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    Frequently Asked Questions

    Antidepressants used for depression

    How long does it take for an antidepressant to work?

    If you have the symptoms of persistent sadness and inability to enjoy yourself, loss of ability to socialize and loss of interest in your usual activities, an antidepressant is likely to help. People begin to see improvement by three weeks provided that they are on the right medication at the right dose. For most patients, the starting dose is not the most effective dose for complete improvement.

    How likely is it that I will respond?

    If you have the hallmark symptoms of biologic depression, the odds are 70% that you will begin to respond by three weeks. However, people who have alcohol or substance dependence are not likely to respond.

    If I am grieving the loss of a loved-one or the loss of a job, will an antidepressant help me?

    Unless the grieving process is way out of proportion to the actual loss and persists without gradually waning in severity, it is unlikely that antidepressants will be of benefit.

    I am in an abusive marriage and feel depressed. Will an antidepressant help?

    Antidepressants are not happy pills. They only restore normal feelings, appropriate for your life situation. If you are an abused spouse or an abused employee you will need to change your situation to feel better.

    I am depressed. Should I stop working?

    If you suffer from a biologic depression (described above) it is better for you if you continue working. People who are isolated and inactive are more acutely aware of their psychic pain. People who continue to work have an earlier and more complete response to medication. Since medications begin to work by three weeks if you hold on you will be feeling better soon. Co-workers will not be able to tell that you are on a medication.

    I can experience no joy. I have no energy and no sense of vitality. I feel hopeless that I will never be the same. Can I become the person I once was?

    The odds are on your side. You should experience a full recovery on antidepressant.

    Are there any new antidepressants?

    At this writing, all new effective antidepressants have been either serotonin reuptake inhibitors, or serotonin-norepinephrine reuptake inhibitors. They have the same properties as older antidepressants.

    What is the single most important factor in predicting a response to an antidepressant?

    If you have a biologic depression you are most likely to respond to an antidepressant that a blood-related first degree relative responded to.

    How long should I stay on an antidepressant once I have responded?

    If this is the first episode of biologic depression, and you have no troubling side-effects, you should stay on for one year.

    Is it common for antidepressants to stop working?

    If you have suffered from a biologic depression, it is not likely that the antidepressant will stop working. Remember that maintenance antidepressant prevents only further episodes of biologic depression. It will not prevent common unhappiness or grief. The most common cause for loss of antidepressant response is that the antidepressant was maintained at too low a dose. It is common for patients to lose their response to the lowest possible dose and then they may develop a tolerance to the medication. A less likely cause of repeated loss of antidepressant response is if you are actually suffering from Bipolar Disorder, or have a close relative who is Bipolar I. Then you are likely to respond to a bipolar medication.

    I once had a great response to an antidepressant. Since then nothing has worked. What should my doctor do?

    Sometimes people develop a selective response to a single medication. It is most likely that you will respond again to that medication.

    I have uncomfortable side effects on antidepressant medications. Is there an antidepressant without side effects?

    Sometimes antidepressants have intolerable side effects if they are started at too high a dose. Often the medication needs to be started at less than the lowest effective dose to avoid intense side-effects. However, there are no active medications without side effects, and if you look carefully for side-effects you are likely to find them. Most effective antidepressants cause weight gain, some sexual dysfunction and sleepiness (if taken in the morning). That is why medications should only be used in cases of moderate to severe symptoms, since in those cases the benefits of the medication vastly outweigh the mild discomforts of side-effects.


    Mood Stabilizers Used for Mood Disorders

    What are mood stabilizers and who will benefit from them?

    Mood stabilizers refer to several types of medications whose primary purpose is to damp down or prevent manic highs in people with Bipolar Type I Disorder. This illness is characterized by distinct episodes of severe depression lasting several weeks or months and episodes of superhuman energy and activity with little need for sleep, again lasting weeks or months. These medications may also be used to resolve a depressive episode or prevent severe depressions in Bipolar Disorder Type 1. Nowadays the use of the term Bipolar Disorder has been broadened considerably and patients called bipolar may have problems which do not resemble the original symptoms of those with Bipolar I.

    These medications may nevertheless be helpful for people with severe depressive episodes and less prolonged or severe manic episodes (called hypo manic episodes because they are not severe).

    Sometimes people with anger problems are called Bipolar. Usually, they are not, but mood stabilizers may also be helpful for explosive anger.

    Mood stabilizers may also be used to boost the efficacy of an antidepressant, even in people who are not bipolar.

    What is rapid cycling Bipolar Disorder?

    This term is most appropriately applied when a person has several severe depressive, manic or hypo manic episodes within the same year. If you are suffering from this condition the most important thing for you to know is that it is usually caused by use of antidepressants.


    Treatment of Anxiety Disorders

     I suffer from attacks that are very frightening. They feel like heart attacks but when I go to the emergency room they find nothing wrong. What are they?

    Panic attacks are sudden episodes of adrenalin rush. The heart pounds, people feel short of breath, they feel hot and sweat profusely. Their extremities shake and feel numb. Panic attacks may also mimic asthma attacks or bouts of colitis. Often the person becomes fearful of the settings in which the panic attacks are likely to occur such as in crowded spaces or places without an easy exit such as elevators or subways.

    The panic attacks respond easily to medication, but avoidance, once it sets in, is much harder to overcome and people may be left as shut-ins long after the panic attacks are gone. For that reason it is very important that people maintain their usual activities despite their fear of panic attacks.

    I feel very self-conscious at office meetings or at parties. I can barely speak. I am apprehensive and sleep poorly before the event, and then for days after I ruminate about my social blunders. Is there a treatment for me?

    The problem that you describe is called social anxiety disorder. It responds well to several medications. It is only necessary to treat with a medication if your level of discomfort is moderate to severe. Otherwise you may respond well to a form of therapy called Cognitive-Behavioral Therapy.

    Some people with social anxiety also have a marked indifference to most social interactions and actually prefer to be alone. These people also have difficulties with understanding and following basic social conventions. This condition which has been recently labeled Autistic Spectrum Disorder does not respond as well to medicine and requires basic social skills training.

    I worry all the time and fret about the smallest changes in my schedule. I often awaken feeling and apprehensive for no obvious reason. My doctor has put me on xanax but it hardly helps. Is there a better medication?    

    Anxiety symptoms are often treated by benzodiazepines like Xanax or by serontin-reuptake inhibitors like Zoloft or by norepinephrine-serotonin inhibitors like Effexor. While benzodiazepines are helpful for the physical symptoms of anxiety such as insomnia, headaches, nervous indigestion, the SSRI’s and NSRI’s are more effective for the psychological symptoms of anxiety such as apprehension, worry, pessimism and negativism.

    I have a fear that I will hurt my daughter even though I have no wish to hurt her and the very thought repulses me. Nevertheless I keep thinking about it and lately I have the need to repeat acts such as kissing her picture in order to get temporary relief from my anxiety. What is wrong with me and is there a cure?

    Obsessive thoughts are painful repeated thoughts of loathsome actions that are frightening for the person thinking them. They are often accompanied by the need to repeat meaningless actions which are called compulsions. This disorder responds well to medication, though the best outcomes combine medication with cognitive-behavioral therapy.

    Obsessions and compulsions are not pleasurable. The thoughts are frightening and the compulsions are only performed to lessen the pain. They need to be distinguished from preoccupations which are repeated thoughts of pleasurable activities such as sex, or addictive behaviors such as gambling or substance abuse. Preoccupations and addictive behaviors do not respond as well to medication and require their own specialized therapies.


    Treatment for Attention Deficit Disorders

    Aren’t treatments for ADD way overused?

    Yes. Unquestionably there are many children placed on stimulants for behavioral problems who do not have ADD. And there are many college students popping stimulants in order to pull all nighters.

    Nevertheless, there are many cases of ADD that are frequently overlooked. Often I will see an adult who is suffering from depression due to a failure at work or a broken marriage who has had ADD symptoms since childhood. An adult with ADD appears poorly focused and distractible. He is disorganized or becomes inflexible and rigid to fight against disorganization. He is a poor listener, frequently forgetful, and often procrastinates. He tends to be irritable and impulsive in blurting out and interrupting or making impulsive purchases. These traits lead to a history of failed jobs and relationships.

    Seventy percent of adults with ADD have a good response to ADD medications. Of course, the medication is no substitute for studying and continuing to try hard. It simply makes success more likely and less difficult to achieve.


    Overall Comments about Medication

    Isn’t there a happy-pill that I can take to get over my problems?

    Medications are most helpful for the conditions for which they have received FDA approval. They are less effective as the conditions for which they are used differ from the original purposes.

    These medications can not treat the unhappiness which comes from abusive work environments or the hurt of failed relationships. They are not a substitute for the hard work of causing actual improvements in the quality of one’s life.

    I relapsed on a generic version of a brand that I did well on. Aren’t brand name drugs always better than the generics?

    Brands and their generic equivalents have the exact same chemical which is the active ingredient used to treat your problem. However, the amount of the active ingredient which each pill contains may differ by 20%. Therefore, if the brand’s tablet is supposed to contain 30mg the generic’s 30mg tablet may only have 24mg. This effective change in dose may cause a relapse in symptoms. However, to avoid taking the costly brand, the doctor can simply increase the dose of the generic by 20% to make up the difference.

    I was not doing well on the antidepressant Celexa so my doctor switched me to the newer drug Lexepro. However, I did not respond to that one either. Does that mean that I will not respond to medication?

    In the area of psychiatry, the drug companies have not come up with new medications in at least a decade. Instead, as their patents expire they invent new forms of the same medication. Although there may be slight differences in the chemical, the body cannot tell the difference between them and handles them in the same way. But since they are different chemicals (outside of the body), the FDA allows the drug company to market the drug under a new name. A doctor may inadvertently write for duplicates of the same medication because the drug is marketed as a new medication. There is no indication that the body can tell the difference between Celexa and Lexepro. It sees them as being identical.

    The same is true for “new” variations of ADD medications. There is no reason to think that Focalin works any differently from Ritalin which is the generic methyphenidate or that Vyvanse is any different from Adderall which is the same as amphetamine salts.

    The “new” antidepressant Prestique should work the same as Effexor which is also called venlafaxine.

    I’ve been drinking six to eight cans of beer on work days and a case on weekends. I’m feeling depressed. My therapist says that I’m self-medicating my depression with alcohol. Will I benefit from an antidepressant and will it help me stop drinking?

    Alcohol at the quantity you are drinking is itself a depressant and the likely cause of your depressive mood. 75% of alcohol-dependant people experience a significant improvement in mood two-three months after stopping drinking. Most antidepressants are dangerous to take if you are drinking heavily since the antidepressant is likely to decrease your liver’s ability to detoxify the alcohol. You will get better results if you seek the professional advice of a licensed addictions specialist.

     I have seen three different doctors and have been given three different diagnoses. Does that mean that psychiatric diagnoses are arbitrary?

    All psychiatric diagnoses are based upon the history you give the doctor. There are no laboratory studies that can confirm a diagnosis of an illness. In the history the doctor attempts to indentify the symptoms of the illness you suffer. There is alot of overlap between the different illnesses in that the different illnesses may share the same symptoms. For that reason the doctor most ask about the symptoms you have, as well as the symptoms you do not have, in order to clearly distinguish the problem that you suffer. If the history is incomplete the doctor may make the wrong conclusion.

    I suffer from mild depression. For years I have been treated with multiple antidepressants but I can not tolerate the side effects. Is there a medication that does not have side effects?

    All effective medications have side effects. In order to decide whether medication treatment is suitable for you, you must decide whether the benefits that you get from medication outway the side effects you suffer. Generally, people who suffer from mild symptoms of depression or anxiety do not feel that the whatever improvement gained is worth the side effects. Generally people with mild depressive or anxiety symptoms will obtain greater overall benefit from cognitive-behavioral therapy without medication. 





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    Dr. Rubin offers psychiatric services in New York at the following locations:

    Garden City, Nassau County, Long Island, NY

    Brooklyn, NY

    Midtown Manhattan, NYC

    (516) 897-0277


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