Depression: What medication does
Prozac, first marketed in 1986, was the first anti-depressant in the United States to target the brain’s supply of serotonin, a chemical important in regulating moods. Two commonly prescribed anti-depressants similar to Prozac are Zoloft, which singer Naomi Judd credits with helping her beat her panic attacks, and Paxil, which treats generalized anxiety disorder – a persistent worry that can overlap with depression.
The mood-lifting effect of an anti-depressant doesn’t kick in until weeks after a patient starts taking it. “People are often tempted to stop taking anti-depressants too soon,” says psychiatrist William Appleton, author of Prozac and the New Anti-Depressants. “They either feel better and think they no longer need the medication, or they may think the medication isn’t helping at all.”
Another quirk of anti-depressants is their unpredictability: What works for one patient often won’t work for another; side effects vary, too. Many patients have to try different prescriptions before finding a medication that works for them.
How do they work? Anti-depressants are not tranquilizers; they don’t knock you out or slow you down. They are regulators, like a cab thermostat. Just as insulin balances chemical levels in a diabetic’s bloodstream, anti-depressants balance chemical levels in the brain.
What are the side effects? Older anti-depressants such as Elavil and Norpramin can cause blurred vision, dry mouth and constipation. Newer anti-depressants such as Prozac, Zoloft and Paxil can cause drowsiness or sleeplessness, as well as upset stomach, rashes and weight change. Typically, these side effects don’t last long, but they start very early – even before the positive, mood-lifting effects of the drug kick in.
Some anti-depressants can cause serious side effects when combined with other medications, so never take an anti-depressant without your doctor’s approval – not even over-the-counter, so-called natural anti-depressants such as SAM-e and St. John’s wort.
Will drugs affect my driving? The common belief that people on anti-depressants are unable to drive is not necessarily true. Anti-depressants are not addictive, are not sedatives and don’t cause hallucinations.
Some of their side effects, such as drowsiness, can interfere with driving, so some carriers don’t allow drivers on anti-depressants to get behind the wheel. Stevens Transport, for example, requires a driver to be off anti-depressants at least a month before driving.
Your personal physician may prescribe anti-depressant medication for you, but the physician who does your U.S. Department of Transportation health exam must approve whether the medication is suitable for you as a commercial driver.
Can I take the drugs and skip the therapy? “Too many people want the quick fix and opt for the pills only and don’t consider psychological therapy,” says San Francisco psychologist John Preston.
The general approach for prescribing anti-depressants is to “go low and start slow,” says Mark Stafford, an associate professor at the University of Alabama at Birmingham. The extended periods of time should also include therapy.
Some professionals believe anti-depressants are over-prescribed. “Too many physicians put people on medication without knowing anything,” says psychologist Karen Shanor. “Anti-depressants should be a last resort, not the first resort.”