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.