Best medication to lift chronic depression?
Q.I would like some advice on the best medication to lift a chronic depression. First the background. I'm 28 yrs old and have been suffering from severe OCD since I was about 17. The OCD has gotten better over the years and it doesn't bother me as much now as it used to. It's still there of course, but I think I can handle it. The real problem is that my OCD led me into a severe depression about 7 years ago. It wont go away despite medication. The depression is marked by difficulty in communicating with people and _extreme_ difficulty to sleep. The quality of my sleep is strange too and I have chronic dizziness with problems to walk properly. I think this is all because the depression. Imagine having this for years and years! Or is it a depression? Perhaps it's something else. I have undergone CAT scan, polysomnography, EEG and there is nothing "neurologically" wrong with me. Personally I'm convinced this is depression that has become chronic. Can it be lifted? Should I try different medications and seek a "magic bullet".
A.There is no "best" medication for depression--each medication will respond differently in different people. A very sedating antidepressant with strong antianxiety qualities is doxepin. It's also really inexpensive in generic form. Side effects include dry mouth and constipation and its therapeutic action is blocking reuptake of both serotonin and norepinephrine. It's also a very strong antihistamine if you have allergies or excess stomach acid. Another "old-time" sedating antidepressant is amitriptyline with more effect on serotonin than norepinephrine but with slightly more anticholinergic side effects (dry mouth, constipation) than doxepin. Amitriptyline was the most prescribed antidepressant until the advent of Prozac and other SSRIs. Be very careful about medication for depression. My original diagnosis was clinical depression and over a two year period I was on Proza, Zoloft, Lithium and more. They all pulled me down further. A second opinion from NIMH sent me for a sleep study where it was found that I had severe OSA. Now that I am sleeping (I had operations for a deviated septum and a UPPP) with a CPAP, I am off all medicines and my spirits have soared. Unfortunately, too many doctors and shrinks think that pills solve everything and they know very little about sleep disorders. When constant sleep deprivation robs you of your ability to think straight and you begin screwing up at work and in relations there is every reason to be depressed. Most medication given for depression can be contraindicated for people with sleep disorders. Check the Sleep Well web site for info on where you can go for information. OSA is Obstructive Sleep Apnea. The individual so afflicted stops breathing(apnea) due to the airway, deep in the throat, collapsing during attempts at inhalation. This happens only during sleep. The attempts by the body to overcome the collased throat (obstruction) results in a sleep arousal, often unknown to the sufferer. This condition is best diagnosed in a sleep disorders laboratory. Often the best treatment is something called CPAP (Continuous Positive Airway Pressure). A little machine that blows some air to the sufferer through a little mask on the nose. This is done only when the individual goes to sleep. And Depression can possibly be a result of untreated OSA. When the OSA is treated, the depression might be relieved.
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