Depression :: Regular follow-up important during antidepressant treatment

Because individuals can react differently to antidepressant medications, regular follow-up is important during the first few weeks of treatment, according to an editorial by Group Health psychiatrist and researcher Greg Simon, MD, MPH.

Simon’s advice, published in the November issue of the American Journal of Psychiatry, comes amidst several recent conflicting studies on the link between antidepressant use and suicide risk in children and adolescents. In the absence of clear evidence–along with proof that antidepressants’ effects differ across individuals–Simon suggests that patients and providers stay well connected as drug therapy begins.

Depression, or a depressed mood, may in everyday English refer to a state of melancholia, unhappiness or sadness, or to a relatively minor downturn in mood that may last only a few hours or days. This is quite distinct from the medical diagnosis of clinical depression. However, if depressed mood lasts at least two weeks, and is accompanied by other symptoms that interfere with daily living, it may be seen as a symptom of clinical depression, dysthymia or some other diagnosable mental illness, or alternatively as sub-syndromal depression.

Finally, he suggests that providers caught between concerns about precipitating a suicide attempt and concerns about untreated depression tell their patients this:

“The Food and Drug Administration requires a warning that antidepressant medications can sometimes cause or increase thoughts of suicide. Studies in children and adolescents have shown that antidepressants can increase suicidal thoughts. However, other studies have shown that the overall risk of attempting suicide goes down after starting antidepressant medication. Even if antidepressants help most people that take them, some people may have very negative reactions, Thus, it is important that we have regular contact over the next few weeks. If you have thoughts about suicide or about harming yourself, please contact me right away.”

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