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From: [e-mail] (Cynthia Frazier)
Newsgroups: alt.support.depression,alt.answers,news.answers
Subject: alt.support.depression FAQ Part 2[5]
Followup-To: poster
Summary: The following Frequently-Asked-Questions (FAQ) attempts to
     impart an understanding of depression including its causes; its
     symptoms; its medication and treatments--including professional
     treatments as well as things you can do to help yourself. In
     addition, information on where to get help, books to read, a list
     of famous people who suffer from depression, internet resources,
     instructions for posting anonymously, and a list of the many
     contributors is included.
Originator: [e-mail]
Date: 11 May 2004 10:50:04 GMT
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Archive-name: alt-support-depression/faq/part2
Posting-Frequency: bi-weekly
Last-modified: 1996/02/13

Note: This is a minor and emergency update to this section only, and is
not
      complete in it's editing. The other sections will be updated very
      soon.


Part 2 of 5
===========

  **Causes** (cont.)
   & What causes depression?
   - What initiates the alteration in brain chemistry?
   - Is a tendency to depression inherited?

  **Treatment**
   - What sorts of psychotherapy are effective for depression?
   - What is Cognitive therapy?


  **Medication**
   - Do certain drugs work best with certain depressive illnesses? What
     are the guidelines for choosing a drug?
   - How do you tell when a treatment is not working? How do you know
     when to switch treatments?
   - How do antidepressants relieve depression?
   - Are Antidepressants just "happy pills?"
   - What percentage of depressed people will respond to
     antidepressants?
   - What does it feel like to respond to an antidepressant? Will I feel
     euphoric if my depression responds to an antidepressant?
   - What are the major categories of anti-depressants?
   - What are the side-effects of some of the commonly used
     antidepressants?
   - What are some techniques that can be used by people taking
     antidepressants to make side effects more tolerable?
   - Many antidepressants seem to have sexual side effects. Can anything
     be done about those side-effects?
   - What should I do if my antidepressant does not work?
   + Can someone build up tolerance to Prozac or other anti-depressants
     so that they stop working after a while?
   + What about the rumors and studies that Prozac causes suicide and/or
     acts of violence?



Causes (cont.)
--------------

Q. What causes depression?

   The group of symptoms which doctors and therapists use to diagnose
   depression ("depressive symptoms"), which includes the important
   proviso that the symptoms have manifested for more than a few weeks
   and that they are interfering with normal life, are the result of an
   alteration in brain chemistry. This alteration is similar to
   temporary, normal variations in brain chemistry which can be triggered
   by illness, stress, frustration, or grief, but it differs in that it
   is self-sustaining and does not resolve itself upon removal of such
   triggering events (if any such trigger can be found at all, which is
   not always the case.)

   Instead, the alteration continues, producing depressive symptoms and
   through those symptoms, enormous new stresses on the person:
   unhappiness, sleep disorders, lack of concentration, difficulty in
   doing one's job, inability to care for one's physical and emotional
   needs, strain on existing relationships with friends and family. These
   new stresses may be sufficient to act as triggers for continuing brain
   chemistry alteration, or they may simply prevent the resolution of the
   difficulties which may have triggered the initial alteration, or both.

   The depressive's change in brain chemistry is usually self-limiting.
   After one to three years, brain chemistry reverts to normal without
   medical treatment. However, at times, is profound enough to result in
   suicidal thinking or behaviors. A large number of untreated seriously
   depressed people will in fact attempt suicide. As many as 17% will
   eventually succeed.

   Depression must be thought of as a potentially fatal illness. Friends
   and relatives may be deceived by the casual way that profoundly
   depressed people speak of suicide or self-mutilation. They are not
   casual because they "don't really mean it"; they are casual because
   these things seem no worse than the mental pain they are already
   suffering. Any comment such as, "You'd be better off if I were gone,"
   or "I wish I could just jump out a window," is the equivalent of a
   sudden high fever; the depressed person must be taken to a
   professional who can monitor their danger. A formulated plan, such as,
   "I'm going to jump in front of the next car that comes by," is the
   equivalent of sudden unconsciousness: an immediate medical emergency
   which may require hospitalization.

   Depression can shut down the survival instinct or temporarily suppress
   it. Therefore, depressed suicidal thinking is not the same as the
   suicidal thinking of normal people who have reached a crisis point in
   their lives. Depressive suicides give less warning, need less time to
   plan, and are willing to attempt more painful and immediate means,
   such as jumping out of a moving car. They may also fight the impulse
   to suicide by compromising on self-injury -- cutting themselves with
   knives, for example, in an attempt to distract themselves from severe
   mental pain. Again, relatives and friends are likely to be astonished
   by how quickly such an impulse can appear and be acted upon.


Q. What initiates the alteration in brain chemistry?

   It can be either a psychological or a physical event. On the physical
   side, a hormonal change may provide the initial trigger: some women
   dip into depression briefly each month during their premenstrual
   phase; some find that the hormone balance created by oral
   contraceptives disposes them to depression; pregnancy, the end of
   pregnancy, and menopause have also been cited. Men's hormone levels
   fluctuate as deeply but less obviously.

   It is well known that certain chronic illnesses have depression as a
   frequent consequence: some forms of heart disease, for example, and
   Parkinsonism. This seems to be the result of a chemical effect rather
   than a purely psychological one, since other, equally traumatic and
   serious illnesses don't show the same high risk of depression.

   The typical chemical changes that characterize depression can also be
   caused by psychosocial factors.


Q. Is a tendency to depression inherited?

   It seems there are some people whose brain chemistry is predisposed
   to the depressive response, and others who are at much lower risk of
   depression even if exposed to the same physical or psychological
   triggers. The close relatives of manic-depressives are at a higher
   risk for unipolar depression than the population at large or their
   adopted/by marriage relations.

   There seems to be a link between high creativity and the gene for
   manic-depression: artists and writers often are not manic-depressive
   themselves, but have a family member who is. Studies of families in
   which members of each generation develop manic-depressive illness
   found that those with the illness have a somewhat different genetic
   make-up than those who do not get ill. However, the reverse is not
   true: not everybody with the genetic make-up that causes vulnerability
   to manic-depressive illness has the disorder. Apparently additional
   factors, possibly a stressful environment, are involved in its onset.

   Major depression also seems to occur, generation after generation, in
   some families. However, depression can occur in people with no family
   history of any form of mental illness. And there probably is no human
   who is entirely immune to depression if stressed enough.

   Psychological triggers: many, if not most, people with depression can
   point to some incident or condition which they believe is responsible
   for their unhappiness. Of course, people with severe depression are
   prone to astonishingly virulent and inappropriate guilt and
   self-hatred. So what they identify as a cause of the depression is not
   the true cause.  Also people are generally more comfortable thinking
   that their depressions had a specific trigger rather than thinking of
   them as occurring for no specific reason.

   The (genuine) life events that are most often associated with
   depression are varied, but the distinguishing features of such events
   are: loss of self-determination, of empowerment, of self-confidence.
   More profoundly: a loss of self, of the abilities or activities that a
   person identifies with herself.

   Stereotypically: a man loses the job that had defined him to himself
   and others, whether that definition was "executive" or "breadwinner";
   a woman who had spent her whole life preparing for and living the
   role of wife, supporter, caretaker, is suddenly left alone by divorce
   or death. In general, any life change, often caused by events beyond
   one's control, which damages the structure that gave life meaning.

   The ability of a person to respond to such an event will depend on
   many factors, including genetic predisposition, support from friends,
   physical health, even the weather. It can also depend on internal
   psychological factors which may best be explored in talk therapy: why
   is the person's self-esteem so bound up in the position or state that
   has been lost? Can she find a new source of self-esteem? Therapy can
   be immensely helpful here.

   Obviously, not everyone to whom this sort of event happens becomes
   depressed, and not every person who becomes depressed has had this
   sort of catastrophe befall them. In fact, if a person suffers a loss
   and then becomes depressed, it may well be that they weathered the
   loss in fine style and then succumbed to a much less obvious
   physhological or biological trigger.

   Once the depressive state has started, both physical and
   psychological problems will be generated in abundance. What faster
   way to lose a job or a spouse than to be too depressed to work or to
   communicate? What worse psychological state for coping with a blow to
   identity can there be than a chemically maintained, profound
   self-hatred? And what can be worse for self-esteem than watching
   one's appearance and household disintegrate as one loses the
   motivation and energy to shower, straighten up, wash dishes or
   laundry, or choose attractive clothes? Health deteriorates as well:
   some depressed people can't sleep or eat, others sleep constantly (a
   real help on the job!) and eat incessantly, sometimes in order to stay
   awake, sometimes because it's the only thing that gives a little
   pleasure or comfort. (Carbohydrates induce production of serotonin,
   so there may be an element of self-medication here); almost no one
   has the impulse to exercise or get fresh air and sunshine. Most if
   not all of these effects form feedback loops, increasing in magnitude
   and becoming triggers for further depression.

   The question, "Is depression mostly physical or psychological," is
   rather beside the point. There is only one of you, not a separate
   physical you, and a psychological you. Depression may be triggered by
   either physical or psychological events. Most commonly, both seem to be
   involved, though it is often difficult to separate the two when one
   is talking about psychology and neurochemistry. However it
   begins, depression quickly develops into a set of physical and
   psychological problems which feed on each other and grow. This is why
   a combination of physical and psychological intervention has been
   shown to give the best results for many patients, regardless of any
   diagnosis.


Treatment
---------

Q. What sorts of psychotherapy are effective for depression?

   Two effective methods of psychotherapy for people with depressions
   are cognitive therapy and interpersonal therapy. Both psychoanalysis
   and insight oriented psychotherapy have not been shown to be
   effective treatments for people with a depressive disorder. Cognitive
   (and cognitive-behavioral) therapists can be found in most major
   cities.

   For a referral to a properly trained cognitive therapist practicing
   close to your location, contact:

      Aaron T. Beck, MD.
      The Center for Cognitive Therapy
      3600 Market Street
      Philadelphia, PA 19101
      [phone].

   While many therapists call themselves cognitive therapists and
   interpersonal therapists, only a few have had proper training. To
   find an interpersonal therapist with the best training, contact:

      Myrna Weissman, Ph.D.
      New Your State Psychiatric Institute
      722 West 168th Street
      New York, NY 10032
      212-960-5880

Q. What is Cognitive therapy?

A. Congitive therapy points out a number of misconceptions or "cognitive
   distortions" that affect the way we view ourselves.  Some of these are:

   1) All or Nothing Thinking: You look at things in absolute
      black-and-white terms. ("I don't think cognitive therapy will solve
      all my problems, so what's the point in even trying." "There's no
      point in getting started on this, I'm so far behind I'll never catch
      up.")

   2) Overgeneralization: View a negative event as a never ending pattern
      of defeat. ("I always mess things up". "He's always late.")

   3) Mental Filter: Dwell on negatives and ignore positives. (Example:
      your boss praises your report but wants a few changes.  All you can
      do is dwell on the criticism.)

   4) Discounting the positives: you insist your positive accomplishments
      "don't count" or are due to luck.

   5) Jumping to conclusions: a) Mind reading ("My shrink only gave me
       half of the cognitive distortion list because he hates me." or b)
       Fortune-Telling --- arbitrarily predict things will turn out badly.

   6) Magnification or minimization: Blow things out of proportion or
      shrink their importance inappropriately.

   7) Emotional reasoning: Reason from how you feel: "I feel frightened
      therefore this must be really dangerous."

   8) "Should statements": criticise yourself or other people based on
      how you think they "should" act or feel.  "I shouldn't have so many
      cognitive distortions" "I shouldn't be so apprehensive about this".
      The only "shoulds', "have to" etc allowed are a) moral shoulds "Thou
      shalt not kill", b) Legal shoulds "You shouldn't try to smuggle
      chewing gum into Singapore" or 3) Physical Law shoulds "If I drop
      this ball it should fall to the ground."

   9) Labeling: Identify yourself or others with their shortcomings:
      Instead of "I made a mistake" you think "I am an idiot".

  10) Personalization: You blame yourself for something you weren't
      entirely responsible for or blame others and overlook your own
      behavior or attitudes.

  The first step in cognitive therapy is to learn to recognise cognitive
  distortions.  At first you feel like your whole mind is a hypertext
  document and every thought you click on reveals some cognitive
  distortion.  To say you "I shouldn't have so many cognitive
  distortions" or "Now that I've recognised my cognitive distortions I
  should _easily_ be able to change the way I act or feel " are cognitive
  distortions.  To say "I feel stupid and incompetant when I see that I
  am always making cognitive distortions, therefore I must be a total
  idiot" is a whole bunch of cognitive distortions.


Medication
----------

Q. Do certain drugs work best with certain depressive illnesses? What
   are the guidelines for choosing a drug?

   There are very few kinds of depression for which there are specific
   antidepressant treatments. When it comes to people with Bipolar
   Disorder who are depressed there are some major problems. Most
   importantly, with any antidepressant, there is a possibility that the
   antidepressant treatment will cause depressed bipolar people not just
   to come out of their depressions, but to develop manic episodes. The
   possibility of an antidepressant causing mania is least when the
   antidepressant is bupropion (Wellbutrin). The possibility of mania is
   greatly reduced if depressed bipolar folks are on a mood stabilizer
   such as lithium, Tegretol or Depakote when they are started on an
   antidepressant.


Q. How do you tell when a treatment is not working? How do you know when
   to switch treatments?

   Antidepressant treatment is clearly not working when the individual
   receiving the treatment remains depressed or becomes depressed again.
   When a recently started antidepressant fails to cause improvement,
   the depressed individual often asks that the medication be stopped,
   and a new one started. It generally does not make sense to change
   antidepressants until 8-weeks at the maximum tolerated dose have
   elapsed. With some tricyclic antidepressants, it is important to
   check the blood level of the antidepressant before it is stopped. The
   blood test can tell if the amount in the blood has been adequate.
   Only after an adequate trial of one antidepressant should another be
   tried. To have been on four antidepressants in an 8-week period means
   that one has not had an adequate trial on any of them.


Q. How do antidepressants relieve depression?

   There are several classes of antidepressants, all of which seem to
   work by increasing levels of certain neurotransmitters (most commonly
   serotonin, norepinephrine, and dopamine) in the brain. It is not
   entirely clear why increasing neurotransmitter levels should reduce
   the severity of a depression. One theory holds that the increased
   concentration of neurotransmitters causes changes in the brain's
   concentration of molecules, receptors, to which these transmitters
   bind. In some unknown way it is the changes in the receptors that are
   thought responsible for improvement.


Q. Are Antidepressants just "happy pills?"

   No matter what their exact mode of action may be, it is clear that
   antidepressants are not "happy pills." There is no street-market in
   antidepressants, for unlike "speed" which will improve the mood of
   almost everybody, antidepressants only improve the mood of depressed
   people. Also unlike the almost instant effects of speed, the
   mood-improving effects of antidepressants develop slowly over a
   number of weeks. "Speed" induces a highly artificial state,
   antidepressants cause the brain to slowly increase its production of
   naturally occurring neurotransmitters.


Q. What percentage of depressed people will respond to antidepressants?

   Generally, about 2/3 of depressed people will respond to any given
   antidepressant. People who do not respond to the first antidepressant
   they have taken, have an excellent chance of responding to another.


Q. What does it feel like to respond to an antidepressant? Will I feel
   euphoric if my depression responds to an antidepressant?

   The most common description of the effects of antidepressants is that
   of feeling the depression gradually lift, and for the person to feel
   normal again. People who have responded to antidepressants are not
   euphoric. They are not unfeeling automatons. The are still able to
   feel sad when bad things happen, and they are able to feel very happy
   in response to happy events. The sadness they feel with
   disappointments is not depression, but is the sadness anyone feels
   when disappointed or when having experienced a loss. Antidepressants
   do not bring about happiness, they just relieve depression. Happiness
   is not something that can be had from a pill.


Q. What are the major categories of anti-depressants?

   There are many classes of antidepressants. Two kinds of
   antidepressants have been around for over 30 years. These are the
   tricyclic antidepressants and the monoamine oxidase inhibitors. While
   there are newer antidepressants, many with fewer side-effects, none
   of the newer antidepressants has been shown to be more effective than
   these two classes of drugs. In fact, many people who have not
   responded to newer antidepressants have been successfully treated
   with one of these classes of drugs.

   The tricyclic antidepressants (TCAs) include such drugs as imipramine
   (Tofranil, amitriptyline (Elavil), desipramine (Norpramin),
   nortriptyline (Aventyl and Pamelor).

   The monoamine oxidase inhibitors (MAOIs) include tranylcypromine
   (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan) which has
   recently been taken off the market in the U.S.A. for marketing rather
   than safety or efficacy reasons.

   One of the popular new classes of antidepressants are the selective
   serotonin reuptake inhibitors (SSRIs). The first of these drugs to be
   marketed in the USA was fluoxetine (Prozac). Sertraline (Zoloft), and
   paroxetine (Paxil) soon followed, and fluvoxamine (Luvox) is
   scheduled to be marketed in late 1994, or early 1995.

   Bupropion (Wellbutrin) is the only drug in its class, as is trazodone
   (Desyrel). The most recently marketed antidepressant (4/94) is
   venlafaxine (Effexor), the first drug in yet another class of drugs.

IVAN:  ANOTHER COMMENT THAT I LEAVE TO YOUR JUDGEMENT:
From: Ian Ford <[e-mail]>
Date: Sun, 22 Jan 1995 20:33:09 -0500
To: [e-mail] (Cynthia Frazier)
Subject: Re: alt.support.depression FAQ Part 2[5]
Newsgroups: alt.support.depression,alt.answers,news.answers

Ref your depression FAQ :

Periactin <is> available w/out prescription in UK. It is a category "P"
medication , i.e. it may be bought from a pharmacy when the pharmacist is
present, but no prescription is necessary. Of course, self-medication is
not necessarily a good idea and you may do best to talk to your doc.
first.
END COMMENT


Q. What are the side-effects of some of the commonly used
   antidepressants?

   Below is a list of some of the more frequently prescribed
   antidepressants, and their most common side effects. The figure
   following each side effect is the percentage of people taking the
   medication who experience that side effect.

   Aventyl (nortriptyline): Dry mouth (15); Constipation (15);
   Weakness-fatigue (10); Tremor (10).

   Effexor (venlafaxine) Nausea (35); Headache (25); Sleepiness (25);
   Dry mouth (20); Insomnia (20); Constipation (15).

   Elavil (amitriptyline): Dry mouth (40); Drowsiness (30); Weight gain
   (30); Constipation (25); Sweating (20).

   Nardil (phenelzine): dry mouth (30); insomnia (25); Increased heart
   rate (25); Lowered blood pressure (20); Sedation (15); Over
   stimulation (10);

   Norpramin (desipramine): dry mouth (15); increased pulse (15);
   constipation (10); reduced blood pressure (10).

   Pamelor - see Aventyl

   Parnate (tranylcypromine) Dry mouth (20); Insomnia (20); Increased
   pulse rate (20); Lowered blood pressure (15); Over stimulation (15);
   Sedation (15).

   Paxil (paroxetine): Decreased sexual interest and/or problems
   achieving orgasm (30); Nausea (25); Sedation (25); Dizziness (15)
   Insomnia (15)

   Prozac (fluoxetine): Decreased sexual interest and/or problems
   achieving orgasm (30); Nausea (20); Headache (20); Nervousness (15);
   Insomnia (15); Diarrhea (15).

   Sinequan (doxepin): Dry mouth (40); Sedation (40); Weight gain (30);
   Lowered blood pressure (25); Constipation (25); Sweating (20).

   Tofranil (imipramine): Dry mouth (30), Reduced blood pressure (30),
   Constipation (20), Difficulty with urination (15).

   Wellbutrin (bupropion): Agitation (30); Weight loss (25), Dizziness
   (20); Decreased appetite (20);

   Zoloft (sertraline): Decreased sexual interest and/or problems
   achieving orgasm (30);Nausea (25); Headache (20); Diarrhea (20);
   Insomnia 15); Dry mouth (15); Sedation (15).


Q. What are some techniques that can be used by people taking
   antidepressants to make side effects more tolerable?

   Listed below are some frequent side effects of antidepressants, and
   some techniques to reduce their severity:

   Dry mouth: Drink lots of water, chew sugarless gum, clean teeth
   daily, ask the dentist to suggest a fluoride rinse to prevent
   cavities, visit the dentist more often than usual for tooth and gum
   hygiene

   Constipation: Drink at least six 8-ounce glasses of water every day,
   eat bran cereals, eat salads twice a day, exercise daily (walk for at
   least 30 minutes a day), ask your doctor about taking a bulk
   producing agent such as Metamucil, also ask about taking a stool
   softener such as Colace, be sure to avoid laxatives such as Ex-Lax.

   Bladder problems: The effects of some antidepressants, especially the
   tricyclic medications may make it difficult for you to start the
   stream of urine. There may be some hesitation between the time you
   try to urinate and the time your urine starts to flow. If it takes
   you over 5-minutes to start the stream, call your doctor.

   Blurred vision: The tricyclic antidepressants may make it difficult
   for you to read. Distant vision is usually unaffected. If reading is
   important to you the effects of the antidepressant can be compensated
   for by a change in glasses. As you may compensate for the change in
   your vision, try to postpone getting new glasses as long as possible.

   Dizziness: Dizziness when getting out of bed or when standing up from
   a chair, or when climbing stairs may be a problem when taking
   tricyclic antidepressants and monoamine oxidase inhibitors. Changing
   posture slowly may help prevent this kind of dizziness. Drinking
   adequate amounts of liquid and eating enough salt each day is
   important. Be sure to speak to your doctor if this side-effect is
   severe.

   Drowsiness: This side effect often passes as you get used to taking
   the antidepressant that has been prescribed for you. Ask your doctor
   if it is safe for you to increase your intake of caffeine, and if so,
   by how much. If you are drowsy be sure not to drive or operate
   dangerous machinery.


Q. Many antidepressants seem to have sexual side effects. Can anything
   be done about those side-effects?

   Both lowered sexual desire and difficulties having an orgasm, in both
   men and women, are particularly a problem with the selective
   serotonin re-uptake inhibitors (Prozac, Zoloft, Paxil and Luvox), and
   the monoamine oxidase inhibitors (Nardil and Parnate). There is no
   treatment for decreased sexual interest except lowering the dose or
   switching to a drug that does not have sexual side effects such as
   bupropion (Wellbutrin). Difficulty having orgasms may be treated by a
   number of medications. Among those medications are: Periactin,
   Urecholine, and Symmetrel. None of these are over-the-counter drugs
   and they must be prescribed by a physician. Unfortunately, many
   psychiatrists are not familiar with using these medications to treat
   the sexual side-effects of antidepressants.


Q. What should I do if my antidepressant does not work?

   Many people decide that their antidepressant is not working
   prematurely. When one starts an antidepressant the hope is for rapid
   relief from depression. What must be remembered is that for an
   antidepressant to work, you must be on an adequate dose of the drug
   for an adequate length of time. A fair trial of any antidepressant is
   at least two months. Prior to a two month trial the only reason to
   abandon an antidepressant trial is if the medication is causing
   severe side effects. With many antidepressants the dose has to be
   increased at intervals far above the starting dose. Unfortunately,
   the two-month period mentioned above, refers to two months following
   the most recent increase in the dose, not the time from starting the
   particular antidepressant.


Q. Can someone build up tolerance to Prozac or other anti-depressants so
   that they stop working after a while?

   Tolerance to Prozac and the other SSRIs is a relatively rare
   phenomenon. What looks like tolerance may develop because the SSRIs
   also have effects on the dopamine systems of the brain, and these
   effects can slow one down dramatically.

   When an SSRI sems not to be working as well as it once did, it often
   can be helped to work once again by adding small doses of a
   dopaminergic agonist such as dextrroamphetamine, Ritalin, or
   bromocriptene. Also, certainly with Proxzac, and possibly with other
   SSRIs, too much of the drug is as ineffective as too little. If
   raising the dose does not help, an certainly if it makes things worse,
   a lowering of the dose may do much to bring back a response.

   I am convinced that many patients respond best is they are treated
   with one of the SSRIs + a tricyclic antidepressant such as desipramine
   (Norpramin), or nortriptyline (Aventyl). Such combinations are often
   effective when an SSRI by itself fails to do the job


Q. What about the rumors and studies that Prozac causes suicide and/or
   acts of violence?

PROZAC-VIOLENCE LINK NOT PROVED

BUT MOOD DRUG DOES HAVE LITANY OF NEGATIVE EFFECTS

Medical Information Service

Q. I am an inmate in the state correction system serving 10 years for
repeated
driving under the influence of alcohol and vehicular manslaughter. My
problems started when I was diagnosed as suffering from depression and was
prescribed an anti-depressant called Prozac. Before using that drug, I was
devoutly against drunken driving, but about three months after starting
it I
became very jumpy, restless, got three arrests for driving while drunk and
then the vehicular manslaughter charge. Could Prozac have caused me to act
differently? What problems occur with Prozac?

-- M.J., Grovetown, Ga.
A Prozac is an anti-depressant known to cause problems such as
nervousness,
tremor, seizures, nausea and headaches, but it has not been shown to be a
direct cause of violent acts, including suicide. People taking Prozac or
other anti-depressants may experience personality changes for a range of
reasons: The stress of waiting for improvement may worsen their mental
state
or the anti-depressant may produce symptoms of a different, undiagnosed
mental illness. Finally, depressed people often abuse drugs and alcohol.
DEPRESSION COMMON

An estimated 20 million Americans experience depression at some time in
their
lives, although most are never diagnosed. Depression is a serious disorder
and considered life-threatening. Nearly 80 percent of all depressed people
contemplate suicide, and 20 percent to 40 percent of those attempt it.

Over the past 25 years, anti-depressant drugs have been the dominant
treatment for depression. Most anti-depressants are descendants of and
improvements on one of the very first mood-controlling drugs, imipramine.
The
newer types of anti-depressants are called selective serotonin reuptake
inhibitors, or SSRIs, which have the positive qualities of imipramine but
try
to remove or reduce some of its negative aspects, such as abnormal heart
rhythms. SSRIs include serraline, paroxetine, fluvoxamine and fluoxetine,
known by its brand name of Prozac.

 ABOUT THE DRUG

Manufactured by Eli Lilly and Co., Prozac was first introduced in 1986
and is the most widely used anti-depressant. More than 10 million people
have
been prescribed it. Studies show it is as effective as other
anti-depressants,
but it has fewer side effects.

According to several studies, the side effects of Prozac can include
nervousness, tremor, jitteriness, nausea, insomnia, headache, fatigue,
mania or manic symptoms, dizziness and, rarely, seizures.

REPORTS ABOUT PROZAC

Over the past several years, there have been numerous reports of violent
acts and suicide by Prozac users. Although medical journals have numerous
reports of such acts, medical studies have not found evidence that Prozac
causes
violence or suicide.

A recent study of 3,065 depression patients taking Prozac by Gary
Tollefson, a researcher at Eli Lilly, supported other researchers'
studies in finding that there was no increased risk of suicide. The study
was published in
the June issue of the Journal of Clinical Psychopharmacology.

In Tollefson's study, about 2 percent had suicidal ideas and 0.2 percent
of the patients attempted suicide.

''Suicide is so common in a population suffering from depression that you
can't necessarily blame the drug. As an analogy, if a migraine sufferer is
given medication and then has a headache, do you blame the medication? The
situation is similar with depression,'' said Susan Sonne, a researcher in
the department of psychiatry at the Medical University of South Carolina,
Charleston, in an interview.

However, people taking Prozac or anti-depressants may experience
personality changes for a range of reasons, experts say:

-- Most depressed people do not seek help until their problem is serious
and often desperate. When placed on anti-depressants, including Prozac,
the
side effects of the medicine start immediately but the therapeutic
benefits may
take four to 12 weeks. During the first few weeks, a patient may become
more distressed and panicked that the drug hasn't made significant
changes,
and as a result may act even more irrationally.

-- There may be too little or no therapeutic effect from the medication.
The drug may reduce the symptoms by 50 percent, which is considered a
therapeutic level, but the effects experienced by the patient are not
enough.
Or the drug may have no therapeutic effect at all, which occurs in about
30 percent of patients. The drug dosage may also be too low and thus
ineffective.
Experts believe this can panic the patient and make the depression much
worse.

These situations may also trigger new or increased alcohol consumption
 ''A depressed person who isn't responding to medication may resort to
self-medication with alcohol,'' said Dr. Alexander Morton, professor of
psychiatry and behavioral sciences, also at Medical University of South
Carolina, in an interview. Alcohol and drug abuse occurs in more than
half of those with depression.

-- The patient may be receiving treatment for depression, but actually
has an underlying, undiagnosed bipolar disorder, such as manic-depressive
disorder. Research shows that an anti-depressant can somehow trigger a
switch
from depression to a manic state. Symptoms typical of mania include
euphoria,
high energy level with poor judgment, risk-taking, delusions of grandeur
and a
need for excitement.

''Since a patient suffering from depression may be very compromised and,
by virtue of their condition, incapable of helping themselves, it is
important for family and friends to intervene when strange behavior is
seen.
For instance . . . after one uncharacteristic DUI I would intervene, find
an
alcohol or drug treatment program and try to receive a full evaluation of
the situation,'' Morton said.


Doctor Data is written by the Medical Information Service of Menlo Park
using medical data bases. For a list of Bay Area data-base services or to
submit medical questions, call [phone], fax [phone] or send
a
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END COMMENT


.IVAN:  HERE ARE SOME SUGGESTIONS/QUESTIONS THAT HAVE COME IN ON THE
MEDICATION SECTION:

The FAQ's are excellent.  In the next edition, I would
like to put in plug for protriptyline (Vivactil).  It's
not widely used and not widely known, but probably
should be included in the list of medications.

It's claim to fame is that it is a tricyclic antidepressant
with a very uncharacteristic tricyclic effect--it is
very stimulating and doesn't cause an increase in
appetite.  For people whose symptom profile includes
a low energy level and for whom the SSRI's just don't seem
to work, Vivactil can often do the job, because it's
main action is on reuptake of norepinephrine, not
serotonin.

It does increase constipation (like the other
tricyclics), but it's not an antihistamine and it's
other main side effect is also dissimilar to the
other tricyclics--insomnia.

I suspect that if the SSRI's had never been invented,
Vivactil would be a lot more popular than it is; however,
for some people, it's just right.

Again--great work on the FAQ's.

Scott Newman
[e-mail]

2) would like definition of 'half-life'

3) would like alternate names of drugs used in other
countries (e.g. Canada!), though I realize this might
be a bit of a nightmare.
END COMMENT