Understanding Antidepressants

Opinions towards antidepressants vary in degree with some opposing the use of them because of reasons ranging from the side effects, to addiction and withdrawal symptoms. On the other side of the spectrum, we see a high recommendation of the use of antidepressants, with proven results in the improvement of mental illnesses over time. With pharmaceutical improvements and advancement, there are also options with little to even no side effects, and a larger variety of drugs available with far more research done on them.

Today I have Dr Wallace Mendelson MD, who is the author of the book Understanding Antidepressants. In his book, he discusses and explains in depth, exactly how antidepressants work, aswel as the chemical compositions of the different types of drugs, whilst also explaining subjects such as side effects and the many different pros vs cons of each drug. He breaks down which drug is the most effective for each mental illness, whilst also providing illustrations of how it effects the brain. I believe it’s an excellent book that should be used by anyone taking antidepressants or considering it. It is a book that can be shown to your GP or therapist and further discussed. Although slightly on the technical side, in terms of the terminology used, it explains the complexity of antidepressants with amazing verbal intricacy. What I also found extremely helpful was the different scientific illustrations Dr Mendelson included throughout the book, therefore successfully attempting to break down the technical terminology used, so that it is far more easier to understand.

To further delve into the subject of antidepressants, who better to ask then Dr Mendelson himself?

Q1. Let’s start off with your book, Understanding Antidepressants. Can you tell us the reasons in which you chose to write it?

Answer: About 16 million Americans experience major depression each year, and at any given time, about one in ten is taking an antidepressant. I have been impressed that despite this widespread usage, the majority of persons taking them, and sometimes the prescribers as well, are not fully informed about them: how they work, and what their benefits and drawbacks might be. I believe that the science behind antidepressants can be expressed in a non- technical and understandable way, which makes it accessible to everyone, and that this knowledge can lead to better decision making. I also believe that it important to understand that there are very effective alternative initial treatments in the form of psychotherapy which should be considered. Additionally, there are procedures such as transcranial magnetic stimulation available if medical therapy should later be unsuccessful.

Q2: There have been both opinions and experiences of people who are against the use of antidepressants because of the risks of addiction and side effects. What are your thoughts and advice on this?

A: One of the purposes of writing this book has been so that persons who are faced with a choice of taking antidepressants can be fully informed about their possible benefits and side effects. There are too many types of antidepressants to fully enumerate side effects here, but I believe that knowing about them makes it possible to make a good judgment in balancing the possible help they may provide with possible downsides.

Having said that, I think you may be referring to one particular issue which has been in the news recently, regarding possible withdrawal difficulties when stopping medication. Let me give a little background about this: stopping antidepressants abruptly can be associated with symptoms including dizziness, malaise, gastrointestinal difficulties, and sleep disturbance. This is particularly true of tricyclic antidepressants. For these reasons, it is always best to gradually lower the dose of medicines and then discontinue after a period of time. With the selective serotonin reuptake inhibitors (SSRIs), withdrawal symptoms have been thought to occur in up to 20 percent of persons. Traditionally these have been thought to be transient. In recent years, a number of patients have begun to describe a variety of difficulties, including headaches, numbness and tingling of the limbs, dizziness, anxiety, and other symptoms, which they say can persist for months or even years. Doctors have had different responses to this. Some feel that these symptoms may be part of the re-emergence of the depression. Others (of whom I am one) think that we should listen to this growing concern and try to understand it. We do not know, for instance, how often this may potentially occur, or whether there might be ways to identify persons more likely to be susceptible to this. Clearly studies need to be done explore this, and sooner rather than later. One issue that needs to be resolved is who can be induced to do this work: the government, pharmaceutical companies, or other institutions?

Q3: There have recently also been claims that doctors have been prescribing medication too soon without trying to offer alternative methods such as therapy and counselling. There have been a few news reports stipulating this. Do you feel that these claims are correct? And if so, what do you think can be done about it?

A: I donʼt think itʼs a matter of ‘too soonʼ; rather, I think itʼs a matter of both doctors and patients being fully informed, so that they can make the best choices. The traditional teaching has been that some forms of psychotherapy such as cognitive behavioral therapy and interpersonal therapy have been found to be equally beneficial in mild to moderately severe depression, while medications are often used in more severe depressions. There are differing opinions about this. Each form of treatment has certain advantages and disadvantages. The best way to approach this is with knowledge, on the part of both doctor and patient. One goal of my book is to explain the science behind the use of antidepressants in an understandable way, so that patients can be fully informed and make better treatment choices in partnership with a doctor. Antidepressants shouldnʼt just happen to you. If a person takes them, it should be the result of a carefully considered choice.

Q4: What would your advice be to those contemplating on introducing antidepressants, but are apprehensive because of the cons such as side effects and long term reliance?

A: I think the best thing is to learn about all the possible treatments available, both psychotherapy and medications. I truly believe that an overall view of the science behind the medical treatments for depression can be expressed in a non-technical way, so that persons considering antidepressants can be fully informed. The key is to become an active partner in the decision-making, not to be a passive recipient of treatment.

Q5: And finally! Do you plan on writing anymore books on the topic of mental health?

A: Yes indeed, I am currently working on a companion book, ‘Understanding Sleeping Pillsʼ. My book ‘The Science of Sleepʼ is currently available on Amazon.

As a final note, I would highly recommend this book to everyone, simply because of its vastness of information. See it as a mini enclyclopedia on antidepressants. How many times do we pick up any product from a store, look at the ingredients list, and find that the majority of them we cannot even pronounce, forget about being aware of what they are? It’s the same with antidepressants. Yes our doctor or therapist will inform us of the effects and side effects that we’ll experience; but do we really know what the drug is and what it does? Should it not be our right that we owe ourselves to be aware?

I would like to thank Dr Wallace Mendelson for the detailed interview and giving me the fantastic opportunity of reading his book. I myself have learnt so much information of antidepressants that I had no knowledge of before. Understanding Antidepressants is highly recommended by me. Because this is the book that will make you aware of everything that ultimately you would never ask, and probably would otherwise never know, but should ask and know! And the beauty of it is, that ultimately this was Dr Mendelson’s goal behind this book, which has undoubtedly been achieved.

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