Depression is a condition lasting at least two weeks in which sadness prevents people from functioning up to their capacity. They lose enjoyment and interest in usual activities, are sad and cannot express warm emotions towards other people, sleep all the time or barely at all, are exhausted, lose their ability to concentrate or think clearly, have feelings of worthlessness or inappropriate guilt, feel that life is hopeless, and they eat less or more than usual. Insomnia in young men is associated with a marked increased risk for depression that persists for at least 30 years afterwards (1). Doctors can treat depression effectively with antidepressants, and the most used and effective antidepressants are called Prozac, Paxil and Zoloft. They raise brain levels of a specific chemical called serotonin that helps to make people feel good. A once a week dose of Prozac can often control depression (2). High brain levels of serotonin often reduce sexual desire (3). On the other hand, Wellbutrin does not raise brain levels of serotonin significantly, does not reduce sexual desire and may even increase desire (4). Patients who need to stay on the serotonin-uptake-inhibitor antidepressants, but want to maintain interest in making love can take the shorter-acting Paxil or Zoloft safely four days a week from Monday to Thursday and not take them from Friday to Sunday (5). Taking Prozac intermittently does not prevent loss of libido because it is a long-acting antidepressant.
When a single drug fails to alleviate depression, two or more drugs taken together are far more effective (6). Buproprion (brand name Wellbutrin) combined with Prozac, Paxil or Zoloft, appears to relieve depression more effectively than single drugs. However, patients on the combination regimen still have a high incidence of decreased sexual desire, insomnia, tiredness and tremor.
Drugs to raise brain levels of serotonin are far more effective in treating depression than just psychotherapy and talking (9) because depression is associated with low brain levels of the neurotransmitter serotonin.
Antidepressants that raise brain serotonin levels are used for other effects. Sibutramine is the new drug to suppress hunger and treat overweight. They may be the drugs of choice to treat premenstrual syndrome (7) and have been shown to treat attention deficit disorder (hyperactivity) in children who are unable to learn because they can't stop moving (8). They can be given safely to people with heart disease (8). Also see my report on thyroid hormones to treat depression
1) PP Chang, DE Ford, LA Mead, L Cooperpatrick, MJ Klag. Insomnia in young men and subsequent depression: The Johns Hopkins Precursors Study. American Journal of Epidemiology 146: 2 (JUL 15 1997):105-114.
2) Burke, W.J.; Hendricks, S.E.; Mcarthur-campbell, D. Is once weekly administration of antidepressants feasible? Experience with fluoxetine. CNS Drugs SEP 1997;8(3):199-202.
3) JH Hsu, WW Shen. Male sexual side effects associated with antidepressants: A descriptive clinical study of 32 patients. International Journal of Psychiatry in Medicine 25: 2(1995):191-201.
4) JG Modell, CR Katholi, JD Modell, RL Depalma. Comparative sexual side effects of bupropion, fluoxetine, paroxetine, and sertraline. Clinical Pharmacology & Therapeutics 61: 4 (APR 1997):476-487.
5) Rothschild AJ. Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. The American Journal of Psychiatry 1995(October);152(10):1514-1516.
6) JA Bodkin, RA Lasser, JD Wines, DM Gardner, RJ Baldessarini. Combining serotonin reuptake inhibitors and bupropion in partial responders to antidepressant monotherapy. Journal of Clinical Psychiatry 58: 4 (APR 1997):137-145.
7) KA Yonkers. Antidepressants in the treatment of premenstrual dysphoric disorder. Journal of Clinical Psychiatry 58: Suppl. 14 (1997):4-13. 8) CW Popper. Antidepressants in the treatment of attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry 58: Suppl. 14 (1997):14-31.
8) Roose SP et al. JAMA, January 28, 1998.
9) MB Jorgensen, H Dam, TG Bolwig. The efficacy of psychotherapy in non-bipolar depression: a review. Acta Psychiatrica Scandinavica 98: 1 (JUL 1998):1-13.
10) K Wada, N Yamada, T Hamamura, H Suzuki, Y Nakano, S Kuroda. Add-on polytherapy with antidepressants and its significance in inpatients with major depression. Psychiatry and Clinical Neurosciences, 1999, Vol 53, Iss 5, pp 557-562.
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