Take time to find the right antidepressant
First, let me say I am not a fan of medicating normal, regular sadness that we encounter in our lives, such as the melancholy associated with losing a job, or when a friend leaves town, or for hormonal cycles.
But there are people who are truly depressed and experiencing the urge to harm themselves. We need to be loving and gentle with them, and if they need medicine, so be it.
So let’s get to it: What class of drug is better — a serotonin-norepinephrine reuptake inhibitor (SNRI)? A selective serotonin reuptake inhibitor (SSRI)? Or a monoamine oxidase (MOA) inhibitor?
The answer is, it depends. One category of meds might work great for you, but could be an epic fail for your friend.
Why is that? Because medication treatment should be based on the specific neurotransmitters that are imbalanced in the patient.
For instance, Zoloft (sertraline) works by making serotonin linger longer, and that’s great if you have reduced serotonin activity.
But what if that’s not your problem? What if you’re depressed because you have low DHEA, a youth hormone that declines after 40?
What if it’s low testosterone or estrogen that’s affecting you?
And what if your levels of serotonin are fine, but you have super low levels of norepinephrine or dopamine? In the latter case, Zoloft wouldn’t work, and might even be harmful, whereas Wellbutrin (bupropion) would be great!
Some of you could benefit from a medication that raises serotonin, dopamine and norepinephrine. Remeron (mirtazapine) works in this way.
Someone else may need lifting of serotonin and norepinephrine but not the dopamine. Effexor (venlafaxine) is an SNRI that does exactly that!
In short, there are many possibilities, so don’t lose hope.
Each of you responds to the medication that restores activity of the particular neurotransmitter in which you are deficient. Not everyone with depression is deficient in the same thing (or things).
Some of my readers say they are in bad shape and feeling isolated and hopeless. I want to help you. Keep doing a little more trial and error with medications (and other therapies outside the pills).
I couldn’t possibly know what’s right for everyone because neurotransmitter levels are as unique as fingerprints.
There are also many different causes for depression. Sometimes it is caused by a folate or B12 deficiency, or thyroid illness. Sometimes it’s from very high inflammatory compounds, or from a biotoxin like mold. It can even be medication-induced.
If you feel like you’re at your wits’ end and you’ve tried everything, or that it’s just “time to go” or to “stop being a burden to others,” please stop thinking that immediately because it simply isn’t true. You haven’t tried everything. There are people who love you and need you.
Suicide prevention hotlines
There are number of hotlines available to help on a 24/7 basis, including:
The National Suicide Prevention Line, call 1-800-273-8255 or text HELLO to 741741
In Northern Virginia, call PRS CrisisLink at (703) 527-4077.
In Washington, D.C., call 1-888-7-WE-HELP or 1-888-793-4357.
Montgomery County, Maryland’s 24-hour hotline is (240) 770-4000.
Veterans can call the Veterans Crisis Line at 1-800-273-8255; Press 1.
This information is opinion only. It is not intended to treat, cure or diagnose your condition. Consult with your doctor before using any new drug or supplement.
Suzy Cohen is a registered pharmacist and the author of The 24-Hour Pharmacist and Real Solutions from Head to Toe. To contact her, visit SuzyCohen.com.