Depression: Symptoms, Treatment, and Family Support

Could you please provide more details or specify what you would like to know about depression?

Hello Doctor: My father suddenly lost control of his emotions one day a year ago and had an argument with my mother.
The argument was about unpleasant experiences from the past.
My father mentioned that these unpleasant memories were not something he intentionally thought about; they inexplicably entered his mind like shadows.
He was taken to a psychiatrist and diagnosed with depression.
However, my father has a unique situation: whenever he has a headache, sweats, and shakes all over, those shadows enter his mind, and he starts arguing with my mother again.
Our family has been accompanying him to the hospital and encouraging him to take his medication, but my father believes that taking these antidepressants makes him drowsy and leaves him feeling weak after waking up, so he is very resistant to medication.
He is also strongly opposed to psychological therapy.
As family members, we have noticed that without these medications, he experiences headaches, sweating, and shaking, which leads to more arguments with my mother.
I would like to ask the doctor: 1.
Does my father's condition qualify as depression? 2.
Do all antidepressants cause drowsiness? Are there medications that can help him stay awake instead of feeling sleepy? Thank you for your response amidst your busy schedule.

Meizi, 20~29 year old female. Ask Date: 2018/06/20

Dr. Wu Enliang reply Psychiatry

1.
Does my father have depression? To determine if he has depression, it is best to consult his psychiatrist, as a diagnosis requires a detailed interview, physical examination, and psychological testing.
I have attached an educational article about depression for your reference.

2.
Do antidepressants really cause drowsiness? Are there any medications that make you feel sleepy without actually sleeping? Yes, some antidepressants can improve mood, such as the NDRI medications mentioned below.
In any case, I encourage your father to discuss this further with his psychiatrist.
Discussing depression and its treatment is common, with approximately 4% to 18% of Western individuals experiencing depressive symptoms at least once in their lifetime, and 50% to 85% experiencing at least one recurrence.
Research from the American Psychiatric Association indicates that the lifetime prevalence of depression in the U.S.
is about 15%, with 8% to 12% in men and 20% to 26% in women.
The average age of onset is 40, with more than half of patients developing symptoms between the ages of 20 and 50.
In Taiwan, community surveys have shown a lifetime prevalence of major depression at 1.14% and mild depression at 1.66%.
However, a recent study in the southern region focusing on the elderly found a prevalence rate as high as 21.1% (5.9% for major depression and 15.2% for mild depression).
Patients with physical illnesses also have a high rate of depression (e.g., 27% to 35% for stroke, 5% to 22% for kidney disease, 20% to 30% for epilepsy, 20% for myocardial infarction, and 10% for diabetes).
Some international studies have found that depression is often underestimated, leading to delayed diagnosis or inadequate treatment, and a significant proportion of patients with other illnesses are misdiagnosed with depression.
The consequences of depression can lead to physical discomfort, job loss, disruption of social and interpersonal relationships, and even self-harm or suicide, imposing significant costs on patients, families, and society.
Depression is a prevalent, far-reaching, and life-threatening condition.
Its occurrence may be related to various factors, including psychological, social, and biological aspects.
Increasing research indicates that its biological causes are related to abnormalities in neurotransmitters in the brain.
Early diagnosis and proactive treatment can successfully treat most cases of depression and prevent recurrence.
Symptoms include emotional, physical, cognitive symptoms, impaired impulse control, and abnormal behavioral expressions.
The classification of depression is continuously evolving, and distinguishing clinical characteristics remains challenging due to considerable heterogeneity.
Treatment for depression includes psychosocial interventions and pharmacotherapy.
Effective medications for depression were not available until the 1950s, marking a significant shift in treatment options, with rapid developments from tricyclic antidepressants (TCAs), tetracyclic antidepressants, monoamine oxidase inhibitors (MAOIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), to newer selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), serotonin 2 receptor antagonists and reuptake inhibitors (SARIs), along with several new drugs under development, such as norepinephrine selective reuptake inhibitors (NESRIs), serotonin 1A agonists, and beta agonists.
The choice of antidepressant should consider safety, tolerability, efficacy, cost, and convenience.
Tricyclic antidepressants were the most widely used class in the past; these medications block the reuptake of norepinephrine and serotonin, increasing their levels in the synapse, improving neurotransmission, and alleviating depressive symptoms.
However, they also block other neurotransmitter receptors, leading to numerous side effects, particularly anticholinergic effects such as dry mouth, blurred vision, constipation, urinary retention, and delirium, which can affect patient tolerance and adherence to medication.
Other side effects include orthostatic hypotension, tachycardia, sedation, extrapyramidal symptoms, psychotic symptoms, weight gain, sweating, and sexual dysfunction.
Additionally, issues such as overdose toxicity, drug interactions, and withdrawal symptoms upon abrupt discontinuation must be carefully monitored.
Monoamine oxidase inhibitors have long been considered a second-line treatment due to adverse side effects.
When using these medications, consuming foods or medications containing certain amines can lead to severe hypertensive crises.
Other side effects include orthostatic hypotension, restlessness, agitation, sleep disturbances, confusion, weight gain, and sexual dysfunction.
Selective serotonin reuptake inhibitors are a newer class of antidepressants that have fewer side effects and are now widely used.
Current options include fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram.
"Selective" indicates effective and precise action while avoiding unnecessary side effects.
In vitro, in vivo, animal, and human studies have shown significant efficacy compared to placebo, and they are equally effective as traditional tricyclic antidepressants in alleviating depressive symptoms, providing sustained efficacy to prevent recurrence, with fewer and milder side effects, higher safety, and lower incidence of drug interactions.
Most patients tolerate these medications well, and their once-daily dosing improves adherence.
Side effects, such as gastrointestinal symptoms, restlessness, sexual dysfunction, and the time required for the medication to take effect, still require further research to overcome.
However, each medication within this class has its differences, and careful consideration of the patient's situation is necessary for selection.
Currently, in advanced countries in Europe and America, these medications are considered first-line treatments for depression.
There are still many new antidepressants available or under development.
The complex distribution of neurotransmitters in the human brain and their interrelationships make the effects of pharmacotherapy difficult to estimate.
Understanding the mechanisms of action of antidepressants is crucial for treating patients, considering their symptoms, and carefully selecting medications based on safety, side effects, efficacy, cost, and convenience, in conjunction with psychotherapy and social interventions, to improve patient conditions and restore function and health.
Dr.
Wu Enliang

Reply Date: 2018/06/20

More Info

Understanding depression, especially in the context of family dynamics, is crucial for both the affected individual and their loved ones. Your father's experience with depression, characterized by sudden emotional outbursts and physical symptoms like headaches and sweating, highlights the complexity of this mental health condition.
1. Does your father have depression?
Based on your description, it appears that your father has been diagnosed with depression by a mental health professional. Depression can manifest in various ways, including emotional instability, irritability, and physical symptoms. The fact that he experiences intrusive thoughts related to past conflicts with your mother, particularly when he is under physical stress (like headaches), suggests that his depression may be exacerbated by stressors. This is not uncommon; many individuals with depression report that their symptoms can be triggered or worsened by stress or physical illness.

2. Do antidepressants cause drowsiness?
Antidepressants can have a range of side effects, and drowsiness is one of them. However, not all antidepressants cause this effect. Some common classes of antidepressants include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which are generally less sedating. On the other hand, certain medications, particularly older tricyclic antidepressants, may cause more sedation. It's important to note that individual responses to medication can vary widely; what causes drowsiness in one person may not have the same effect on another. If your father is experiencing significant side effects, he should discuss this with his doctor, who may adjust the dosage or switch him to a different medication that better suits his needs.

Treatment and Family Support
Encouraging Treatment Compliance:
Your father's reluctance to take medication or engage in therapy is a common challenge in treating depression. Many individuals feel that medication alters their personality or leads to unwanted side effects, which can create a cycle of avoidance. As family members, it’s essential to approach this situation with empathy and understanding. Instead of pushing him to take medication or attend therapy, try to have open conversations about his feelings regarding treatment. You might say something like, "I understand that you feel tired and weak after taking your medication. Can we talk about how it makes you feel and see if there’s a way to make it better?"
Creating a Supportive Environment:
Family support plays a critical role in the recovery process. Encourage your father to express his feelings and validate his experiences. Let him know that it’s okay to feel overwhelmed and that he is not alone in this struggle. You can also help by creating a calm and supportive home environment, which may reduce stressors that trigger his symptoms.

Exploring Alternative Therapies:
If your father is resistant to traditional therapy, consider exploring alternative therapies that might appeal to him. Activities like mindfulness meditation, yoga, or even gentle exercise can be beneficial for mental health and may be more acceptable to him than conventional therapy.
Educating Yourself and Your Family:
Understanding depression and its effects can empower you and your family to provide better support. Consider reading books or attending workshops on mental health to gain insights into how to communicate effectively with your father and support him through his treatment journey.

Conclusion
In summary, your father's symptoms align with depression, and while medication can have side effects like drowsiness, there are many options available that might suit him better. Open communication, empathy, and a supportive environment are key components in helping him navigate his treatment. Encourage him to discuss his concerns with his healthcare provider, who can tailor a treatment plan that addresses both his mental health needs and his concerns about medication. Remember, recovery from depression is often a gradual process, and your support can make a significant difference.

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