Ask Your Pharmacist

November 18, 2021
Q:

I have been feeling blah for so long. I just want my life back and this pandemic to be over. Are there medications that can help me?

A:

You are not alone. Many of us are experiencing what has been described as COVID-19 languish. The world is recovering from the pandemic but progress is slow. As we come to realize what a new normal lifestyle looks like post-pandemic, the reality is sometimes daunting.

Everyone can feel down now and again, but what you are feeling may be depression. Depression is a common and serious medical condition that negatively affects how you feel, the way you think, and how you act. When those feelings occur more days than not over two weeks or longer, this is an indicator to contact your physician or nurse practitioner to discuss ways to feel better. Common signs and symptoms of depression may include: having little interest or pleasure in things which you once enjoyed, feeling down, depressed, hopeless, trouble concentrating, feeling bad about yourself, lack of energy, feeling tired all the time, poor appetite, or overeating. 

Mental health researchers measured the occurrence of depression among adults in eight Canadian provinces, including New Brunswick. During the fall of 2020, the prevalence of depression in Canadian adults was 16 per cent. This represents an approximate doubling in depression compared to pre COVID-19 (seven per cent). 

If you are diagnosed with depression, medication therapy can help restore the balance of neurotransmitters responsible for mood in the brain. There are many classes or groups of prescription antidepressants. These classes of medications work in different ways to affect the balance of neurotransmitters in our brain. Experts believe that serotonin and norepinephrine are two particularly important neurotransmitters in our brain that play a role in mood, and several antidepressant classes target these chemicals.

An important fact I wish I understood when I started taking my first antidepressant is this: they take time to work. Improvements in physical symptoms such as the ability to get and maintain a healthy amount of sleep and appetite usually begin around the two-week mark. Other improvements in energy level, mood, and anxiety generally show by week four. If you are going to experience side effects, they tend to occur during the first week of therapy. During my first week on an antidepressant, I felt spaced out, a little nauseated, and had zero improvement in anxiety and depression. If you experience side effects, your pharmacist can help minimize them so that hopefully you can continue therapy until things start to improve. 

Despite there being several kinds of antidepressants available, the efficacy (i.e. their ability to work) is approximately the same. This means, for example, that for any given antidepressant medication, it is likely to work in seven out of 10 of us. This also means then that three out of 10 of us will not respond. If you do not respond to your antidepressant, that does not mean you won’t respond to a different class of antidepressant, or even a different antidepressant within a given class. There are several different treatment options, and the difference in how well we respond really can be quite individual. 

Antidepressant medications work only when you remember to take them. Most antidepressant medications require daily dosing to maintain mental health. They are not intended to be used on an as-needed basis. Generally, for a first episode of depression, most people will be on six to 12 months of antidepressant therapy. At that point, you and your doctor can discuss the benefits of continuing therapy or not. Antidepressant therapy should be weaned off gradually and never stopped abruptly. Abrupt cessation of antidepressant therapy can cause unpleasant withdrawal side effects, and in some instances, can lead to relapse of depression. Changes in therapy should be supervised by a health professional who can be objective with you about the feelings you are experiencing. Individuals who combine antidepressant therapy and psychological counselling have higher rates of success than those who take medication only. 

It is difficult to be objective about our own thoughts and feelings. Do not hesitate to contact a health professional if you are experiencing any of the above symptoms of depression. If you or someone you know is in immediate danger of self-harm call 9-1-1.  You can visit Wellness Together Canada for access to free 24/7 mental health and substance misuse support at: https://wellnesstogether.ca/en-CA/crisis  

Dr Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Sharp’s Corner Drugstore in Sussex, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.