WHAT IS DOUBLE, SECONDARY DEPRESSIONS, AND CAN PROZAC BE USED TO TREAT THIS CONDITION?

Double depression is a diagnosis made when a patient who has been suffering from chronic, long-term mild depression (dysthymia) plummets into an episode of major depression. Many psychiatrists have found that maintaining a patient on Prozac seems both to treat the dysthymia and to prevent the superimposed major depression from recurring. Although no clear-cut studies have proven Prozac to be effective in double depression, psychiatrists have reported numerous case histories in which both forms of depression seem to be alleviated and even prevented by Prozac. Often the dosage must be increased when the major depression occurs on top of dysthymia.

Secondary depression can develop in the presence of a previously existing condition, whether it is medical, such as a hypothyroidism, stroke, Parkinson’s disease, or AIDS, or psychiatric, such as schizophrenia, panic disorder, or bulimia, among others. The key is which came first. When the depression clearly develops chronologically after the other primary medical or psychiatric condition, it is considered secondary.

Is Prozac an effective treatment for secondary depression? It can be. But the first step should always be to focus on bringing the primary disorder under control. If the depression persists even after the primary illness has been treated, Prozac can be added and is often effective, as are other antidepressants.

Antidepressants can also be effective in the presence of other psychiatric disorders and can be combined with other medications, so long as the primary treatment is not an MAOI antidepressant. In the case of schizophrenia, Prozac can be safely combined with major tranquilizers. When anxiety disorders are primary, Prozac can be given with minor tranquilizers, and when the diagnosis is bipolar manic depression, it can be taken along with lithium, Tegretol, or Depakote.

With obsessive-compulsive disorder, bulimia, and panic disorder, evidence is emerging that Prozac may alleviate the symptoms of both the primary illness and the secondary depression so often experienced in these disorders.

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