Showing posts with label Depression. Show all posts
Showing posts with label Depression. Show all posts

St. John's Wort

What is St. John's wort?

St. John's wort (Hypericum perforatum) is a plant with yellow flowers that people in European countries have used for centuries to treat mild to moderate depression. In the United States, it is sold as a dietary supplement and can be found at health food stores and pharmacies.

What is St. John's wort used for?

St. John's wort is used in the short-term treatment of mild to moderate depression. One study found that St. John's wort may also be effective in treating moderate to severe major depression.1

It may take up to 2 to 3 weeks for St. John's wort to improve depressive symptoms. Not all preparations of St. John's wort are the same. A standardized form means the amount of St. John's wort is the same in every capsule.

Is St. John's wort safe?

St. John's wort causes fewer side effects (such as digestive discomfort or headaches) than antidepressant medicines, although it may cause a rash with sun exposure.

St. John's wort may interact with medicines used to treat some other illnesses, such as AIDS. It is important to let your doctor or pharmacist know if you want to try St. John's wort so that he or she can determine whether it might interfere with other medicines you are taking.

  • Do not take St. John's wort while you are taking other antidepressants. You may overmedicate yourself, resulting in serious negative side effects. Always talk with your doctor before you take any herbal remedies to treat depression or other conditions.
  • Do not take St. John's wort while you are taking protease inhibitors (PIs) or nucleoside reverse transcriptase inhibitors (NRTIs) for the treatment of HIV infection.
  • Do not take St. John's wort while you are pregnant or breast-feeding.

The U.S. Food and Drug Administration (FDA) does not regulate dietary supplements in the same way it regulates medication. A dietary supplement can be sold with limited or no research on how well it works.

Always tell your doctor if you are using a dietary supplement or if you are thinking about combining a dietary supplement with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on a dietary supplement. This is especially important for women who are pregnant or breast-feeding.

When using dietary supplements, keep in mind the following:

  • Like conventional medicines, dietary supplements may cause side effects, trigger allergic reactions, or interact with prescription and nonprescription medicines or other supplements you might be taking. A side effect or interaction with another medicine or supplement may make other health conditions worse.
  • Dietary supplements may not be standardized in their manufacturing. This means that how well they work or any side effects they cause may differ among brands or even within different lots of the same brand. The form you buy in health food or grocery stores may not be the same as the form used in research.
  • The long-term effects of most dietary supplements, other than vitamins and minerals, are not known. Many dietary supplements are not used long-term.

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Mood-stabilizing Medicines for Bipolar Disorder

Generic NameBrand Name
lithiumLithobid

The above medicines are taken as tablets or capsules (orally).

Generic NameBrand Name
carbamazepineEquetro, Tegretol
divalproex sodiumDepakote
lamotrigineLamictal
valproate sodiumDepakene syrup

These medicines are available in syrup, tablet, capsule, and chewable tablet forms.

How It Works

Each of these medicines works similarly to treat bipolar disorder. Mood stabilizers balance certain brain chemicals (neurotransmitters) that control emotional states and behavior.

Valproate and divalproex have been approved as treatments for acute manic episodes in bipolar disorder.1 Lamotrigine was recently approved for the long-term maintenance treatment of bipolar I disorder. These medicines, which are also called anticonvulsants, have been used for some time to treat seizures.

Why It Is Used

Lithium is usually one of the first medicines prescribed for bipolar disorder to treat mania and to prevent the return of both manic and depressive episodes.

Valproate, divalproex sodium, lamotrigine, and carbamazepine may be used during a manic episode or to prevent mood cycling between depression and mania.

Valproate may be taken along with lithium carbonate or antidepressants to avoid a depressive episode. Valproate is also used during manic episodes for people who do not respond well to lithium carbonate alone.

Carbamazepine is used to treat mania and may be used in people who cannot take or don't respond to lithium or valproate.

How Well It Works

Lithium carbonate may provide relief from acute episodes of mania or depression and can help prevent them from recurring.

Lithium is often helpful in treating manic episodes that are not mixed with any depressive mood.2 Long-term use of lithium has been shown to reduce the risk of suicide related to bipolar disorder.1

Divalproex has been shown to help reduce rapid cycling between moods and is effective in those with bipolar disorder who also have substance abuse or anxiety problems.2

Initial research shows that lamotrigine is effective in treating both depression and mania associated with bipolar disorder.2 Lamotrigine improves mood, alertness, and the way you relate to others. It has also been shown to be an effective treatment for rapid cycling.3 Lamotrigine is usually taken alone, without other medicines normally used to treat bipolar disorder.

Side Effects

Side effects of lithium may include:

  • Nausea, vomiting, and diarrhea.
  • Trembling.
  • Increased thirst and increased need to urinate.
  • Weight gain in the first few months of use.
  • Drowsiness.
  • A metallic taste in the mouth.
  • Abnormalities in kidney function.
  • Abnormalities in thyroid function.

More serious side effects of lithium can include blacking out, slurred speech, changes in heart rhythm or a heart block, and an increase in the number of white blood cells (not usually because of an infection).

Side effects of valproate may include weight gain, drowsiness, low energy, stomach upset, changes in liver function, and problems with platelet functioning (thrombocytopenia). Uncommon side effects can include temporary hair loss, headaches, and confusion.

A warning label has been added to valproate injections and divalproex tablets and capsules that warns of a potential increase in pancreatitis associated with the use of these products. A recent study connected long-term use of valproate to the development of polycystic ovary syndrome in women.4

Lamotrigine was well tolerated by people in initial studies. Some side effects occurred, including headaches, sleepiness, weight gain, and, most seriously, Stevens-Johnson syndrome, which causes dangerous sores on the mucous membranes of the mouth, nose, genitals, and eyelids. Serious negative side effects were uncommon. Rare side effects can include dizziness, blurred vision, nausea and vomiting, liver function problems, hypersensitivity reaction, and Stevens-Johnson syndrome. Although rare, a dangerous rash from lamotrigine may require hospitalization and may be life-threatening. If you develop a rash, fever, or swollen glands, stop taking lamotrigine and call your doctor right away.

Side effects of carbamazepine may include nausea, vomiting, diarrhea, Stevens-Johnson syndrome, dizziness, blurred vision, drowsiness, and headache.

Anticonvulsants may raise the risk of birth defects. If you are pregnant or thinking of getting pregnant, talk to your doctor before you take these medicines.

The U.S. Food and Drug Administration (FDA) has issued a warning on anticonvulsants and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Do not stop taking these medicines suddenly. You should taper off of these drugs slowly with the help of your doctor to avoid negative and serious side effects.

High blood levels of lithium carbonate can be life-threatening. People who take lithium carbonate need to have their blood checked regularly to measure the amount of the drug in their blood.

Your doctor will need to periodically test the function of your kidneys and thyroid gland if you are taking lithium.

Sometimes other medicines cause higher- or lower-than-expected amounts of lithium carbonate in a person's blood. People who take lithium carbonate need to tell their doctors if they take other medicines.

Some mood stabilizers may interact negatively with other medicines. Be sure to talk with your doctor about any medicines you are taking.

Your doctor may want you to have regular blood tests while on valproate, divalproex, lamotrigine, or carbamazepine to check your medicine levels, liver function, and blood counts.

If you have been taking antidepressants but have not been able to control your episodes of depression or mania, you may want to ask your doctor about taking lamotrigine to treat bipolar disorder.

Making the decision about which medicines to use can be a very complicated issue in the treatment of bipolar disorder. Be sure to discuss all the options and side effects with your doctor. You may have to try several medicines or combinations of medicines before you find out what works best for you.

Taking medicines for bipolar disorder during pregnancy may increase the risk of birth defects. If you are pregnant, or thinking of becoming pregnant, talk to your doctor. Medicines may need to be continued if your bipolar disorder is severe. Your doctor can help weigh the risks of treatment against the risk of harm to your pregnancy.

If you must take medicines during pregnancy to treat bipolar disorder, the mood stabilizer lithium has been shown to have a lower risk of neural tube birth defects than carbamazepine. But lithium may raise the risk of other birth defects, such as heart defects.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

  1. Müller-Oerlinghausen B, et al. (2002). Bipolar disorder. Lancet, 359(9302): 241–247.
  2. Sachs GS, et al. (2000). Expert Consensus Guidelines Series: Medication Treatment of Bipolar Disorder. Available online: http://www.psychguides.com/gl-treatment_of_bp2000.html.
  3. Calabrese JR, et al. (2001). Bipolar rapid cycling: Focus on depression as its hallmark. Journal of Clinical Psychiatry, 62(Suppl 14): 34–55.
  4. American Psychiatric Association (2002). Practice guideline for the treatment of patients with bipolar disorder (revision). American Journal of Psychiatry, 159(4, Suppl):1–50.

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When to Get Help for PTSD

When you or someone in your family has post-traumatic stress disorder (PTSD), it's important to know when and how to get help.

Call 911 or other emergency numbers right away if you:

  • Think you can't keep from hurting yourself or someone else.
  • Hear voices that tell you to hurt yourself.

If you know someone who is threatening to commit suicide, try to find out whether the person:

  • Has the weapons or medicines to commit suicide or do harm to another person.
  • Has set a time and place to commit suicide or describes a plan to do so.
  • Thinks that there is no other way to end the pain and is feeling hopeless.

If a suicide threat seems real:

  • Call 911, a suicide hotline, or the police.
  • If you feel safe, stay with the person or ask someone you trust to stay with the person until the crisis has passed.
  • Encourage him or her to seek professional help.
  • Don't argue with the person ("It's not as bad as you think") or challenge the person ("You're not the type to commit suicide").
  • Tell the person you don't want him or her to die. Talk about the situation as openly as possible.

Call your doctor if you or someone you know has any of the warning signs of suicide. These include:

  • Talking or thinking a lot about killing yourself.
  • Feeling like you're not in control of your thoughts.
  • Spending a lot of time alone.
  • Depression followed by sudden cheerfulness, which may mean the person has made a decision about a suicide plan.
  • A previous suicide attempt.
  • Drinking too much alcohol or using drugs (alcohol or substance abuse).
  • Always talking, writing, or drawing about death or suicide.
  • Giving away personal possessions and putting affairs in order, such as writing a will.

Call your doctor if you or your loved one has had any of the following symptoms for more than 3 months or if they are causing a lot of stress or making life hard to deal with.

  • You find it hard to sleep and have nightmares about the event.
  • You find it hard to focus, control anger, or feel safe.
  • You feel very guilty about surviving a traumatic event that others did not survive.
  • You have attacks of intense fear or anxiety that come on without reason.
  • You have physical symptoms such as chest pain, a rapid or irregular heartbeat, or trouble breathing.
  • You find it hard to stop thinking about the event and are often reminded of it.

Preparing for an emergency

It's important to have things ready to go in case you or your loved one has an emergency.

Have emergency phone numbers for the:

  • Social worker or case manager.
  • Doctor.
  • Local sheriff or police.
  • Hospital and emergency room.

Create a "hospital pack" for medical emergencies that includes:

  • Insurance card or information.
  • List of the medicines you take, and dosages.
  • List of current medical problems.
  • List of mental health treatment history.
  • Clothes and personal things you may need at the hospital.

You or your loved one may want to talk to others about what to do in an emergency. Talk to a neighbor about child care or house-sitting during an emergency. Talk to your employer and your loved one's employer about how to deal with job responsibilities at this time.

If your spouse or loved one is admitted to the hospital, it's helpful to:

  • Give him or her some space after being admitted.
  • Give background information to the caseworker or social worker.
  • Stay calm. When visiting your loved one, focus on your hope for recovery.
  • Use this time to relax and recharge.

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Seasonal Affective Disorder: Using Light Therapy

Key points



  • Bright light therapy is an effective treatment for seasonal affective disorder (SAD).1, 2
  • Light therapy is easy and safe. It has few side effects and can be done at home.
  • People who have eye problems or take medicines that cause sensitivity to light should not use light therapy without first consulting a doctor.

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Antipsychotics for the Treatment of Bipolar Disorder

First-generation, or typical, antipsychotic medicine

Generic NameBrand Name
haloperidolHaldol

Second-generation, or atypical, antipsychotic medicines

Generic NameBrand Name
aripiprazoleAbilify
olanzapineZyprexa
olanzapine and fluoxetine hydrochlorideSymbyax
quetiapine fumarateSeroquel
risperidoneRisperdal
ziprasidone hydrochlorideGeodon

These medicines are available in liquid, tablet, or injectable form.

How It Works

These medicines balance certain chemicals in the brain (neurotransmitters). It is not clear exactly how these medicines work for the treatment of bipolar disorder. But they quickly improve manic episodes.

Why It Is Used

Each of these medicines has been approved by the U.S. Food and Drug Administration (FDA) to treat bipolar disorder. Some medicines work better for different people than others. Second-generation antipsychotic medicines may have fewer side effects than first-generation antipsychotic medicines. Be sure to talk with your doctor about how the medicine is working for you. Sometimes you might need to try more than one type of medicine before you find one that works best for you.

These medicines have all been found to be an effective treatment of manic episodes. Quetiapine has been approved by the FDA to treat both mania and depression. Other antipsychotic medicines, such as olanzapine, are also being studied for the treatment of depression in bipolar disorder. The single medicine combining olanzapine and fluoxetine (Symbyax) is also used to treat depressive episodes associated with bipolar disorder. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), which is used to balance certain brain chemicals (neurotransmitters) that are thought to cause depression.

How Well It Works

Drugs in this classification work quickly in the treatment of bipolar disorder, especially in older adults. These medicines have all been found to be an effective treatment of manic episodes. Some studies show the combination of an antipsychotic and a mood stabilizer may be more effective than a mood stabilizer alone.1

Side Effects

The most common side effects of olanzapine include dry mouth, constipation, weight gain, drowsiness, and increased appetite.2 Other common side effects are shakiness or tremors, slurred speech, and low blood pressure that makes you feel dizzy when you stand up. In addition, olanzapine raises the risk of diabetes and/or abnormalities in cholesterol levels. Abnormalities in blood glucose levels have been reported less for people who use risperidone or quetiapine.

Risperidone may cause sleepiness, weight gain, abnormal cholesterol levels, and breast tenderness. Side effects include a rash, headaches, constipation, decreased sexual desire and function, or increased heart palpitations. Risperidone may also be linked to an increased risk of stroke in older adults.

Ziprasidone may make you sleepy or cause nausea, dizziness, restlessness, diarrhea, coughing, or a rash. Ziprasidone may also cause abnormal muscle movements such as tremors or shuffling.

Quetiapine can cause side effects such as sleepiness, headaches, dizziness, rash, fever, weight gain, abnormal cholesterol levels, dry mouth, and other flu-like symptoms.

The use of antipsychotics has also been linked to the risk of movement disorders. The risk of developing a movement disorder is less for newer antipsychotics such as aripiprazole, olanzapine, risperidone, and quetiapine. But it is important to tell your doctor about any abnormal muscle movements.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Before taking olanzapine, risperidone, ziprasidone, or quetiapine, be sure to tell your doctor if you have:

  • A heart condition.
  • A seizure disorder.
  • Problems with liver function.
  • Problems with blood pressure.
  • Diabetes or high blood sugar.
  • Constipation.
  • A history of breast cancer.
  • Problems with swallowing.
  • Problems with fainting.

You should not take ziprasidone if you have long QT syndrome (a specific heart-rhythm problem) or severe heart failure or you have had a recent heart attack. Ziprasidone should not be taken with certain medicines used to treat abnormal heartbeats.

Aripiprazole has been linked to a rare risk for neuroleptic syndrome. Neuroleptic syndrome is a life-threatening reaction that begins with a high fever along with changes in heart rate and breathing patterns.

These medicines should be started in low doses, especially in the elderly. Talk with your doctor about any other medicines you may be taking to make sure there are no negative drug interactions.

You may need regular blood tests and blood pressure monitoring while taking these medicines.

Avoid herbal stimulants (such as ma huang, ginseng, or kola), which may increase your chances of having serious side effects.

Talk to your doctor or pharmacist about drinking grapefruit juice while you are taking an antipsychotic medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases your chances of having serious side effects.

Taking medicines during pregnancy for bipolar disorder may increase the risk of birth defects. If you are pregnant, or thinking of becoming pregnant, talk to your doctor. Medicines may need to be continued if your bipolar disorder is severe. Your doctor can help weigh the risks of treatment against the risk of harm to your pregnancy.


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Depression -- Homeopathic Remedies

Healthwise Knowledgebase.

When a person feels depressed,

something needs attention. Too much stress can make it hard to cope, and important feelings may be suppressed or turned inside. A major loss or grief requires time and emotional support for real recovery-and even a buildup of minor stresses (disappointments, setbacks, trouble in relationships, or work-related problems) can contribute to depression. Dietary deficiencies, allergies and sensitivities, hormonal imbalances, or biochemical conditions may also be involved. A person going through a period of mild sadness or depression may find relief through homeopathy. The guidance of an experienced homeopath is often valuable, to choose a remedy that fits the situation best. Any person with deep, long-lasting, or recurring depression should seek the care of a licensed mental health professional.

Although homeopathic substances listed in this article are generally not known to cause serious side effects, their effectiveness has not been demonstrated by scientific research. Consumers should check labels carefully, since a homeopathic product that is not diluted, or not diluted enough, can contain ingredients that cause allergic reactions, side effects, or interactions. It is always advisable to discuss any new treatment program with your healthcare practitioner.

For dosage information, please read the information at the end of this section. See also “Using Homeopathy With Professional Guidance” in What Is Homeopathy?

Homeopathic Options

Arsenicum album

Anxious, insecure, and perfectionistic people who need this remedy may set high standards for themselves and others and become depressed if their expectations are not met. Worry about material security sometimes borders on despair. When feeling ill, these people can be demanding and dependent, even suspicious of others, fearing their condition could be serious.

Aurum metallicum

This remedy can be helpful to serious people, strongly focused on work and achievement, who become depressed if they feel they have failed in some way. Discouragement, self-reproach, humiliation, and anger can lead to feelings of emptiness and worthlessness. The person may feel worse at night, with nightmares or insomnia.

Calcarea carbonica

A dependable, industrious person who becomes overwhelmed from too much worry, work, or physical illness may benefit from this remedy. Anxiety, fatigue, confusion, discouragement, self-pity, and a dread of disaster may develop. A person who needs this remedy often feels chilly and sluggish and easily tires on exertion.

Causticum

A person who feels depressed because of grief and loss (either recent or over time) may benefit from this remedy. Frequent crying or a feeling of mental dullness and forgetfulness (with anxious checking to see if the door is locked, if the stove is off, etc.) are other indications. People who need this remedy are often deeply sympathetic toward others and, having a strong sense of justice, can be deeply discouraged or angry about the world.

Cimicifuga

A person who needs this remedy can be energetic and talkative when feeling well, but upset and gloomy when depressed-with exaggerated fears (of insanity, of being attacked, of disaster). Painful menstrual periods and headaches that involve the neck are often seen when this remedy is needed.

Ignatia amara

Sensitive people who suffer grief or disappointment and try to keep the hurt inside may benefit from this remedy. Wanting not to cry or appear too vulnerable to others, they may seem guarded, defensive, and moody. They may also burst out laughing, or into tears, for no apparent reason. A feeling of a lump in the throat and heaviness in the chest with frequent sighing or yawning are strong indications for Ignatia. Insomnia (or excessive sleeping), headaches, and cramping pains in the abdomen and back are also often seen.

Kali phosphoricum

If a person feels depressed after working too hard, being physically ill, or going through prolonged emotional stress or excitement, this remedy can be helpful. Exhausted, nervous, and jumpy, they may have difficulty working or concentrating-and become discouraged and lose confidence. Headaches from mental effort, easy perspiration, sensitivity to cold, anemia, insomnia, and indigestion are often seen when this remedy is needed.

Natrum carbonicum

Individuals who need this remedy are usually mild, gentle, and selfless-making an effort to be cheerful and helpful, and avoiding conflict whenever possible. After being hurt or disappointed, they can become depressed, but keep their feelings to themselves. Even when feeling lonely, they withdraw to rest or listen to sad music, which can isolate them even more. Nervous and physically sensitive (to sun, to weather changes, and to many foods, especially milk), they may also get depressed when feeling weak or ill.

Natrum muriaticum

People who need this remedy seem reserved, responsible, and private-yet have strong inner feelings (grief, romantic attachment, anger, or fear of misfortune) that they rarely show. Even though they want other people to feel for them, they can act affronted or angry if someone tries to console them, and need to be alone to cry. Anxiety, brooding about past grievances, migraines, back pain, and insomnia can also be experienced when the person is depressed. A craving for salt and tiredness from sun exposure are other indications for this remedy.

Pulsatilla

People who needs this remedy have a childlike softness and sensitivity-and can also be whiny, jealous, and moody. When depressed, they are sad and tearful, wanting a lot of attention and comforting. Crying, fresh air, and gentle exercise usually improve their mood. Getting too warm or being in a stuffy room can increase anxiety. Depression around the time of hormonal changes (puberty, menstrual periods, or menopause) can often be helped with Pulsatilla.

Sepia

People who feel weary, irritable, and indifferent to family members, and worn out by the demands of everyday life may respond to this remedy. They want to be left alone and may respond in an angry or cutting way if anyone bothers them. They often feel better from crying, but would rather have others keep their distance and not try to console them or cheer them up. Menstrual problems, a sagging feeling in internal organs, sluggish digestion, and improvement from vigorous exercise are other indications for this remedy.

Staphysagria

Quiet, sensitive, emotional people who have difficulty standing up for themselves may benefit from this remedy. Hurt feelings, shame, resentment, and suppressed emotions can lead them to depression. If under too much pressure, they can sometimes lose their natural inhibition and fly into rages or throw things. A person who needs this remedy may also have insomnia (feeling sleepy all day, but unable to sleep at night), toothaches, headaches, stomachaches, or bladder infections that are stress-related.

Dosage

Homeopathy Dosage Directions

Select the remedy that most closely matches the symptoms. In conditions where self-treatment is appropriate, unless otherwise directed by a physician, a lower potency (6X, 6C, 12X, 12C, 30X, or 30C) should be used. In addition, instructions for use are usually printed on the label.

Many homeopathic physicians suggest that remedies be used as follows: Take one dose and wait for a response. If improvement is seen, continue to wait and let the remedy work. If improvement lags significantly or has clearly stopped, another dose may be taken. The frequency of dosage varies with the condition and the individual. Sometimes a dose may be required several times an hour; other times a dose may be indicated several times a day; and in some situations, one dose per day (or less) can be sufficient.

If no response is seen within a reasonable amount of time, select a different remedy.

For more information, including references, see What is Homeopathy? and Understanding Homeopathic Potencies.

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Mood Stabilizers for Child and Teen Bipolar Disorder

Generic NameBrand Name
lithium carbonateEskalith, Lithobid, Lithonate

The above medicines are taken as tablets or capsules (orally).

Generic NameBrand Name
carbamazepineEpitol, Tegretol
divalproex sodiumDepakote
lamotrigineLamictal

These medicines are available in syrup, tablet, capsule, and chewable tablet forms.

How It Works

Mood stabilizers help even out the mood swings associated with bipolar disorder by balancing brain chemicals (neurotransmitters) that control emotions.

Divalproex, carbamazepine, and lamotrigine are anticonvulsants that doctors also use to treat seizures. It is not known exactly how these medicines affect mood. But experts think they may slow down certain electrical impulses in the brain that are linked to seizures and mood problems.

Why It Is Used

Mood stabilizers may be used to treat sudden manic episodes. Continued use of mood stabilizers can eliminate extreme mood swings of depression and mania and improve your child's quality of life. Your doctor may prescribe mood stabilizers with other medicines (such as antipsychotics) for more effective reduction of mood swings.

How Well It Works

Mood stabilizers have been well studied in adults, but there are currently few studies in children.

Lithium

Limited research shows that lithium is safe and effective in reducing symptoms of bipolar disorder in children and may be particularly helpful for those who also have substance abuse problems.1 Long-term use of lithium has also been shown to reduce the risk of suicide associated with bipolar disorder in adults.2

Divalproex

Studies of divalproex have shown it to be promising as a safe and effective treatment for children with mania due to bipolar disorder.1

Carbamazepine

Carbamazepine is an anticonvulsant medicine which has also been shown to be effective as a mood stabilizer in children and teens with bipolar disorder.1

Lamotrigine

Research indicates that lamotrigine is effective in treating both depression and mania in adults with bipolar disorder.3

Side Effects

Lithium

Side effects of lithium may include:

  • Nausea, vomiting, and diarrhea.
  • Trembling.
  • Increased thirst and increased need to urinate.
  • Weight gain in the first few months of use.
  • Drowsiness.
  • A metallic taste in the mouth.
  • Bed-wetting (enuresis).
  • Acne.
  • Abnormal kidney function.
  • Abnormal function of the thyroid or parathyroid gland.
  • Increased number of white blood cells (not caused by an infection).

More serious side effects of lithium can include blacking out, slurred speech, and changes in heart rhythm or a heart block (problems with the heart's electrical signals that cause an abnormal heartbeat).

Divalproex

Divalproex can cause side effects such as nausea, trouble sleeping, or dizziness. Other, more serious side effects are rare but can occur and include liver function problems, pancreatitis, or a severe allergic reaction. Call your doctor if your child is taking divalproex and experiences shaking, hair loss, drowsiness or weakness, a depressive episode or other psychiatric changes, or if your child complains of headache.

Carbamazepine

Side effects of carbamazepine can include dry mouth and throat, constipation, problems urinating, dizziness or drowsiness, nausea, vomiting, or loss of appetite. Rare but serious side effects include the risk of problems producing enough bone marrow, liver inflammation, and, most seriously, Stevens-Johnson syndrome, which causes sores on the mucous membranes of the mouth, nose, genitals, and eyelids and which can be fatal.

Lamotrigine

Lamotrigine was well tolerated in initial studies. Some side effects occurred, including headaches, sleepiness, weight gain, and minor skin rashes that developed when people stopped taking the medicine. Serious negative side effects were uncommon. Rare side effects can include dizziness, blurred vision, nausea and vomiting, liver function problems and, most seriously, Stevens-Johnson syndrome.

The U.S. Food and Drug Administration (FDA) has issued a warning on anticonvulsants and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

While these medicines have been well studied for use in adults, there are no long-term studies that confirm the effectiveness and safety of mood stabilizers in children and adolescents with bipolar disorder. Be sure to use these medicines exactly as your doctor prescribes them. If your child has intolerable side effects with any of these medicines, call your doctor immediately.

Carbamazepine can interact with other medicines, and a doctor must carefully monitor your child's health when your child takes this medicine.4 Your child should not take carbamazepine along with monoamine oxidase inhibitors (MAOIs) because serious, sometimes fatal, reactions can occur.

Do not stop taking these medicines suddenly. Your child should taper off of these drugs slowly, with guidance from a doctor, to avoid negative and serious side effects.

High blood levels of lithium carbonate can be life-threatening. At first your child will need to have his or her blood checked about every 2 weeks to measure the amount of lithium in the blood and to monitor kidney function. Make sure your child's doctor knows about all the medicines your child is taking. Some medicines can raise or lower the effectiveness of lithium. Some nonprescription medicines, such as ibuprofen (for example, Motrin) or naproxen (Aleve, for example), can increase lithium levels in some people.

Regular blood tests are also needed to monitor the amount of carbamazepine and divalproex in the blood. And your doctor will need to test your child's liver periodically while he or she is taking these medicines.

Mood stabilizers may interact negatively with other medicines and should not be taken with some antibiotics or medicines that treat indigestion, seizures, or heart problems.

Mood stabilizers may increase the chance of birth defects. Be sure to tell the doctor if your child becomes pregnant.


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Antidepressants for Depression

Generic NameBrand Name
bupropionWellbutrin, Wellbutrin SR
desvenlafaxinePristiq
duloxetineCymbalta
mirtazapineRemeron
trazodone
venlafaxineEffexor, Effexor XR

All of these antidepressants are tablets taken by mouth (orally).

These antidepressants are newer (second-generation) antidepressants and tend to have fewer side effects than older (first-generation) antidepressants such and . Serotonin reuptake inhibitors (SSRIs) also are second-generation antidepressants.

How It Works

Bupropion, duloxetine, mirtazapine, trazodone, and venlafaxine balance certain brain chemicals (neurotransmitters) that are important to your mood. When these brain chemicals are balanced, it helps the symptoms of depression.

Why It Is Used

Your doctor may suggest these medicines when other antidepressants don't work or have bothersome side effects. For example:

  • Bupropion may be used if other antidepressants cause problems with sexual function. It is less likely to do this.
  • Mirtazapine may be useful if you are experiencing insomnia or agitation.
  • Trazodone in small dosages is often used along with an SSRI to help with sleep disturbances.

You take these medicines alone or with another medicine.

Make sure your doctor knows all your medical history, all health problems you have, and all medicines you are taking before you use these medicines.

These medicines have not been approved for use in people under the age of 18.

How Well It Works

These antidepressants work to treat depression.

Bupropion, duloxetine, mirtazapine, trazodone, and venlafaxine help adults and have been approved by the U.S. Food and Drug Administration (FDA) for treating depression.

Side Effects

Bupropion, duloxetine, mirtazapine, trazodone, and venlafaxine have different side effects than selective serotonin reuptake inhibitors (SSRIs), cyclic antidepressants, or monoamine oxidase inhibitors (MAOIs).

Trazodone has numerous side effects, and in rare cases, some can be severe.

The most common side effects of each of these medicines are listed below.

Bupropion possible side effects

  • Weight loss of more than 5 lb (2.3 kg)
  • Agitation, confusion, nervousness, and anxiety

In rare cases, bupropion can cause other adverse effects such as allergic reactions, dry mouth, headaches, heart palpitations, and seizures.

Bupropion may trigger seizures in some people. Talk to your doctor before taking this medicine if you have a history of seizures or eating disorders.

Desvenlafaxine possible side effects

  • Constipation
  • Not feeling hungry
  • Dry mouth
  • Blurred vision
  • Fatigue
  • Odd dreams

Duloxetine possible side effects

  • Nausea
  • Dry mouth
  • Constipation
  • Decreased appetite
  • Fatigue
  • Sleepiness
  • Increased sweating
  • Sexual dysfunction

More serious side effects are rare but can include liver problems (particularly in people who drink a lot of alcohol), increased blood pressure, mania or hypomania, seizures, and mydriasis (pupil dilation), which can cause problems for people with narrow-angle glaucoma.

When you stop using duloxetine, side effects can include dizziness, nausea, headache, paresthesia (abnormal touch sensation or tingling), vomiting, irritability, and nightmares.

Mirtazapine possible side effects

  • Drowsiness
  • Increased appetite or weight gain
  • Increased cholesterol levels
  • Dizziness
  • Dry mouth
  • Constipation

Other more serious side effects are rare but can include agranulocytosis (insufficient white blood cell count), allergic reactions, and liver or pancreas problems.

Trazodone possible side effects

  • Drowsiness
  • Dizziness or lightheadedness
  • Blurred vision
  • Weight gain
  • Dry mouth
  • Constipation
  • Headache
  • Nausea

Side effects may also include priapism, a painful condition in which the penis stays erect. If this happens, call your doctor at once.

Venlafaxine possible side effects

  • Constipation
  • Headaches
  • Weight loss
  • Dry mouth
  • Slight increase in cholesterol
  • Hypertension
  • Sexual dysfunction
  • Enlarged (dilated) pupils

When you stop using venlafaxine, side effects can include dizziness, nausea, headache, abnormal touch sensation or tingling (paresthesia), vomiting, irritability, and nightmares.

FDA Advisories

  • The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.
  • The FDA recommends people at risk for glaucoma be watched for signs of pupil dilation (mydriasis) when taking venlafaxine.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Antidepressant medicines work in different ways. No antidepressant works better than another, but different ones work better or worse for different people. The side effects of antidepressant medicines are different and may lead you to chose one instead of another. Tell your doctor about side effects.

You may have to try different medicines or take more than one to help your symptoms. Most people find a medicine that works within a few tries. Other people take longer to find the right one and may need to take the antidepressant and another type of medicine.

Take your antidepressant as your doctor says. Don't quit taking your medicines without talking to your doctor. If you quit suddenly, it can cause dizziness, anxiety, fatigue, and headache. If you and your doctor decide you can quit using medicine, gradually reduce the dose over several weeks.

You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

Like with other antidepressants, these medicines should not be used along with monoamine oxidase inhibitors (MAOIs) because serious, sometimes fatal, reactions can occur. To avoid serious reactions, wait at least 14 days after ending an MAOI treatment before beginning treatment with any one of these medicines.

Taking medicines for depression during pregnancy may make birth defects more likely. If you are pregnant or thinking of becoming pregnant, talk to your doctor. Medicines may need to be continued if your depression is severe. Your doctor can help weigh the risks of treatment against the risk of harm to your pregnancy.

These medicines must be used very carefully in those who have bipolar disorder because they may trigger a manic episode. If you have bipolar disorder, your doctor may prescribe them, along with a mood stabilizer.

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Depression: Taking Antidepressants Safely

If your doctor has prescribed antidepressants, there are some important things you need to know about how to take them. Following these guidelines can reduce problems and help you get the most benefit from your medicine.

Key points

  • Antidepressants work best when you take them exactly as your doctor prescribes them. This also helps reduce side effects.
  • You may start to feel better within 1 to 3 weeks after you start to take an antidepressant. If you have not improved at all in 3 weeks, you may need to try a different medicine.
  • Antidepressants can cause side effects, but most of them are mild and go away after you take the medicine for a few weeks.
  • Taking an antidepressant for at least 6 months after you feel better can help keep you from getting depressed again.
  • Be sure your doctor knows about any other health conditions you have and any medicines you take regularly. This information can affect which antidepressant your doctor prescribes for you.
  • Quitting antidepressants suddenly can cause withdrawal symptoms or cause depression to return. If you are having a problem with your medicine or are ready to quit taking antidepressants, work with your doctor to slowly reduce the dose over a period of a few weeks.

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Examining the Link Between PTSD and Depression

Depression is common in men and women with post-traumatic stress disorder (PTSD). Major life events like divorce, going to war, or being in an accident sometimes can lead to depression. The trauma that is causing your PTSD also may be making you depressed.

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Having a family history of depression or having a serious illness such as cancer also may put you at risk. Depression can affect all ages and races.

Depression can make you feel overwhelmed, sad, or hopeless. You may feel like your problems are piling up, and you can't fix them. These symptoms can last for a long time, or they might come and go.

Other symptoms of depression include:

  • Feeling angry or grumpy.
  • Crying for no reason.
  • Feeling empty or numb.
  • Feeling guilty or worthless.
  • Losing interest in things you used to enjoy.
  • Having trouble remembering things or making decisions.
  • Having problems sleeping.
  • Having problems with sex.
  • Thinking about or planning to hurt yourself.

You also may have physical symptoms such as:

  • Headaches or other body aches and pains.
  • Digestive problems such as constipation or diarrhea.

Without treatment, depression can make other health problems worse. You also may be more likely to get sick.

Being depressed doesn't mean you're weak, and it doesn't mean you're just feeling sorry for yourself. It is a problem that can be helped.

If you think you may be depressed, talk to your doctor. Starting treatment now is the best thing you can do for depression. Counseling and medicine can help you get better.

To find out if you have depression, your doctor will give you a physical exam and ask questions about how you feel. He or she may refer to these questions as a psychological exam. Your doctor will want to know what other health problems you have, or what health problems run in your family.

For more information, see the topics Post-Traumatic Stress Disorder and Depression.

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Lack of Light Can Lead to Seasonal Affective Disorder (SAD)

What is seasonal affective disorder (SAD)?

Seasonal affective disorder, or SAD, is a type of depression that affects a person during the same season each year. If you get depressed in the winter but feel much better in spring and summer, you may have SAD.

Anyone can get SAD, but it is more common in:

  • People who live in areas where winter days are very short or there are big changes in the amount of daylight in different seasons.
  • Women.
  • People between the ages of 15 and 55. The risk of getting SAD for the first time goes down as you age.
  • People who have a close relative with SAD.

What causes SAD?

Experts are not sure what causes SAD, but they think it may be caused by a lack of sunlight. Lack of light may upset your sleep-wake cycle and other circadian rhythms. And it may cause problems with a brain chemical called serotonin that affects mood.

What are the symptoms?

If you have SAD, you may:

  • Feel sad, grumpy, moody, or anxious.
  • Lose interest in your usual activities.
  • Eat more and crave carbohydrates, such as bread and pasta.
  • Gain weight.
  • Sleep more and feel drowsy during the daytime.

Symptoms come and go at about the same time each year. For most people with SAD, symptoms start in September or October and end in April or May.

How is SAD diagnosed?

It can sometimes be hard to tell the difference between nonseasonal depression and SAD, because many of the symptoms are the same. To diagnose SAD, your doctor will want to know if:

  • You have been depressed during the same season and have gotten better when the seasons changed for at least 2 years in a row.
  • You have symptoms that often occur with SAD, such as being very hungry (especially craving carbohydrates), gaining weight, and sleeping more than usual.
  • A close relative—a parent, brother, or sister—has had SAD.

How is it treated?

Doctors often prescribe light therapy to treat SAD. There are two types of light therapy:

  • Bright light treatment. For this treatment, you sit in front of a "light box" for half an hour or longer, usually in the morning.
  • Dawn simulation. For this treatment, a dim light goes on in the morning while you sleep, and it gets brighter over time, like a sunrise.

Light therapy works well for most people with SAD, and it is easy to use. You may start to feel better within a week or so after you start light therapy. But you need to stick with it and use it every day until the season changes. If you don't, your depression could come back.

Other treatments that may help include:

  • Antidepressants. These medicines can improve the balance of brain chemicals that affect mood.
  • Counseling. Some types of counseling, such as cognitive-behavioral therapy, can help you learn more about SAD and how to manage your symptoms.

If your doctor prescribes antidepressants, be sure you take them the way you are told to. Do not stop taking them just because you feel better. This could cause side effects or make your depression worse. When you are ready to stop, your doctor can help you slowly reduce the dose to prevent problems.

You may feel better if you get regular exercise. Being active during the daytime, especially first thing in the morning, may help you have more energy and feel less depressed. Moderate exercise such as walking, riding a stationary bike, or swimming is a good way to get started.

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Bipolar Disorder in Children and Teens

    Emotional Symptoms



  1. Kids and teens with depression often feel a deep sadness for no apparent reason. They may cry a lot, feel guilty about things that aren't their fault and withdraw from friends and family. They may seem very irritable and angry, and lash out at you over little things.

    2. Physical Symptoms



  1. Depressed kids may have frequent headaches or stomachaches. They may sleep a lot or suffer from insomnia, and they may eat more or less than usual.

    3. Effects

  3. Children and teens with depression often turn to drugs or alcohol in an attempt to find relief. School performance and friendships suffer as the depression takes hold and limits the child's ability to function. Depression can lead to suicide, even in children.

    4. Risk Factors

  4. A child is more likely to develop depression if he has a close family member with the disorder. Traumatic life events can also trigger depression in children and teens. Adolescent girls who have given birth are at risk for postpartum depression.

    5. Treatment

  5. Depression is highly treatable through therapy and, if necessary, medication. Children and teens taking antidepressants should be monitored closely because of possible adverse side effects. There is a small risk of antidepressants leading to suicidal thoughts in young people.

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Depression in Children and Teens

This topic covers depression in children and teens. For information about depression in adults, see the topic Depression. For information about depression with episodes of high energy (mania), see the topic Bipolar Disorder in Children and Teens.

What is depression in children and teens?

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Depression is a serious mood disorder that can take the joy from a child’s life. It is normal for a child to be moody or sad from time to time. You can expect these feelings after the death of a pet or a move to a new city. But if these feelings last for weeks or months, they may be a sign of depression.

Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve. As many as 3 in 100 young children and 9 in 100 teens have serious depression.1

Still, many children don't get the treatment they need. This is partly because it can be hard to tell the difference between depression and normal moodiness. Also, depression may not look the same in a child as in an adult.

If you are worried about your child, learn more about the symptoms in children. Talk to your child to see how he or she is feeling. If you think your child is depressed, talk to your doctor or a counselor. The sooner a child gets treatment, the sooner he or she will start to feel better.

What are the symptoms?

A child may be depressed if he or she:

  • Is grumpy, sad, or bored most of the time.
  • Does not take pleasure in things he or she used to enjoy.

A child who is depressed may also:

  • Lose or gain weight.
  • Sleep too much or too little.
  • Feel hopeless, worthless, or guilty.
  • Have trouble concentrating, thinking, or making decisions.
  • Think about death or suicide a lot.

The symptoms of depression are often overlooked at first. It can be hard to see that symptoms are all part of the same problem.

Also, the symptoms may be different depending on how old the child is.

  • Very young children may lack energy and become withdrawn. They may show little emotion, seem to feel hopeless, and have trouble sleeping.
  • Grade school children may have a lot of headaches or stomachaches. They may lose interest in friends and activities that they once liked. Some children with severe depression may see or hear things that aren't there (hallucinate) or have false beliefs (delusions).
  • Teens may sleep a lot or move or speak more slowly than usual. Teens with severe depression may hallucinate or have delusions.

Depression can range from mild to severe. A child who feels a little “down” most of the time for a year or more may have a mild, ongoing form of depression called dysthymia (say “dis-THY-mee-uh”). In its most severe form, depression can cause a child to lose hope and want to die.

Whether depression is mild or severe, there are treatments that can help.

What causes depression?

Just what causes depression is not well understood. But it is linked to an imbalance of brain chemicals that affect mood. Things that may cause these chemicals to get out of balance include:

  • Stressful events, such as changing schools, going through a divorce, or having a death in the family.
  • Some medicines, such as steroids or narcotics for pain relief.
  • Family history. In some children, depression seems to be inherited.

How is depression diagnosed?

To diagnose depression, a doctor may do a physical exam and ask questions about the child's past health. You may be asked to fill out a form about your child’s symptoms. The doctor may ask your child questions to learn more about how the child thinks, acts, and feels.

Some diseases can cause symptoms that look like depression. So the child may have tests to help rule out physical problems, such as a low thyroid level or anemia.

It is common for children with depression to have other problems too, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems to help your child get the right diagnosis and treatment.

How is it treated?

Usually one of the first steps in treating depression is education for the child and his or her family. Teaching both the child and the family about depression can be a big help. It makes them less likely to blame themselves for the problem. Sometimes it can help other family members see that they are also depressed.

Counseling may help the child feel better. The type of counseling will depend on the age of the child. For young children, play therapy may be best. Older children and teens may benefit from cognitive-behavioral therapy. This type of counseling can help them change negative thoughts that make them feel bad.

Medicine may be an option if the child is very depressed. Combining antidepressant medicine with counseling often works best. A child with severe depression may need to be treated in the hospital.

There are some things you can do at home to help your child start to feel better.

  • Urge your child to get regular exercise, eat a healthy diet, and get enough sleep.
  • See that your child takes any medicine as prescribed and goes to all follow-up appointments.
  • Make time to talk and listen to your child. Ask how he or she is feeling. Express your love and support.
  • Remind your child that things will get better in time.

What should you know about antidepressant medicines?

Antidepressant medicines often work well for children who are depressed, but there are some important things you should know about them.

  • Children who take antidepressants should be watched closely. These medicines may increase the risk that a child will think about or try suicide, especially in the first few weeks of use. If your child takes an antidepressant, learn the warning signs of suicide, and get help right away if you see any of them. Common warning signs include:
    • Talking, drawing, or writing about death.
    • Giving away belongings.
    • Withdrawing from family and friends.
    • Having a way to do it, such as a gun or pills.
  • Your child may start to feel better after 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressants as prescribed and keeps taking them so they have time to work.
  • A child may need to try several different antidepressants to find one that works. If you notice any questions or have concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child's doctor.
  • Do not let a child suddenly stop taking antidepressants. This could be dangerous. Your doctor can help you taper off the dose slowly to prevent problems.

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Manage and Overcome Your Postpartum Depression

If you have the "baby blues" after childbirth, you're not alone—about half of women have a few days of mild depression after having a baby.1 However unsettling, a certain amount of insomnia, irritability, tears, overwhelmed feelings, and mood swings are normal. Baby blues usually peak around the fourth postpartum day and subside in less than 2 weeks, when hormonal changes have settled down. But you can have bouts of baby blues throughout your baby's first year.

If your depressed feelings have lasted more than 2 weeks, your body isn't recovering from childbirth as expected. Postpartum depression:

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  • Is very common, affecting 1 in 8 women during the first months of their babies' lives.2
  • Is a serious medical condition that can be prolonged and disabling without treatment and can affect a baby's development.
  • Is best treated with counseling and an antidepressant medicine.3
  • Can further improve when you take some home treatment measures.

To prevent serious problems for you and your baby, now is the time to work with your doctor to treat your symptoms.

If you are having thoughts of hurting yourself, your baby, or anyone else, see your doctor immediately or call 911 for emergency medical care.

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How to Support Someone Who is Depressed

f someone you care about has been diagnosed with depression, you may feel helpless. Maybe you're watching a once-vibrant person slide into inactivity or seeing a good friend lose interest in activities that he or she used to enjoy. The change in your loved one's or friend's behavior may be so great that you feel you no longer know him or her.

You probably want to help in some way. This Actionset will give you the tools to do so.

Key points

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  • Depression is a disease. It's not being lazy, and you can't "just get over it."
  • The best thing you can do for someone who is depressed is to help him or her start or continue treatment.
  • Offer support. You can do this by understanding what depression is, being patient, and offering help.
  • Don't ignore talk about suicide. Talk to a doctor, or call 911 or emergency help if needed.
  • Reassure the person that he or she will get better with the right kind of treatment. Treatment depends on how severe the depression is and includes medicine, counseling, self-care, or a combination of these.

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Fitness

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