Posts Tagged ‘Antidepressants’

Antidepressants Need Time & Patience for Success – AUDIO

By Barret Procyshyn.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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Antidepressants Need Time & Patience for Success

By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy

Anti-depressants are a very common class of medications seen in the pharmacy. People of all ages can be diagnosed with depression and everyone from young teenagers to the elderly are prescribed antidepressants. Depression has been an illness treated for many years. However; we now better diagnose the disease in more recent times. While there is not much evidence newer anti-depressants are more effective than the “old ones”, new medications do have less side effects and are much better tolerated.

Antidepressants are good medications and they do work well for most people; helping them feel like their “old self” again. However; it is very important to be realistic about the medication’s effectiveness and about how you are likely to feel during the first few weeks of using the medication. If you can better understand both the positive and negative effects of the medication, you will be more likely to have success with the treatment. While on an antidepressant, take note of any side effects and whether or not they improve. It is a good idea to keep some type of journal for your health care providers.

As mentioned, newer antidepressants now have fewer side effects than older generation treatment options. However, side effects can and still do occur. The good news is side effects usually arise around the start of treatment and diminish in a few days or weeks. Although the side effects may be bothersome most are not dangerous. The most common side effects are nausea, vomiting, diarrhea, trouble sleeping, headaches or jittery feelings.

To reduce side effects, antidepressants are often started at low doses and are slowly increased over time. Your pharmacist can also recommend other strategies to reduce side effects. For example you may want to take smaller, but more frequent doses to reduce nausea or vomiting. If you are finding the antidepressant is making it hard to fall asleep, taking it in the morning may be an effective solution.

Occasionally long term effects from antidepressants do occur. Certain antidepressants may cause these long term effects, while others do not, so do not be surprised if your doctor tries switching to a different antidepressant at some point. Weight gain sometimes does occur when antidepressants are used. This may be due to increased appetite or regaining weight lost due to the depression. Exercise and a well-balanced diet are very effective. Exercise may also help with the treatment of depression so it is something to strongly consider.

As mentioned, insomnia is usually a short term problem but it can be prolonged. Consistent sleeping times, eliminating caffeine consumption later in the day and avoiding alcohol are all good sleep practices. Short term sleep aid medication can be used as a last resort.

A more serious long term effect of antidepressants can be emotional numbness. This is when you feel emotionally detached from events and people you would normally care about. This lack of feeling may result in switching to a slightly different antidepressant or lowering the current dose. No matter the circumstance never stop an anti-depressant without consulting a health professional first. These medications need to be stopped slowly with a decreasing dose.

While antidepressants are effective, they are a very slow acting medication. While Tylenol may help a headache in a matter of minutes or an antibiotic clears an infection in a few days antidepressants can take weeks to start working. Some patients may think their new medication is not working, however; it just has not been given enough time. This misunderstanding can sometimes cause treatment failure. While some patients may feel the benefits in the first week, most benefits begin to appear in two to four weeks. Usually your doctor will make adjustments to doses within four weeks if no response is seen. If a dose increase or multiple increases are not effective, the medication can be switched or another medication is sometimes added. Patience is the key to success. It can take up to eight weeks for some patients to feel the full benefit.

Treating depression successfully will result in improved energy, better sleep and hopefully better overall functioning. You will hopefully see improvements in your social life and in work performance. Life can start looking up again and you will start enjoying things you might have lost interest in.

 

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Antidepressants and Blood Thinners

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

My dad grew up near Lake Superior in Northern Ontarioin small town called Wawa.  When he grew up, Wawa had no highway connecting it to the rest of Canada and no TV.  My mom grew up just outside of Hamilton in a town called Ancaster.  So my mom was a city girl.  They met when my dad was going to University in Hamilton.  Eventually my dad took my mom back to Wawa.  On one trip he took her moose hunting.  My mom and dad were in one canoe and my grandfather and Edward Nimmon were in another.  My grandfather and Edward went to one end of a peninsula and pushed bush to drive the moose towards my mom and dad at the other end.  My mom described it as a beautiful day.  It was warm.  They tied up their canoe at the bottom of a little six foot cliff, scrambled up the rocks and got comfortable.  They just had to wait until the moose showed up.  Then my mom remembers a distant rustling and cracking noise.  The noise was getting louder.  And louder.  Then in my mom’s mind everything started to shake like an earthquake.  She said, “Bob, I’m scared we have to go!”  My dad gently convinced my mom to stay and got prepared to shoot the moose that was going to pop out of the bush.  But my mom was going to have none of that.  She told my dad she was going to jump off of the 6 foot cliff into the canoe below and paddle away to safety.  Now my dad had a decision to make.  Take the shot at the moose his dad and hunting partner had pushed through the bush or save his wife and their canoe.  So he probably made the right decision and put down his rifle.

 

Human beings are notoriously bad at assessing risk.  My mom was convinced the moose was going to do her such harm that she was willing to jump off a cliff into a canoe.  That would have been an obvious overreaction to the risk she was facing.

 

I had a patient ask me about an article in the Canadian Medical Journal.  The patient had heard an interview with a doctor about this article and it had scared her.  During the interview it was said that if someone was taking an antidepressant and ASA together, the patient would bleed a lot.  The interview said that doctors and pharmacists didn’t know about this interaction.  The interview said maybe patients shouldn’t trust their doctors and pharmacists.  Was this interview an overreaction to the study?  Let’s review what the article said.

 

In the September 26, 2011 edition Labos et al published a paper about the risk of bleeding when a patient took an SSRI and antiplatelet therapy together.  SSRI stands for Selective Serotonin Reuptake inhibitor.  An SSRI is a type of antidepressant.  The original SSRI was prozac, but the class now includes several other products like paxil or paroxetine, zoloft or sertraline and celexa or citalopram.  Antiplatelet agents include ASA and clopidogrel or plavix.  These medications are used to thin the blood to prevent heart attacks and strokes.  They are often given after a patient has a heart attack to prevent another one.  The paper was an interesting read.  The authors did say that if an SSRI and ASA or clopidogrel were taken together the chances of bleeding went up.  And no, I didn’t know about this interaction before I read this study. 

 

The study looked backwards on the records of 27, 058 patients who were over 50 and discharged from the hospital after a heart attack.  The authors followed the records of these patients until they were admitted to the hospital with a bleed, a heart attack, the patient died or the study period ended.  The authors of the study concluded patients on an SSRI plus either ASA or clopidogrel or both have an increase chance of a bleed.  But the study was not perfect.  To begin with it wasn’t a double blind placebo controlled trial.  That means the people running the study weren’t able to control what the study subjects were doing.  For example the authors only knew if a patient filled their ASA by prescription.  They had no idea if a patient went and bought ASA over the counter and used it.  The study authors had no idea if patient bought other things over the counter that cause stomach bleeds like ibuprofen.  The study authors had no idea if the patients actually took their drugs.  They only know the drugs were purchased at a pharmacy.  So although the study results are interesting, they should be confirmed by other studies before we leap to any conclusions.

 

Next let’s assume SSRI’s when given with ASA or clopidogrel increase the chance of a stomach bleed.  Should we never ever put someone on ASA and an SSRI?  As usual we would have to balance the risk versus the benefit.  If we had a patient in her 40’s who was at risk of a stroke and was also depressed, what should we do?  Given such a patient is at low risk of a stomach bleed, the doctor might rightly decide to put her on an SSRI for her depression and ASA to prevent a stroke.  The doctor should monitor the patient for signs of a stomach bleed, but taking the two medications together would be possible.

 

I’m glad this study was brought to my attention.  Although I don’t think an interaction between SSRI’s and antiplatelet medications has conclusively been proven, if possible I will recommend a patient not to take both.  But I don’t want anyone to rush out and throw away either their ASA or their antidepressant.  The risk of a bleed is not 100%.  Your doctor may think the bleeding risk is low in your case.  In any case discuss your concerns with your doctor before you do anything rash.  Otherwise you will be jumping into a canoe from a cliff.

 

As always if you have any questions or concerns about these or other products, ask your pharmacist.

 

CMAJ article http://www.cmaj.ca/content/early/2011/09/26/cmaj.100912.full.pdf+html

 

Have you heard Trevor on the radio?  Listen to 730 CKDM Tuesday Mornings at 8:35 am!  We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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