Ask Your Pharmacist

October 8, 2020
Q:

I was diagnosed with depression and anxiety some years ago. I love working with the public, but it’s been so stressful these past months with COVID-19, having to wear a mask to work, and now the thought of a second wave exhausts me. My doctor is switching me to a new antidepressant. What can I expect in the coming weeks?

A:

I bet your experience is one that many New Brunswickers are living with daily, and I want to acknowledge the courage it took you to ask this question. There is power in sharing experiences about depression and anxiety; talking openly makes it seem a little less overwhelming. I will answer your question from the perspective of a pharmacist who has lived with depression and anxiety for the last 23 years. 

There are many different classes, or groups, of antidepressants medications that work in a particular way. Antidepressant medications (i.e. selective serotonin reuptake inhibitors (SSRIs), venlafaxine, bupropion XL, tricyclic antidepressants, etc.) may be prescribed by your doctor or nurse practitioner to be used along with counselling. Antidepressants work to increase chemicals in the brain (i.e. serotonin) that scientists believe are important in regulating mood.

An important fact I wish I understood when I started taking my first antidepressant back in 2002 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. 

I was apprehensive the first time I switched antidepressant medications under my doctor’s advisement. I looked at it as a failure both of the drug and of myself, and I felt hopeless. 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. 

Switching antidepressants is a decision made between your physician or nurse practitioner and yourself based on how well the medication is working for you and on your ability to tolerate any side effects that you may be experiencing. If after a successful trial of antidepressant therapy, you are not experiencing optimal relief of your symptoms, it may make sense to look at options such as dosage adjustment, changing therapy, or adding on to existing therapy. Any change made should be done in cooperation with your prescriber and in collaboration with your pharmacist. It can be unpleasant and sometimes even dangerous to attempt to change your antidepressant therapy, or stop cold turkey, without monitoring and support from your health care team.   

It took a few tries of different antidepressant therapy and also some dosage adjustments to get the right selection for me. I’m relieved to say that living happily with depression and anxiety is absolutely possible. It’s hard work, and it’s about more than taking a pill. Although medication helps, I also go to therapy once a week. I don’t miss doses, and I don’t miss appointments. Ever. When we start to feel better, we may be misled into thinking that we don’t need treatment anymore. It’s important to continue your antidepressant therapy until you and your health care provider decides to make a change. I make regular physical activity part of my life. Whether it’s CrossFit or cycling, or enjoying the fall colours of New Brunswick during a hike, I keep active. Regular physical activity releases endorphins and other chemicals that enhance mood. Minimize alcohol intake and avoiding illicit drug use. Although some people use marijuana to relieve anxiety, marijuana withdrawal and misuse can lead to enhanced anxiety and paranoia.  

The COVID-19 pandemic has been mentally challenging for many of us. It is important to pay attention to our thoughts and mood, always, but especially during these stressful days. Our thoughts inevitably inform our behaviour. We need to be mindful of signs and symptoms of depression in ourselves and others and seek medical help and psychological support when needed. I hope we can look back at 2020 not just as the year COVID-19 hit, but the year that we consciously made “compassion the radicalness of our time” (the Dalai Lama).

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.