Depression is characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. Exact cause is unknown but probably involves heredity, changes in neurotransmitter levels, altered neuroendocrine function and psychological factors.
Depression is potentially life threatening and it can occur at any age from childhood to late life. Many of affected are socially disabled. The most common complication of depression is suicide.
There is long term risk from taking SSRI, for example persistent sexual dysfunction, increased risk of liver toxicity and deteriorating health. However, there is improved efficacy and adverse effect profile than tricyclic antidepressants. The typical side effect of SSRI includes: agitation, anxiety, dizziness, headache, insomnia, nausea, nervousness, somnolence, drowsiness and tremor.
The side effects of serotonin reuptake inhibitors includes arrhythmias, heart block, convulsion, drowsiness, dry mouth, blurred vision, constipation and urinary retention.
SSRI is often the initial drugs of choice. Different SSRI are equally effective for typical cases, but certain properties of the drugs make them more or less appropriate for certain patients. If one SSRI is ineffective, another SSRI can be substituted , or an antidepressant from a different class may be used instead.
For a first episode of mild or moderate depression, the antidepressant should be given for 6 months, then taper gradually over 2 months. If the episode is severe or there is a recurrence or there is a suicidal risk, the dose that produces full remission should be continued during maintenance. Continued therapy with an antidepressant for 6-12 months (up to 2 years in patient > 50 years old) is usually needed to prevent relapse.
Counselling play a main role in patient taking antidepressant medication. Side effects of medication may occur immediately but resolution of symptoms may take 2-4 weeks. Thus, assessment of compliance at every visit is a must. Family and friends should be involve in the assessment of response as well.
