sleep, and that symptom is the most disturbing and dangerous. Tricyclics
tend to be more sedating than SSRIs and, in a reactive depression, may be
more useful for that quality than for their antidepressant effect. Amitriptyline,
a tricyclic that is quite sedating, is used for sleep. Trazodone, a sedating
SARI that has a relatively short half-life, is a better choice as a safe sleeping
medication since it causes less grogginess the next day.
Sometimes people get stuck in a reactive depression. Not only can’t
they stop ruminating about who or what they’ve lost, but the thoughts
seem to become more frequent and more morbid. If a reactive depression
does not appear to be abating over the course of a month or so, medications
make more sense. Meanwhile, the best thing you can do for people suf-
fering a loss is to stay close and encourage them to talk. They often want
a lot of alone time, but it is not a good idea to give it to them.
Serotonergics
Kinesha’s depression came out of nowhere, for no discernible rea-
son, changing her from a well-adjusted, outgoing person into a
zombie. She can’t think clearly, has no energy, and feels as if
she’s dragging herself through her daily activities. Her mother
had a history of depressive episodes as well.As discussed in the chapter on fear, this group includes SNRIs, SSRIs,
SARIs, NDRIs, and NASAs. By far the most widely used medications for
depression are SSRIs.
Kinesha is the sort of person for whom serotonergics—especially
SSRIs—are nothing short of wonder drugs. It’s likely that her endogenous
depressive episode arose from a change in her brain chemistry, perhaps
that very serotonin deficiency that gets so much publicity in magazines.
Kinesha’s doctor wanted to prescribe Prozac. She knew that its activating
properties work particularly well for the kind of glum, unmotivated depres-
sion that Kinesha was experiencing.
“Prozac? You want to put me on Prozac?” Kinesha’s tone makes
it sound like her doctor is suggesting heroin. “No thank you. I
don’t need any of that stuff. I’ve read all about it, and I’d rather
just work things through on my own.”160 ❧Explosions into Sadness