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QUESTIONS AND ANSWERS ABOUT MAJOR DEPRESSION
Instructions to Patients to be Read Before the Patient Leaves His Office
Joseph H. Talley, M.D.
These are several questions and answers about the disease called depression. Please read all of these carefully, since it is very important that you understand your disease as thoroughly as possible.
l. WHAT IS DEPRESSION? It is a disease affecting the entire mind and body, causing a person to feel miserable in many ways. Changes in brain chemistry make it happen. It is a brain disease.
2. WHAT CAUSES DEPRESSION? We do not know. We used to think it was due to something unhappy in a person's life or to some psychological hang-up. We now know, however, that this disease happens to people who have no reason "to be depressed." In other words, depression can strike normal and healthy people.
3. DOES HAVING A DEPRESSION MEAN THAT A PERSON IS GOING "CRAZY"'? NO, but it will very often make him think he is.
4. IS IT A COMMON DISEASE? Yes, it is the most common disease seen in all of medicine; however, it is often confused with other illnesses. For example, many people who think, or who are told, they have low blood, vitamin deficiency, sinus headaches, low sugar, menopause, burnout, and "all run-down and need a rest" actually have depression that causes their troubles.
5. WHAT TROUBLE DOES A PERSON HAVE WHO HAS DEPRESSION? A person who has depression will usually feel most of the following things:
a. He will feel very tired all the time, even when he has not worked or exerted himself very much. He will be just as tired on days when he has rested as on days when he has worked hard.
b. His sleep will usually be affected in one of two ways. He will either go to sleep and then wake up during the night and remain awake, or else he will sleep too much - even during the day. He will not get restful sleep.
c. He will feel very irritable. He will get upset very easily over little things that ordinarily would not upset him.
d. He will feel very sad for no reason, and, in fact, may break into tears without knowing why.
e. His normal sex drive will be decreased; in fact, it often will go away altogether.
f. He will often have a headache that is present most of the time. Almost any chronic pain elsewhere such as in the stomach or back can be caused by depression. These pains are not imaginary; they are quite real and often severe.
g. He will find it difficult to enjoy things. He will feel little enthusiasm even for things he used to look forward to.
h. Hs will often be constipated or have other digestive symptoms such as abdominal pain or diarrhea. He may lose or gain weight.
i. He will find it difficult to concentrate, make decisions, remember things and getting things done.
j. He will feel like he is an ineffective, worthless person, even though there is no reason to feel that way.
6. IS THIS REALLY A SERIOUS DISEASE? Yes. In a mild depression. the person will often think he just has a case of the blues, or that he is just getting older. His efficiency will be affected. In a more severe depression, it is a very serious disease. This disease can cause a previously healthy and happy person to kill himself.
7. CAN A PERSON DO ANYTHING TO FIGHT BRAIN DISEASE? Not by his own efforts. This is a disease over which a person has no control, and it will do him no good to "try to fight this myself."
8. IS THERE ANY EFFECTIVE TREATMENT? Very much so. There are several medicines which are usually very effective in treating depression. They are also very safe medicines.
9. ARE THERE MEDICINES TRANQUILIZERS, SLEEPING PILLS, PAIN PILLS, HORMONE PILLS? NO, none of these. They are called antidepressants.
10. ARE ANTIDEPRESSANTS ADDICTING? Absolutely not. A person can not become addicted even though he takes these medications for months or years. People who take insulin and high blood pressure pills are not addicted; neither are people who take antidepressants. A person who does not have depression would feel no effect if he took an antidepressant. They work on the brain chemistry that gets out of balance and results in depression.
11. DO THEY HAVE SIDE EFFECTS? Unfortunately, they have pesky side effects; they rarely have serious side effects. The chief side effects are dry mouth, constipation and drowsiness. Dry mouth can be effectively overcome by drinking water or sucking non caloric mints. Constipation is corrected by adding bulk to one's diet. The sleepy effects are taken care by taking the medicine before bedtime. The body usually adjusts to all these side effects. Some newer antidepressants do not have side effects.
12. ARE ANTIDEPRESSANTS THE SAME AS "PEP PILLS" OR "UPPERS?" Absolutely not. Pep pills give anybody a sudden boost of energy whether they have depression or not. Pep pills are all dangerous, and not used for depression. Antidepressant pills, on the other hand will do nothing to a person without a depression, but will help a person who has depression by returning his brain chemical to normal.
13. HOW LONG DOES A PERSON HAVE TO TAKE ANTIDEPRESSANTS? It varies. Sometimes as little as three months, other times longer than a year. These medications can be taken safely for as long as they are needed, even for a lifetime.
14. DOES THIS DISEASE HAPPEN TO A PERSON WITHOUT ANYTHING IN HIS PERSONAL LIFE CAUSING IT? Yes. However, many people have things in their personal life that are bothering them a great deal, and if they happen to get depression while these things are bothering them, then everything gets much worse. For example, if a person is having difficulty in their marriage or job and they get a depression also, then the difficulties with the marriage or job will get worse, because their ability to cope with their difficulties is impaired.
15. WHAT SHOULD I TELL MY SPOUSE OR RELATIVES ABOUT DEPRESSION? Have them read this paper too. A person with depression will almost always find that their spouse or relatives are very much affected by the way he feels. Most often relatives will not realize that a person's symptoms are due to a disease, and will think you simply do not love them any more. They may think the fault is somehow theirs. it is very important that they know that depression is simply a disease - just as pneumonia or diabetes are diseases, and that you or they are not responsible for it. We would welcome them to come back with you on your return visit and discuss this with them in detail. it is a great help to have your loved ones understand what is happening, why you need medication, etc.
ANTIDEPRESSANT MEDICATIONS
Please read the following directions until you are certain that you understand them thoroughly, but call if there are any questions about your medications.
1. The name of your antidepressant medication is circled below. The bold italicized names are the chemical names for the brand names listed under them:
Imipramine Desipramine Amitriptyline Trazodone Protripyline Fluoxetine Sertraline
Tofranil Norpramine Elavil Desyrel Vivactil Prozac Zoloft
Tofranil-PM Pertofrane Endep
Imavate
Janimine
Pramine Trimipramine Nortipyline Doxepin Maprotiline Amozapine Paroxetine
Presamine Surmontil Aventyl Adapin Ludiomil Asendin Paxil
Pamelor Sinequan
2. Antidepressants must be taken regularly, not just when you feel like you need them. In other words, never stop taking the medications because you feel better and think you no longer need them. Stop them only when I tell you. Your treatment with antidepressants will last a minimum of three months.
3. Take your medication all in one dose, and take them about four hours before you intend to go to bed. That will put some of your side effects such as drowsiness while you sleep. There are two exceptions' Trazodone (Desyrel) should be taken right at bedtime with a snack. Fluoxetine (Prozac) should be taken after arising.
4. Most of the good effects of this medication will not show themselves for about two weeks. Some of the medications will help you sleep right away, but all of the other beneficial effects will be delayed for two weeks or sometimes longer. When the medication does begin to work your headaches or other pain will go away. Your tendencies to cry and feel irritable will go away; in other words, you will feel like you are back to normal.
5. When you do begin to feel back to normal, do not stop taking the medication. If you do, within three or four days you will feel worse again.
6. It is extremely important that I see you again after the first two weeks of treatment in order to evaluate whether the diagnosis and treatment is correct. Whatever you do, do not stop taking the medication until you see me.
7. If anything troublesome happens which you think may be due to the medication, call and let me know what is happening. Many times the problems will have nothing to do with the medication at all. However, it is true that with a few people there may be such reactions as constipation, blurring of vision, delay of urination. or a lot of perspiration... Such side effects are usually temporary and can be controlled other ways.
8. You should be able to work, drive, and carry out your usual activities while taking the medicine. When first beginning the antidepressant, you should use some caution about driving or engaging in other hazardous activity until you see how the medicine will affect you. Usually you can do anything you wish, especially after the first two or three days. If you are too sleepy after that, or cannot sleep, it usually means that we need to change the type of antidepressant to one that gives more or less drowsiness, and I can easily do that by phone. Call if there is any problem.
9. You should be aware that the safety of these medications lies in the fact that you cannot hide from troublesome life situations with them. If, for example, you do not have the true medical disease of depression, but instead are only working too hard, you will receive no "energy" from these pills. If you do not have a depression, but instead are simply unhappy with a life situation that would make anyone unhappy, then the pills will give no happiness. If your headache or stomach ache are due to some other disease, the pills won't help.
They only work when the disease depression is present, and in that situation they usually give dramatic and gratifying relief to all of the symptoms. Thus you can see the basic difference between these medications and such drugs as alcohol, "uppers", "nerve pills", sleeping pills and the like. These medications cannot be used as an escape from life's problems. and are not habit forming. The antidepressants cannot be used in that way, and that is their greatest safety feature.
JOSEPH H. TALLEY, M.D.
GROVER, NORTH CAROLINA
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