When You Don't Know Where to Turn / A Self-Diagnosing Guide to Counseling and Therapy

by Steven J. Bartlett

Depression

Depression can be a seriously incapacitating emotional disorder. Depression can range from a lingering sense of sadness or grief to a feeling of utter hopelessness, guilt, despondency, uncontrollable crying, and suicidal thoughts. The following symptoms are typical: insomnia or early waking, loss of appetite and loss of interest in sex, inability to concentrate, great difficulty in making decisions, and a reduced desire and ability to assume job and family responsibilities. Though depression is called "the common cold of emotional illness," it is not to be taken lightly, since severe depression is life-threatening, as many suicides testify. Depression affects one out of five people during their lifetimes; more women suffer from depression than men.

At the time of this writing,[[2]] the most widely prescribed antidepressants are the tricyclics. They are most effective in treating endogenous depressions; MAO inhibitors (see below) are more useful in cases of "atypical" depression, which frequently is associated with a situation the patient cannot come to terms with, such as the loss of a job or of a loved one.

[[2]] Since this book was published, SSRIs or selective serotonin reuptake inhibitors, have become the most commonly prescribed antidepressant medication in the U.S and many other countries. For readers interested in more information about SSRIs, see Wikipedia's article, http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor.

Tricyclic antidepressants include these (trade names):

Avenyl
Elavil
Norpramin
Pamelor
Sinequan
Surmontil
Tofranil
Vivactil

Approximately 70 percent of patients who take tricyclics improve. Several newer drugs—the tetracyclics, dibenzoxapines, and triazolopyridenes—are similar to the tricyclics in their effects. They include these (trade names):

Asedin
Desyrel
Ludiomil

If tricyclics do not help, MAO inhibitors (monoamine oxidase inhibitors) are usually tried. MAO inhibitors must be used with great caution because they can interact with certain foods, beverages, or drugs to produce severe high blood pressure. Many foods and beverages are prepared by fermentation processes; e.g., cheese, anchovies, pickled herring, pastrami, olives, beer, and wine, all of which patients who take MAO inhibitors must avoid. These foods and beverages contain a chemical compound, an amine called tyramine, which can cause dangerously high blood pressure, a hypertensive crisis, in people taking an MAO inhibitor. Furthermore, MAO inhibitors cannot be taken with antihistamines; patients who take MAO inhibitors may be warned to avoid other drug interactions. These warnings should be taken seriously because MAO inhibitors are one of the most potentially toxic groups of psychoactive drugs. Yet they can make the difference between night and day for many cases of depression.