Also they can be treated with a variety of antidepressant medicaments, which accompanied of a psychotherapy, can completely alleviate the depressive disorders. The only psychotherapy is effective in some people with forms lighter than depression. The people with moderated or severe depression more often improve with antidepressant. The majority obtain an optimal result with a combined treatment of medicaments to obtain a relief relatively quick of the symptoms and psychotherapy to learn to confront better the troubles of the life, including the depression. The Psychiatrist can prescribe medicaments and one of the diverse forms of psychotherapy that have shown to be effective for the depression, or both, depending on the diagnosis of the patient and the seriousness of the symptoms.

There are many forms of psychotherapy that can be used with the depressive patients, some therapies are short term (10-20 weeks), can be useful for the depressive patients. The therapies “of conversation” help the patients to analyze their troubles and to solve them, through an oral exchange with the therapist. Sometimes these talks are combined with the “tasks to do in house” between a session and another. The professionals of the psychotherapy who use a therapy “of behavior” try to help that the patient finds the most satisfactory form of obtain it through their own actions. Also, they guide the patient to abandon the patterns of conduct which contribute to their depression or that are consequence of their depression.

There is an electro-convulsive therapy, which is done in patients whose depression is severe, in melancholic depressions or in depressive states that put on danger your life and for the patients that cannot take antidepressants. This therapy is often effective in cases in which the antidepressant medicaments don’t supply a sufficient relief. Before administrate the treatment, which is done under anesthesia of brief duration, it’s applied a muscular relaxing. Electrodes are put on precise places of the head, to send electrical impulses. The stimulation cause a brief convulsion (approximately 30 seconds) inside the brain. The person who receives the treatment doesn’t perceive consciously the electrical stimulation. To obtain the maximum therapeutic benefit are required several sessions, usually an average of three by week.

There are many types of medicaments, medicines and/or antidepressant remedies used to treat depressive disorders, that don’t solve the problem, but they hide it, just like the conventional drugs (hashish, heroin, cocaine, so on). These include the “selective inhibitors of the recaptation of the Serotonin” (ISRS) that are new medicaments, the tricyclic and the “inhibitors of the monoaminoxidase” (IMAO). The ISRS and the other medicaments even newer that affect the neurotransmisors like the dopamine or the noradrenalin, generally  have less secondary effects than the tricyclics. Sometimes the physician proves a variety of antidepressants before being found the medicament or the most effective combination of medicaments. Generally the dose should be gone increasing until the medication is effective. In general, the complete therapeutic effect of the antidepressant medicaments is not observed immediately. We have to take it en appropriate dose for 3 or 4 weeks, and in some cases it takes until 8 weeks, to being produced the complete effect. However, sometimes they begin to see improvements in the first weeks.
It’s possible that the patient is felt tempted to stop taking the medicament prematurely. The patient can be felt better and think that it isn’t needed anymore. Or can think that the medicament is not helping at all. It’s important to follow taking the medicament until this has opportunity of acting in the body. Some secondary effects (see section Secondary Effects, page 13) can appear even before it’s produced the antidepressive effect. Once the patient feels better, is important to continue with the medicament for 4 to 9 months to prevent a relapse of the depression. Some medicaments must be stopped taking gradually (that’s reducing the dose little by little) to give time to that the body adapts and to prevent symptoms of abstinence, those which are produced when some medicaments are discontinued abruptly. In the cases of bipolar disorder and severe depression chronic or recurrent, it’s possible that the patient has to take the medicament indefinitely.

 

On the contrary about some people think, the antidepressant medicaments are not addictive. However, like happen with any kind of medicaments prescribed by extended times, the antidepressants have to be supervised carefully by the physician to determine if they are given in a correct dose. The physician must verify the dosage and the effectiveness of the treatment periodically.
There is a little group of people who doesn’t respond to the antidepressants used more commonly (tricyclics, ISRS and other new antidepressants) and for which the IMAO are the best treatment. People who are taking this type of antidepressants must avoid some foods. Certain aliments contain high levels of the substance named Tyramine (the one which normally is found in fermented cheeses, wines and pickle, or canned food of vinegar). When the patient takes a IMAO, these aliments must be strictly avoided, just like some medicaments like the decongestants that are taken for the colds and some allergies. The interaction of the Tyramine with the IMAO can cause a hypertensive crisis (sudden and extreme increase of the blood pressure) that can take to the rupture of an artery in the brain, that means a stroke. The physician must supply to the patient a complete list of the forbidden foods. The patient must take this list with him/her every time. The other types of antidepressants (tricyclics, ISRS and other new antidepressants) don’t require food restrictions.

They must never be combined medicaments of any kina – prescribed, without prescription or borrowed – without consulting the physician. Any other health professional who can prescribe you a medicament (for example the dentist or another specialist) has to know which medicaments are taking the patient. Although some medicaments are innocuous when are taken alone, if they are taken in combination with others can cause dangerous secondary effects. Some substances, like alcohol and drugs of addiction, can reduce the effectiveness of the antidepressants and therefore they must be avoided. They must be avoided the wine, the beer and the distilled alcoholic drinks, for example, tequila, gin, rum, vodka, whisky and liquors. To some people who are taking one of the new antidepressants, the physician can allow them the use of a moderated quantity of alcohol, if the person has not had an alcoholism problem.
The sedatives or anxiolytic medicaments, which are given for the anxiety, are not antidepressants. Sometimes are prescribed together with the antidepressants, however, by themselves are not effective to treat the depression. The stimulants, like the amphetamines, are not effective to treat the depression. Occasionally they are used under strict medical supervision in people who suffer at the same time of a physical disease and depression.

The questions about the prescribed antidepressants and troubles which can be related with the medicament, must be treated with the physician.
The lithium has been for many years the treatment of election for the bipolar disorder by its effectiveness to prevent the extremes of the state of mood common in this disorder. Its use must be supervised carefully by the physician, because there is little difference between the effective dose and the toxics. If a persona had a preexistent disorder of thyroid, renal, cardiac or epilepsy, the lithium cannot be advisable. Luckily, other medicaments have demonstrated to be useful to control the extreme changes of mood. Among these are found two anticonvulsives: The Carbamazepine (Tegretol®) and the Valproic Acid (Depakote®). Both medicaments have had a wide acceptance in the clinical practice. The Valproic Acid has been approved by the Food and Drugs Administration of USA like a treatment of first line for the acute mania. Other anticonvulsives that were starting to use more recently are the Lamotrigin (Lamictal®) and the Gabapentin (Neurontin®). We are studying how effective are these for the treatment of the bipolar disorder.
Most of the people with bipolar disorder take more than a medicament. Together with the lithium and an anticonvulsive, the patient can need a medicament for other symptoms which are associated frequently with the bipolarity: agitation, anxiety, depression and insomnia. It’s de vital importance to find the best possible combination of these medicaments for each patient. For this, it’s required that the physician supervise the treatment carefully.

A great percentage of people suffer unpleasant secondary effects, sometimes unusual or that interferes with the normal functioning, so the patient must inform immediately to the physician, so that the doctor changes you the prescription. These are the secondary effects more common of the antidepressants and the forms of handle them.

• Dry mouth: Is useful to take sips of water, eat chewing gum, brush your teeth daily.
• Constipation: The diet must include cereals with high content of fiber, prunes, fruits and vegetables.
• Difficulty when urinate: Empty the bladder can be hard and the spurt of urine cannot be so strong as usual; that must be notified to the physician if there’s a serious difficulty or pain.
• Sexual Problems: The sexual functioning can be altered; if it becomes worrying, it must be talked with the physician.
• Blurred Vision: This generally happens soon and doesn’t require glasses.
• Sickness: It’s convenient to get up slowly from the bed or the chair.

• Daytime drowsiness: This generally happens soon. One person who feels drowsy or sedated should not drive nor operate machines or vehicle. The antidepressants more sedatives are taken generally when you go to bed, to help to sleep and minimize the daytime drowsiness.
• Headache: Generally it passes.

• Nausea: It’s also temporary, even when the sensation of nausea occurs after each dose, it’s only for a while.
• Nervousness and insomnia (difficulty to sleep or wake up often during the night): These can occur during the first weeks; usually they are solved with the time or taking a smaller dose.

Agitation (to feel worried, trembling or nervous): If this happens for first time after taking the medicament and it’s persistent, the physician must be notified.