Depression Symptoms Treatment

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Question. I am 19 and have experienced depression for over two years. My doctor recently prescribed Serzone, which caused severe headache, nausea and strangely hot skin. Then he switched me to Paxil, which caused severe nausea and vomiting. I have not returned to my doctor because he assured me the Paxil would not cause me to become ill. I am very nervous about trying further treatment, but I am still depressed. What do you recommend?

Answer. First of all, I recommend gaining some perspective on your problem with medication. It is quite common for patients to have a negative experience with one or two medications, before finding that another one works very well for them. Both of the medications you tried affect mainly a brain chemical called serotonin. This is also found in the GI tract, and sometimes this type of medication can cause nausea, vomiting, etc. I would suggest discussing a trial on Wellbutrin with your doctor, since this rarely causes GI side effects. However, I do not want to assure you of a good response! The only sure thing in the field of medicine is that illness is always a reality, and that hope is always worth having. Some patients may experience mild jitters with Wellbutrin, as well as other potential side effects that you should discuss with your doctor. But most patients tolerate it very well.

Some patients who cannot tolerate one of the SSRIs (Prozac, Paxil, Zoloft, Luvox) still tolerate another, and this is a viable option if Wellbutrin doesn’t work for you. I would start off with very low doses of any SSRI, and increase the dose very slowly. If you did have GI complaints, a medication called ondansetron could be used to counteract nausea. Another option would be a low-dose trial of nortriptyline, one of the older (but very reliable) tricyclic antidepressants. Tricyclics can cause dry mouth, constipation, and occasional lightheadedness, but usually don’t cause nausea, vomiting, or headache. Remeron is a new antidepressant with a low incidence of nausea or headache, and might be tolerated better than the SSRIs, but can be quite sedating. Remeron also has a 1 in 1000 risk of a fairly serious blood abnormality, so it is not a first-line agent.

The bottom line is, there is no perfect antidepressant. In your case the motto should be start low, go slow, with dosage. Finally, if you really do not want to go through multiple medication trials, I would strongly urge you to get involved in psychotherapy, if you are not already. Cognitive-behavioral therapy has a particularly good record in the treatment of depression. Indeed, I would recommend CBT with or without a medication trial. Good luck, and don’t give up!