Should I Take Antidepressant Medication?

Question: My son recently died and my mother is terminally ill, so I have been quite depressed lately. My doctor has given me a sample of Prozac but I am afraid to start taking it, because I am worried about the effect it might have on me. Can you please tell me what I should do?

Answer: An antidepressant medication such as Prozac may be considered in situations like this, but it is not without risks and side effects.

Let me first extend my condolences on the loss of your son and best wishes to both you and your mother.

One important distinction is that grief after a major loss can look and feel like depression, but it is not always the same condition. If symptoms are persistent, pervasive, and disabling (or include thoughts of self-harm), that may indicate a depressive illness on top of grief and should be assessed by a clinician.

Depressive Mood Symptoms

It’s understandable that you are feeling depressed. When unavoidable stress overwhelms our inborn and learned coping mechanisms, the result is often depression.

Some people react to depression by becoming despondent and lethargic. Others express their emotions by being variously anxious, irritated, worried or supercharged with racing thoughts.

Perhaps you suffer from one of these, or other symptoms of depression, such as eating too much or too little, sleep disturbances, indifference towards usually enjoyable activities (including sex), memory problems, clouded thinking and low energy. Often, stomach aches and headaches become prominent complaints.

In the worst cases, depression can lead to thoughts of suicide. If you are entertaining any thoughts about hurting yourself or others, stop reading right now and call your doctor or your local suicide hotline.

Depression Triggers

As you know, depression may be triggered by a variety of personal or social crises — such as a death, divorce or serious illness. But depression also can result from such medical conditions as an under-functioning thyroid or chronic pain. Depression even can be triggered by some of the drugs used to treat such chronic diseases as heart disease and epilepsy. Depressed patients should be checked for possible physical causes.

While we all have short periods of low moods, you probably are depressed if you have been bothered with a cluster of these symptoms for more than two weeks. In fact, around 1 in 16 Australians will experience depression this year (Beyond Blue). Women are affected more than men, and the elderly are commonly afflicted, yet woefully under-diagnosed.

As for the antidepressant Prozac (Fluoxetine), it is commonly prescribed, or a similar medication used, to help people cope when depression is lengthy or severe enough to interfere with routine tasks.

In a situation like yours, some people benefit from a time-limited course of medication, but the right duration varies and should be decided with your doctor based on diagnosis, response, and side effects.

Medication is not always the solution. In addition to — or instead of — taking a pill, there are a number of things you can do to help yourself feel better. You can find some great advice on how to dramatically and naturally improve your mood online. As always, you should discuss your situation with your health-care practitioner.

Are Mood Enhancing Medications Safe?

The serotonin-enhancing medications (SSRIs) like Prozac, Paxil and Zoloft are generally safe. They can react with other drugs that are metabolized by the same pathways, and it can be tricky using them with other psychoactive agents. Typically, these pitfalls are managed easily.

Side Effects of Antidepressants

On the other hand, some bothersome side effects include insomnia, anxiety and sleepiness. A gentle ramp-up of dosage may help reduce side effects.

Longer-term use of SSRIs can result in several significant problems. Up to 80% of long-term SSRI users report sexual problems ranging widely from increased arousal to difficulties achieving orgasm. Of course, there’s a fairly high incidence of sexual dysfunction in depressed people, so it’s hard to lay all the blame on the medications.

Some Prozac users report sexual side effects. Management options, including medication changes or other approaches, are usually discussed with a clinician.

Fatigue, daytime yawning and apathy can occur with SSRIs, too. Lowering the dose, or changing agents is often helpful. More and more doctors are recommending “hybrid” antidepressants that tend to ease some of these side effects.

Weight Gain

Perhaps the biggest unwelcome consequence of the prolonged use of all types of antidepressants is that patients gain weight. If you are concerned about gaining weight, ask your doctor to avoid Paxil and Remeron.

However, any antidepressant has the potential to add kilos if used for a long time. On the other hand, if your appetite has been destroyed by depression, you may need to eat more nutritiously, anyway.

Try Alternatives and Discontinue in Time

Prozac is a time-tested, generally safe and effective treatment. It may make sense to follow your doctor’s advice, while also considering psychotherapy and supportive habits for daily life.

Many people start to feel better over time, but medication should not be stopped abruptly or on a guess; if you and your doctor decide it’s time to stop, it is usually tapered under medical supervision.