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Diagnosis

If you have symptoms of depression, your doctor will perform a thorough physical and psychological evaluation. You will probably receive a neurological examination that assesses the functioning of your brain and nervous system by testing your coordination, reflexes, and balance. The doctor may also order blood and other laboratory tests to rule out any medical conditions that could be causing your symptoms. He or she will interview you to find out if any of your close relatives have ever had a mood disorder or if you abuse any substances, including alcohol, that could be contributing to your condition. After making a preliminary diagnosis of depression, your doctor will recommend treatment or refer you to a psychiatrist (see page 710) or other mental health professional for treatment.

Medications for Mental Disorders

Medications cannot cure a mental disorder, but they can help control and alleviate its symptoms. The length of time a person needs to take a given medication depends on the disorder. In addition, medications prescribed for mental disorders do not produce the same effect in every person. You may need to try more than one drug before you and your doctor find the one that is right for you. Sometimes a combination of medications works best.

Medications for Mood Disorders

The two most common classes of drugs prescribed for mood disorders are antidepressants, which are used to treat depression (see page 709), and mood stabilizers, which are used to treat bipolar disorder (see page 715).

Antidepressants

Doctors prescribe antidepressants for severe depression, although antidepressants also can be used to treat certain anxiety disorders (see page 718) and phobias (see page 721). It takes about 1 to 3 weeks before an antidepressant begins to improve symptoms. How long a person needs to take an antidepressant depends on the severity of the illness, but treatment usually lasts for several months and may continue up to a year or more. Up to 70 percent of people who have depression will get better if they regularly take the appropriate antidepressant medication.

Selective Serotonin Reuptake Inhibitors Selective serotonin reuptake inhibitors (SSRIs) have become the treatment of choice for depression. They work by altering the activity of serotonin, a neurotransmitter (chemical messenger) in the brain. SSRIs have fewer side effects than the older antidepressant medications.

The most common SSRIs are fluoxetine, sertraline, citalopram, fluvoxamine, and paroxetine.

Serotonin Norepinephrine Reuptake Inhibitors

Serotonin norepinephrine reuptake inhibitors (SNRIs) are newer antidepressants that work by altering the activity of serotonin and norepinephrine, two important neurotransmitters (chemical messengers) in the brain. Like SSRIs, they have fewer side effects than the older antidepressants. The most common SNRIs are venlafaxine and milnacipran.

Tricyclic Antidepressants Once the first-line treatment for depression, tricyclic antidepressants have a number of side effects, including blurred vision, constipation, weight gain, and drowsiness, although not every person experiences every side effect. They alleviate the symptoms of depression in a way similar to that of SSRIs and SNRIs. Examples of tricyclic antidepressants include imipramine, doxepin, amitriptyline, nortriptyline, and desipramine.

Monoamine Oxidase Inhibitors Monoamine oxidase inhibitors (MAOIs) work by obstructing a protein that breaks down certain neurotransmitters needed for feelings of well-being. MAOIs can interact adversely with many prescription and over-the-counter drugs and also with red wine and some foods, such as aged cheese, causing life-threatening symptoms, including dangerously high blood pressure. Common MAOIs include phenelzine, tranylcypromine, and isocarboxazid.

Other Antidepressants Newer drugs have been developed that work on neurotransmitters other than, or in combination with, serotonin. They seem to have fewer side effects than the older drugs. Examples