Answers About Antidepressants

Last night we invited your questions in response to our coverage of antidepressants and the risk of suicide. We received hundreds of questions from viewers, and while we can't answer them all, ABC's Medical Editor Dr. Tim Johnson has worked to answer some of them as best he can. Check out his answers below.

Question: How long can someone stay on Paxil, years? Then how does one get off the medication? (from Cindy R. in Tampa, Fla.)

Answer: Only your doctor can tell you how long to stay on a medication. Some patients stay on antidepressants for years, as long as the drugs continue to help and don't cause troublesome side effects. Paroxetine (sold as Paxil) can have side effects, such as dizziness, confusion, unusual dreams or feeling "drugged." You should talk to your doctor about any and all side effects you experience while taking the drug, and your doctor may or may not decide to take you off the drug because of those side effects.

If you do stop taking the medication, a doctor will typically suggest taking smaller and smaller doses, until you aren't taking anything at all. If you suddenly stop taking paroxetine, you may experience withdrawal symptoms such as depression or anxiety. Again, tell your doctor if you experience any of these symptoms when your dose of paroxetine is decreased.

For more information on Paxil and its side effects, check out http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a698032.html#how

Question: My impression of antidepressants is that they're basically a crapshoot -- odds are you'll feel even worse and have to switch a couple of times before you feel better. Do you think science will ever progress enough that a blood test can determine the right medicine and its dosage? (from Ron B. in Erie, Penn.)

Answer: Unfortunately, even scientists are stymied by antidepressants and the way they work. The brain is a very complicated organ, so it isn't always easy to treat with medication. Most antidepressants take about a month to "kick in" -- and that month can be a critical period of adjustment. But the drugs do help a lot of people feel better, even though it can sometimes be hard to find the drug that works best.

There actually is a test, called the CYP450 test, that can basically tell whether or not a drug might "work" with your metabolism. But the test can't tell you whether that drug will alleviate depression, and it only works for certain drugs. It's possible that someday, scientists will find a more exact test, but we may have a long way to go before then.

Question: My wife is taking Lexapro after her first pregnancy to help with feelings of depression. We are ready to have another child and I am worried that this drug could affect her next pregnancy. Is it OK for her to be taking this drug while she is pregnant? (From Jeff S. in Kinston, N.C.)

Answer: That's actually a tricky issue -- something that your wife definitely needs to discuss with her doctor. Taking antidepressants during pregnancy could pose risks for your baby, but stopping may pose risks for your wife. Some antidepressants have not been linked to increased birth defects -- including fluoxetine (Prozac, Sarafem, others), sertraline (Zoloft) and bupropion (Wellbutrin) -- but scientists are still looking.

As far as Lexapro goes, here's what the experts say about that:

"Studies in animals in medicines similar to this one have shown that it may cause decreased survival rates and slowed growth in offspring when given to the mother in doses many times higher than the usual human dose. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant."

For more information on antidepressants and pregnancy, check out: http://www.mayoclinic.com/health/antidepressants/DN00007

Question: Regarding treatment of depression, does it differ how treatment would be applied based on the source of depression? For example, if someone knows why they are depressed versus someone that doesn't know. Is depression basically always the same? (From Ed M. in Philadelphia.)

Answer: No, depression is not always the same and the same treatment won't work for everyone. For example, people who have low self-esteem or who are readily overwhelmed by stress, are prone to depression. And in recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs.

Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses, or none at all.

That's why it's helpful to talk about depression with a psychiatrist, therapist or someone else you trust when figuring out a short- or long-term treatment. Question: My 12-year-old daughter was just put on Zoloft yesterday. What are some of the signs I need to watch for if there are any thoughts of suicide? I am very interested in this now. (from Cindy M., Coconut Creek, Fla.)

Answer: It's good to know that for any patient taking antidepressants the first month is a critical period because all antidepressants take about a month to start working. The American Association of Suicidology has a list of warning signs for suicide, with the helpful mnemonic acronym: IS PATH WARM?

I is for Ideation: Expressed or communicated ideation, such as threatening to hurt or kill oneself, or talking about wanting to; looking for ways to kill oneself by seeking access to firearms, available pills, or other means; talking or writing about death, dying or suicide, when these actions are out of the ordinary.

S is for Substance Abuse: Increased substance (alcohol or drug) use

P is for Purposelessness: Feeling or expressing no reason for living; no sense of purpose in life

A is for Anxiety: Anxiety, agitation, inability to sleep or sleeping all the time

T is for Trapped: Feeling trapped (like there's no way out)

H is for Hopelessness: Feeling hopeless or a sense of hopelessness

W is for Withdrawal: Withdrawal from friends, family and society

A is for Anger: Feeling rage, uncontrolled anger, seeking revenge

R is for Recklessness: Acting reckless or engaging in risk activities, seemingly without thinking

M is for Mood Change: Dramatic mood changes It's important to talk to a doctor you trust if these signs show up in a loved one, or in yourself. There are treatment options -- including things other than typical antidepressants -- that doctors can recommend.

For more information on suicide, depression, and treating depression, check out the resources below.

From the Suicide Prevention Action Network: http://www.spanusa.org/

Treatment info from Mental Health America: http://www.mentalhealthamerica.net/

From the American Psychiatric Association: http://www.psych.org/

From the National Institutes of Health: http://www.nimh.nih.gov/publicat/depression.cfm

For parents of children or adolescents with depression: http://www.parentsmedguide.org/

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