effect.

If these studies can be duplicated, then it will change the way physicians treat depression. Says Dr Ian Cook of the David Geffen School of Medicine at the University of California Los Angeles, "The conventional wisdom has been for many years that the changes in personality that one sees during treatment tend to be thought of as a reflection of getting the depression under control," he said. He further stated that these observations may help better predict who is at risk for depression and which of these individuals may benefit most from treatment.

Archives of General Psychiatry 2009.

Can a change in neuroticism improve depression? Part 1

Depression when severe can present with a variety other symptoms like paranoia, anxiety and sometimes delusions. Sometimes it is the individual personality that is often very prone to these symptoms. Now a study using the drug paroxetine suggests that by controlling personality features or neuroticism, the symptoms of depression can be better controlled.

Says Tony Tang a psychology professor at Northwestern University in Evanston, Illinois, "Our data suggests that modern antidepressants work partly by correcting key personality risk factors of depression."  Tony Tang and his colleagues observed that individuals who tend to be neurotic, experience not only more negative emotions but tend to be very emotionally labile, and experience wild mood swings frequently.

"It's the basic tendency toward having negative emotions," Tang further added. In their analysis it was observed that people who tend to be highly neurotic were also at a higher risk of developing depression. Further these researchers observed that extroverted individuals who tend to be outgoing and more sociable were less likely to develop depression.

It has been known for years that personality traits are affected by certain brain chemicals and that is why this study was undertaken. Perhaps instead of targeting the  symptoms, the researcher could target the personality.

Depression during Pregnancy

While most people are aware that depression occurs after pregnancy, not many health professionals are aware that depression is also common during pregnancy. In the last decade, several studies have shown women are in fact more likely to suffer from depression during pregnancy than the post partum period. Estimates indicate that about 20% of women develop some type of depressive symptom during pregnancy. In North America, there are about 4 million live births annually, and this equates to about 500,000 pregnancies that are associated with depression each year. The risk of depression is a lot higher in women who have a history of depression prior to pregnancy. At least 70 percent of women who discontinue their anti depressant medications relapse during pregnancy.

A recent study showed that depression is quite common at 32 weeks of pregnancy than 8 weeks after birth. However, in the majority, depression finally disappears 8 months after giving birth.

Depression during pregnancy is often difficult to diagnose because the symptoms often mimic symptoms associated with pregnancy. Symptoms like decreased energy, irritability, changing mood and poor concentration are common during pregnancy. However, women who are depressed are more likely to have poor prenatal care and are more likely to smoke, use alcohol or other drugs. The other problem is that many pregnant women with mental illness like depression are less likely to access care. In addition, even when they have access, they are unable to afford the medical treatment.

Universal symptoms of depression, such as reduced sleep and decreased appetite, may also have an unfavorable impact on pregnancy. Suicidal ideation and self-harm during pregnancy is also unpredictably high.

Now there is evidence indicating that a mother’s mood during pregnancy may affect her unborn child. Depression during pregnancy is linked to inferior obstetrical results such as premature birth, pre-eclampsia, low birth weight and a higher rate of admission to baby care units. More important is the fact that depression during pregnancy also continues into the postnatal period. Other data indicate that the ongoing materal depression also has an adverse affect on mother infant bonding and leads to dysfunctional behavior in the growing child. Based on these findings, researchers are urging physicians to recognize the importance of treating prenatal depression.

Can I take 5-HTP (L-tryptophan) for my depression?

5-HTP is a well-known dietary supplement also known as l tryptophan. The amino acid is easily available in many health food stores and sold for the treatment of depression, pain disorders, sleep difficulties, obesity, anxiety and obsessive-compulsive disorders. 

The problem is that l tryptophan has never been fully assessed clinically in randomized clinical trials and so all reports about its efficacy are anecdotal. In the last few years the quality and quantity of L tryptophan sold has also come under question. Moreover, no two same products of L-tryptophan contain the same dose. 

Alternative health care practitioners recommend anywhere from 50- 1,500 mg per day of L tryptophan. As to whether it really works for any disorder is anyone’s guess. Reports on cyberspace indicate that it does jack-shit. 

If you do decide to use L-tryptophan, a word of warning. Often health supplements come from the Orient and are often spiked with real pharmaceutical drugs- so knowing where to buy your health supplements is also very important.