Depression (cont.)
What about discontinuing antidepressants?
Antidepressants should be gradually tapered and should not be abruptly discontinued. Abruptly stopping an antidepressant in some patients can cause discontinuation syndrome.
For example, abruptly stopping a SSRI such as paroxetine can cause dizziness, nausea, flu-like symptoms, body aches, anxiety, irritability, fatigue, and vivid dreams. These symptoms typically occur within days of abrupt cessation, and can last one to two weeks (up to 21 days). Among the SSRIs, paroxetine and fluvoxamine cause more pronounced discontinuation symptoms than fluoxetine, sertraline, and citalopram. Some patients experience discontinuation symptoms despite gradual tapering of the SSRI. Abrupt cessation of venlafaxine can cause
discontinuation symptoms similar to those of SSRIs.
Abruptly stopping MAOIs can lead to irritability, agitation, and delirium. Similarly abruptly stopping a TCA can cause agitation, irritability, and abnormal heart rhythms.
What about self-help?
Depressive disorders make those afflicted feel exhausted, worthless,
helpless, and hopeless. Such negative thoughts and feelings make some people
feel like giving up. It is important to realize that these negative views are
part of the depression and typically do not accurately reflect the actual
situation. It should be remembered that negative thinking fades as treatment
begins to take effect. In the meantime, the following are helpful guidelines and
advice for the depressed individual:
- Eat healthy foods and make time to get enough rest to physically promote improvement in your mood.
- Express your feelings, either to friends, in a journal, or using art to help release some negative feelings.
- Do not set difficult goals for yourself or take on a
great deal of responsibility.
- Break large tasks into small ones, set some
priorities, and do what you can when you can.
- Do not expect too much from yourself too soon, as
this will only increase feelings of failure.
- Try to be with other people, which is usually better
than being alone.
- Participate in activities that may make you feel
better.
- You might try exercising mildly, going to a movie or
a ball game, or participating in religious or social activities.
- Don't rush or overdo it. Don't get upset if your mood
is not greatly improved right away. Feeling better takes time.
- Do not make major life decisions, such as changing
jobs or getting married or divorced without consulting others who know you
well. These people often can have a more objective view of your situation. In
any case, it is advisable to postpone important decisions until your
depression has lifted.
- Do not expect to "snap out" of your depression.
People rarely do. Help yourself as much as you can, and do not blame yourself
for not being up to par.
- Remember, do not accept your negative thinking. It is part of the
depression and will disappear as your depression responds to treatment.
- Plan how you would get help for yourself in an emergency, like calling friends, family, your physical or mental-health professional or a local emergency room if you were to develop thoughts of harming yourself or someone else.
- Limit your access to things that could be used to hurt yourself or others (for example, do not keep excess medication of any kind, firearms or other weapons in the home).
Next: How can someone help a person who is depressed? »
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