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Antidepressants help ease a range of symptoms

Steve Snodgrass

With symptoms that include fatigue, decreased energy, low appetite and weight loss (or overeating and weight gain), insomnia or oversleeping, and headaches -- depression can be a debilitating medical condition. Fortunately, antidepressants have been around for decades and many have proven effective for patients.

This week on “Take Care,” we speak to Dr. Michael Hirsch about antidepressants. Hirsch is a psychiatrist and instructor at Harvard Medical School. He is also lead editor at the Massachusetts General Hospital Psychiatry Academy.

Antidepressants are medications used not only for depression but for other conditions -- like anxiety. And although doctors and scientists know how the drugs work in the brain, “we don’t understand as well how that translates into their antidepressant effect,” Hirsch says. They were actually discovered by chance.

Symptoms of depression can be wide-ranging. The most common often include: sad, irritable or anxious moods; loss of interest or pleasure; impaired concentration and decision making; fatigue and loss of energy; and feelings of hopelessness or worthlessness.

“Oftentimes people will have physical symptoms as well, and that can bring them to their doctor,” adds Hirsch.

Most depression is diagnosed by primary care doctors, according to Hirsch, and they feel comfortable doing so. But psychiatrists can also make the initial diagnosis.

“One thing to keep in mind is that there’s a really big difference between what you would consider sadness due to an external event like a relationship breakup or being fired, versus what we consider real clinical, major depression,” Hirsch says. “Major depression, in the medical sense, isn’t just everyday sadness or a response to a negative event.”

Historical information and descriptive information is used to make a diagnosis, and according to Hirsch, prescribing an antidepressant comes down to the medication’s side effects and the specific symptoms.

“There isn’t really convincing evidence that any one antidepressant works better than any other, but there are enough differences among them that for any individual patient one antidepressant – or class of antidepressants – may fit their symptoms better than another,” Hirsch says.

A patient can expect to see a response to antidepressants within a few weeks. And people who do have some sort of response in that time frame are more likely to have a full response than those who don’t.