Dr. Michael Hirsch Offers Guidance on Antidepressants
"There is no compelling evidence that antidepressants are associated with any long-term health problems."(MICHAEL HIRSCH)
Michael Hirsch, MD, is a board-certified psychiatrist specializing in psychopharmacology and psychotherapy of depression, bipolar disorder, anxiety disorders, and adult attention deficit disorder. He is the director of psychopharmacology at Beth Israel Deaconess Medical Center in Boston and an instructor in psychiatry at Harvard Medical School. Dr. Hirsch also serves on the editorial board of the Harvard Mental Health Letter and has written and lectured extensively on contemporary issues in the treatment of mental illness.
Q: I see so many antidepressant ads. Are these drugs the latest and the best?
A: No. There is no good evidence that one antidepressant medication works better than any other. Each person is different, and one medicine may have a number of side effects for you, while for someone else it is totally different. If there is a positive side to these ads, it's that they can make people more comfortable about getting help with the medication they need.
Q: How do I know if I need antidepressants?
A: If you have clinical depression, not just the blues. Depression is usually differentiated from the blues by the severity of the symptoms and whether it lasts for an extended time. Symptoms can be a very low mood, changes in sleep (too much or too little), changes in appetite, trouble focusing and concentrating, low energy level, suicidal thoughts, feelings of isolation, and the inability to experience pleasure. When depressed, you don't want to do things you used to enjoy. If you become concerned about any of these symptoms, you should see a doctor.Next Page: I am feeling very down and anxious because of events in my life, but I felt fine before. Should I consider medication?
[ pagebreak ] Q: I am feeling very down and anxious because of events in my life, but I felt fine before. Should I consider medication?
A: Possibly. Sometimes, external events—a death in the family, say—can trigger debilitating depression or anxiety. If you are worried that you are experiencing prolonged or extreme mood changes due to a difficult life event, you should speak to a doctor to see if medication should be considered.
Q: Should I be concerned about long-term health problems associated with antidepressant medication?
A: There is no compelling evidence that antidepressants are associated with any long-term health problems. Untreated depression, however, can be extremely disabling and is associated with lots of problems: trouble learning and retaining new information, difficulty living your normal life, having problems at work, and even the risk of suicide.
More about antidepressants
Q: Is it possible that one day my antidepressant medicine will stop working?
A: Yes, and for reasons psychiatrists don't quite understand. Some people get along well for a long time and then, out of the blue, the medication that was working does not work at all. The good news is that in those situations patients often will respond to a new medication.Next Page: How will I know when it's OK to get off medication?
[ pagebreak ] Q: How will I know when it's OK to get off medication?
A: There is not one simple answer; you really must work with your doctor. In general, patients should stay on their medication for at least eight to 12 months. There is evidence that people who go off medication too soon have a much higher risk of a relapse of depression.
Q: I know people who take antidepressants and drink alcohol. Can I?
A: Moderate alcohol consumption—one to two drinks a day—usually is not a problem. Everyone is different, however, so you should consult your doctor before drinking while on an antidepressant.
Q: Most antidepressants come with a long list of side effects, some quite scary. What can I do if I experience them?
A: These lists of side effects can be misleading because antidepressants are usually well tolerated. The drug companies want to err on the side of caution, so they disclose every single problem ever associated with the medication, even if they occur very rarely. If you do experience side effects, your doctor can work with you to switch medications or lower your dose.
Q: Sometimes I self-medicate, taking fewer pills when I feel good and more when I feel low. Is this OK?
A: No. These medications need to build up to a therapeutic level in your blood. If you start and stop there is a good chance you will negate their efficacy.
[ pagebreak ] Q: My job requires periodic drug testing. Are antidepressants detectable? I don't want my bosses to find out.
A: Generally not. They are detectable only if you are looking for them in a special test. I've never heard of this happening during a workplace drug test.
Q: Should I allow my general practitioner or gynecologist to prescribe antidepressants, or should I consult a psychiatrist?
A: Today GPs are usually comfortable prescribing antidepressants, and they are familiar with the drugs and what they do. However, if the first drug prescribed does not work or you have some sort of complication, it makes a lot of sense to see a specialist such as a psychiatrist or psychopharmacologist.
Q: Do some antidepressant drugs actually trigger suicidal thoughts?
A: This has been reported, but there has been controversy over how to interpret these reports. On the other hand, I think it is clear that depressed patients who take antidepressants are much better off than depressed patients who do not receive treatment.
Q: Do you think depression will be totally controllable with medication in the future?
A: Through advances in genetic research and neuroimaging techniques over the next two decades, we will likely be able to develop more targeted treatments for many biological factors that lead to depression. So depression treatment will likely be much more effective than it is today. I would be surprised, however, if it was completely controllable with drugs in all people.