Speaking from a lifetime of depression, I can hear what you are saying. However, there is hope. I went from Zoloft to Prozac to now Paxil. The Paxil is really working for me.
Depression is a chemical imbalance in your brain. You have naturally occurring neurotransmitters in your brain, one of them being serotonin. It seems that depressed people do not have enough serotonin back in their neurons (nerve cells) and that serotonin maintains good mood.
Here is some info about it:
http://www.mayoclinic.com/health/ssris/MH00066
How SSRIs work
Precisely how SSRIs affect depression isn't clear. Certain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitter serotonin (ser-oh-TOE-nin). Some research suggests that abnormalities in neurotransmitter activity affect mood and behavior. SSRIs seem to relieve symptoms of depression by blocking the reabsorption (reuptake) of serotonin by certain nerve cells in the brain. This leaves more serotonin available in the brain. Increased serotonin enhances neurotransmission — the sending of nerve impulses — and improves mood. SSRIs are called selective because they seem to affect only serotonin, not other neurotransmitters.
Antidepressants, in general, may also work by playing a neuroprotective role in how they relieve anxiety and depression. It's thought that antidepressants may increase the effects of brain receptors that help nerve cells keep sensitivity to glutamate — an organic compound of a nonessential amino acid — in check. This increased support of nerve cells lowers glutamate sensitivity, providing protection against the glutamate overwhelming and exciting key brain areas related to anxiety and depression.
Therapeutic effects of antidepressants may vary in people, due in part to each person's genetic makeup. It's thought that people's sensitivity to antidepressant effects, especially selective serotonin reuptake inhibitor effects, can vary depending on:
- How each person's serotonin reuptake receptor function works
- His or her alleles — the parts of chromosomes that determine inherited characteristics, such as height and hair color, which combine to make each person unique
Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. Although antidepressants may not cure depression, they can help you achieve remission — the disappearance or nearly complete reduction of depression symptoms.
SSRIs approved to treat depression
Some SSRIs are available in extended-release form or controlled-release form, often designated with the letters XR or CR. These forms provide controlled release of the medication throughout the day or for a week at a time with a single dose.
Here are the SSRIs approved by the Food and Drug Administration (FDA) specifically to treat depression, with their generic, or chemical, names followed by available brand names in parentheses:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac, Prozac Weekly)
- Paroxetine (Paxil, Paxil CR, Pexeva)
- Sertraline (Zoloft)
Also, an olanzapine and fluoxetine combination (Symbyax) recently received FDA approval for treating bipolar depression. Symbyax is classed as both an SSRI antidepressant and an atypical antipsychotic.
These medications may also be used to treat conditions other than depression.
Side effects of SSRIs
All SSRIs have the same general mechanism of action and side effects. However, individual SSRIs have some different pharmacological characteristics. That means you may respond differently to certain SSRIs or have different side effects with different SSRIs. For instance, you may have unpleasant side effects with one SSRI but not another. Also, they're less likely to have adverse interactions with other medications and are less dangerous if taken as an overdose.
Side effects of SSRIs include:
- Nausea
- Sexual dysfunction, including reduced desire or orgasm difficulties
- Dry mouth
- Headache
- Diarrhea
- Nervousness
- Rash
- Agitation
- Restlessness
- Increased sweating
- Weight gain
- Drowsiness
- Insomnia
You may experience less nausea with extended- and controlled-release forms of SSRIs.
Also, here is info about bulemia. This also is caused by a chemical imbalance. It is believed in certain circles that if you treat the depression with an SSRI (selective serotonin Reuptake Inhibitor) you also can treat your bulemia...
From
http://www.psychiatric-disorders.com/articles/eating-disorders/bulimia/bulimia-treatment.php
Treating Bulimia Nervosa: Psychotherapy and Antidepressants
Bulimia nervosa responds better to treatment than anorexia nervosa. For bulimia treatment to succeed, therapy must alter the bulimic's unrealistic idea of body image and ideal weight. Healthy eating habits must be learned, and the patient must break free from the "addiction" of binge eating and purging.
Bulimia treatment may include psychotherapy, antidepressants, or a combination of the two. Cognitive behavioral therapy has better long-term results than antidepressants. A combined treatment regimen of both antidepressants and therapy is thought to yield better results than either treatment alone.
Bulimia Therapy: Changing Body Image and Teaching Healthy Eating Habits
Bulimia nervosa therapy is best performed by a specialist in treating eating disorders. For best results, the patient should undergo weekly therapy sessions for at least five months.
Cognitive-behavioral therapy is most often used to treat bulimia nervosa. The goals of cognitive-behavioral therapy are to change the patient's eating habits and his or her perception of the ideal body and weight.
During bulimia therapy, patients are educated on the health risks associated with the disease and how the cycle of binge eating and purging is affected by self-esteem and body image. Craving-control techniques and methods of developing healthy eating habits are taught during therapy.
Bulimia therapy also helps patients identify triggers of their binge eating, and develop more positive solutions to stress and emotions. As part of the process of reevaluating body image and ideal weight, therapy also attempts to improve self-esteem and replace body image with healthier methods of self-evaluation.
Antidepressants and Bulimia Nervosa Treatment
Treating bulimia with
antidepressants has shown some success. Antidepressants can lessen bulimia symptoms and support therapy in restoring healthy eating patterns. While antidepressants are used to treat depression in anorexics, the medication does not seem to affect anorexia symptoms. In contrast, bulimics often benefit from antidepressants even if they aren't depressed.
SSRI (selective serotonin reuptake inhibitors) are the family of antidepressants most commonly used to treat bulimia nervosa. SSRI antidepressants reduce the severity of obsessive behavior, anxiety, impulsivity and depression often associated with bulimia. Reducing such symptoms may help bulimia patients overcome concerns about ideal weight and return to healthy eating habits.
Fluoxetine is the only SSRI specifically approved by the U.S. Food and Drug Administration (FDA) for the treatment of bulimia. Clinical trials have shown other SSRI antidepressants have benefits for bulimia patients, including sertraline, paroxetine, and citalopram.
Clinical trials also suggest certain tricyclic antidepressants (imipramine, nortryptyline, and desipramine) and monoamine oxidase inhibitors may be useful in bulimia nervosa treatment. Treating bulimia with antidepressants containing bupropion is not recommended, as the medication can causes seizures in purging patients.
Additional Bulimia Treatments
In addition to bulimia therapy and antidepressants, a number of other treatments may help bulimics during recovery, to help reevaluate body image and develop healthy eating habits.
- Dental Care: While undergoing bulimia treatment, patients who induce vomiting may be able to slow the progress of dental erosion by using a soft toothbrush and rinsing with a fluoride rinse.
- Family Therapy: If distorted body image and eating habits are rooted in family dynamics, family therapy may help resolve issues contributing to bulimia and preventing healthy eating.
- Group Therapy: Group therapy, support groups, and 12-step programs for eating disorders provide environments in which recovering bulimics can share experiences and discuss body image and ideal weight freely with other patients. Group therapy may help reduce relapse rates.
- Laxative Dependency Treatment: Treating laxative dependency in bulimia is difficult. Attempts should be made to educate the patient about the dangers of laxative abuse and how little laxatives actually contribute to weight loss.
Restoring normal bowel function after laxative abuse may take weeks. Bowel function may return faster with a regimen of healthy eating, high fiber diet, rehydration and moderate exercise (however, exercise as treatment is not recommended when excessive exercise is part of the bulimic's purging strategy).
- Marital or Couple's Therapy: Couple's therapy helps resolve interpersonal conflicts that may otherwise hinder successful treatment.
- Nutritional Therapy: Consulting a qualified dietician or nutritional specialist may help bulimia patients learn healthy eating habits and devise menus geared towards proper nutrition and healthy eating.
Bulimia Treatment and Relapse
Overall, bulimia nervosa responds better to treatment than anorexia, and patients are often able to alter both body image and develop healthy eating habits. Elements of bulimia persist after treatment however—a recovered bulimic's sense of body image and ideal weight may always be a little distorted.
While prognosis for bulimia patients is generally positive, some factors reduce the chances of successful treatment. These include:
- denial of health problems
- frequent and persistent vomiting
- high levels of impulsivity
- history of obesity
- history of substance abuse
- hospitalization due to bulimia complications
- no motivation for recovery
- poor socialization skills
- severe depression
- severely distorted body image.
Short-term success for bulimia treatment ranges from fifty to seventy percent of cases, although relapse rates after six months can be as high as thirty to fifty percent. Few long-term studies on bulimia treatment outcomes have been pursued, so information on long-term relapse rates is unavailable.
Resources
Beers, M.H. & Berkow, R. (ed). Eating disorders: Bulimia nervosa.
The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, NJ, 1999.
Behrman, R.E. & Kliegman, R.M. (ed).
Nelson Essentials of Pediatrics, 3rd Edition. W.B. Saunders Company, Philadelphia, 1998.
Deshmukh, R. & Franco, K. (nd).
Eating disorders.
Gowers, S. & Bryant-Waugh, R. (2004). Management of child and adolescent eating disorders: The current evidence base and future directions.
Journal of Child Psychology and Psychiatry 45, 63-83.
MedicineNet. (updated 2002).
Bulimia nervosa.
Mehler, P.S. (2003, August 28). Bulimia nervosa.
The New England Journal of Medicine 349(9), 875-881.
Rome, E.S. & Ammerman, S. (2003, December). Medical complications of eating disorders: An update.
Journal of Adolescent Health 33(6), 418-426.
