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Antidepressants at College (page 3)

By — John Wiley & Sons, Inc.
Updated on Aug 25, 2011

Which Ones and How Long?

How do you decide which antidepressant to use? The standard of care today is to start with an SSRI as the first-line medication. These types of antidepressant medications are very effective, usually have minimal side effects, and are very safe to use. The choices of one SSRI over another probably are most driven by safety, provider experience, cost factors (some are now available in generic forms), and prior experience or symptoms of the student. They are all probably equally effective. It is not unusual for primary care doctors to prescribe antidepressants, but when that is the case, it is important that the person is followed regularly and the dosing is optimum. For example, if one has a lot of obsessive symptoms or binge eating urges, higher doses of medication are often needed to address those symptoms.

The other question that is frequently asked is: How long do I stay on these medications? The answer varies depending on benefits and side effects. In general, for a first episode of depression, it is recommended that people stay on medication for nine to twelve months. The reason for this is that the relapse rate is much lower if people stop after nine months.

When a person stops the medication, it is important to stop gradually. It is all too common that students forget their medication when they leave on break or vacation, and either have some discomfort withdrawing (sometimes it is irritability, sometimes flu-like symptoms or lethargy), or feel fine off the medication and decide they don't need it anymore. Unfortunately, the recurrence of symptoms often occurs one to three months after stopping the medication, so they don't notice any problems immediately.

There are several other antidepressants on the market that can be quite effective and have some different benefits and side effects. These include Wellbutrin (buproprion), Remeron (mirtazapine), Serzone (nefazodone), Desyryl (trazodone), and Luvox (fluvoxamine). The older tricyclics and another category of medication called Monoamine oxidase (MAO) inhibitors are also used. They each have their benefits and their place. Wellbutrin, for example, does not cause sexual side effects and may have some benefit for attention problems. Serzone, Remeron, and Desyryl can be sedating and help with sleep, which is a benefit or problem, depending on symptoms. One other medication worth mentioning in this category is Lamictal (lamotrigine), an anticonvulsant that shows promise in the treatment of bipolar depression, where the other antidepressants may pose the risk of causing mania. Lamictal has some rare but serious side effects and requires close monitoring.

Key Points About Antidepressants

  • For some people, depression is largely biologic, and medication makes a huge difference. Your child isn't signing up for the rest of his or her life, just a three to six week trial. If it works, usually nine to twelve months is the length of time to use them.
  • Antidepressants in general are very safe. There are unusual and rare side effects, but millions of people have been using antidepressants, and there appear to be no long-term deleterious effects.
  • When you or your child has questions or concerns about effects or side effects, ask the prescriber. There aren't any "dumb" questions.
  • Don't stop medication abruptly. Tell your child that

if he or she should forgot to bring the medication home on break or such, a temporary supply can often be obtained with a phone call to the prescriber or pharmacy.

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