Why do I feel so depressed?
Depression does not occur because someone has done something “wrong”. Like any other medical illness, depression is caused at least in part by biochemical changes in the brain, which lead to depressive symptoms. This is why medications which help correct chemical imbalances in the brain relieve depression. In fact, if a chemical imbalance is not present, antidepressant medications will not have any effect – they will not make a person “happy” when they are not clinically depressed.
How long before I feel better?
Generally speaking, people will start to notice improvement in symptoms such as sleep disturbances or crying spells and energy levels a few weeks after starting their treatment. Improvement in depressed mood is usually slower, and it may take six to eight weeks before people notice they are feeling much less depressed. If someone has not improved after three to four weeks of therapy, the dose of the initial medication may be optimized, a different drug may be added, or the initial drug may be substituted. Up to 80% of people with depression do get better with the right medication.
Will my depression come back?
The likelihood of depression recurring depends on how many previous episodes you have had. For people who are experiencing their first depression, the likelihood of having a second episode is around 50%. For people who’ve had two depressive episodes, chances of having a third are around 70% and for those who’ve had three and more episodes, all but 10% will experience further illness. Having someone else in your family who has depression makes it more likely your own depression will recur. Other risk factors for recurrent depression are the presence of chronic medical problems, a history of early trauma or abuse, dysthymia, onset of depression younger than 25 years or older than 60 years, and a long pattern of negative thinking, low self-esteem and relationship difficulties. A depression which does not completely resolve with treatment, as well as severe depression, also increase the likelihood depression will recur.
This is why most people with depression need to be treated for at least six to nine months to prevent relapse, and for greater than 12 months if someone is being treated for a recurrent episode. Depending on the likelihood of depression recurring, some people stay on the same dose of their medication for long-term maintenance therapy. The saying doctors have is, “The dose that gets you well is the dose that keeps you well” and people will do better over the long run if the same dose is used throughout.
Can I pass depression on to my children?
Certain types of depression, especially, bipolar affective disorder, would appear to run in families. However, even identical twins do not share an equal risk to develop depression, and depressive illness appears to be a combination of vulnerability to depression (part of which may be inherited but not necessarily), difficult life events and biochemical imbalances in the brain.
I have trouble reaching orgasm now that I’m taking an SSRI. Can I stop my medication on weekends to improve my sexual function?
Some doctors recommend drug holidays where people stop taking their medication on the weekend. The biggest concern about stopping and starting medication revolves around compliance issues, but there is some evidence that people may not respond as well to the medication if treatment is continuously interrupted. For these reasons, drug holidays are not recommended and an alternative antidepressant or an additional medication to offset unwanted sexual side effects are better solutions.