Antidepressants are drugs that can help with depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, dysthymia, or mild persistent depression, among other things.
They try to address chemical imbalances in the brain’s neurotransmitters, which are thought to be the cause of mood and behaviour abnormalities.
In the 1950s, the first antidepressants were developed. In the previous 20 years, their use has become increasingly common.
According to the Centers for Disease Control and Prevention (CDC), antidepressant use among people aged 12 and up increased from 7.7% in 1999-2002 to 12.7 percent in 2011-2014 in the United States. Antidepressants are used by roughly twice as many women as they are by men.
Types
Antidepressants are classified into five categories:
SNRIs and SSRIs
The most widely given type of antidepressant is this class of medication.
In addition to major depression and mood disorders, serotonin and noradrenaline reuptake inhibitors (SNRIs) are used to treat attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety disorders, menopausal symptoms, fibromyalgia and chronic neuropathic pain, among other conditions.
SNRIs work by increasing the levels of serotonin and norepinephrine in the brain, two neurotransmitters that are important in maintaining a stable mood.
Duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq) are examples of antidepressants .
Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed medications. They are helpful in the treatment of depression, and they have less adverse effects than the other antidepressants available on the market.
SSRIs are medications that prevent serotonin from being reabsorbed or reabsorbed in the brain. Because of this, it is easier for brain cells to receive and transmit messages, resulting in healthier and more stable moods.
They are referred to as “selective” because they appear to have a disproportionate effect on serotonin while having little effect on the other neurotransmitters.
The following adverse effects of SSRIs and SNRIs have been reported:
- hypoglycemia, or low blood sugar
- low sodium
- nausea
- rash
- dry mouth
- constipation or diarrhea
- weight loss
- sweating
- tremor
- sedation
- sexual dysfunction
- insomnia
- headache
- dizziness
- anxiety and agitation
- abnormal thinking
Citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft) are examples of antidepressants .
Individuals who take SSRIs and SNRIs, particularly those under the age of 18, have been reported to have suicidal thoughts, particularly when they first begin taking the medications.
As required by the Food and Drug Administration, all antidepressants are labelled with a black-box warning to this effect.
Tricyclic antidepressants (TCAs)
Tricyclic antidepressants (TCAs) are so named because the chemical structure of these drugs has three rings, which is why they are used to treat depression. Some of the conditions they are used to treat include depression, fibromyalgia, anxiety, and chronic pain. They also have anti-inflammatory properties.
The following adverse effects of tricyclics are possible.
- seizures
- insomnia
- anxiety
- arrhythmia, or irregular heartbeat
- hypertension
- rash
- nausea and vomiting
- abdominal cramps
- weight loss
- constipation
- urinary retention
- increased pressure on the eye
- sexual dysfunction
Amitriptyline (Elavil), amoxapine-clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil) are examples of antipsychotic medications .
Monoamine oxidase inhibitors (MAOIs)
Before the introduction of SSRIs and SNRIs, this type of antidepressant was commonly prescribed. It is still in use today.
It works by interfering with the activity of monoamine oxidase, a brain enzyme. Monoamine oxidase is an enzyme that aids in the breakdown of neurotransmitters such as serotonin.
It follows that if less serotonin is broken down, there will be more serotonin in the circulation. As a result, there should be more stable moods and less worry in principle.
If SSRIs have failed to provide relief, doctors are increasingly turning to MAOIs. Because MAOIs interact with a variety of other drugs as well as certain foods, they are often reserved for cases in which other antidepressants have failed to provide relief.
The following are some of the side effects:
- blurred vision
- rash
- seizures
- edema
- weight loss or weight gain
- sexual dysfunction
- diarrhea, nausea, and constipation
- anxiety
- insomnia and drowsiness
- headache
- dizziness
- arrhythmia, or irregular heart rhythm
- fainting or feeling faint when standing up
- hypertension, or high blood pressure
MAOIs include medications such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline (Selegiline) (EMSAM, Eldepryl).
Noradrenaline and specific serotoninergic antidepressants (NASSAs)
Anxiety disorders, several personality disorders, and depression are all treated with these medications.
The following are examples of possible negative effects:
- constipation
- dry mouth
- weight gain
- drowsiness and sedation
- blurred vision
- dizziness
Seizures, white blood cell decrease, fainting, and allergic reactions are some of the most serious side events that can occur.
Mianserin (Tolvon) and Mirtazapine (Remeron, Avanza, Zispin) are two examples of such medications.
How do antidepressants work?
An antidepressant’s mechanism of action is explained in this YouTube video by Paul Bogdan.
Side effects
Any negative effects may most likely manifest themselves within the first two weeks of treatment and then gradually subside.
Nausea and anxiety are common side effects, however the severity of these effects will vary depending on the type of medication used, as previously indicated.
A doctor should be notified as soon as possible if any of the adverse effects are particularly unpleasant, or if they include suicidal ideation.
Aside from that, research has found that antidepressant usage, particularly among children and adolescents, is associated with the following negative side effects.
Excessive elevation of mood and activation of behavioural responses
This may include mania or hypomania. However, it is important to emphasise that antidepressants do not cause bipolar illness; however, they may disclose a condition that has not yet manifested itself.
Suicidal ideas or actions
The use of antidepressants for the first time has been associated with an increased chance of experiencing suicidal thoughts, according to a few publications.
These side effects could be caused by the medications or by other factors such as the amount of time it takes for the medication to take effect, or they could be caused by an undiagnosed bipolar condition, which would necessitate using an alternative method to therapy.
The Food and Drug Administration requires all antidepressants include a black box warning about this potential side effect.
Withdrawal symptoms
In contrast to certain medications, it is not required to continually increasing the dose in order to have the same impact with antidepressants. In this sense, they do not have an addictive quality.
The withdrawal symptoms associated with stopping an antidepressant are different from those associated with quitting a substance such as smoking, which can be quite unpleasant.
However, roughly one in every three people who have used SSRIs or SNRIs report experiencing some withdrawal symptoms after ceasing treatment with these medications.
Symptoms ranged in duration from 2 weeks to 2 months and included the following:
- anxiety
- dizziness
- nightmares or vivid dreams
- electric shock-like sensations in the body
- flu-like symptoms
- abdominal pain
The majority of the time, the symptoms were modest. Severe occurrences are extremely rare, and they are more likely to occur after discontinuing Seroxat and Effexor.
Doctors should reduce the dose gradually in order to limit the likelihood of unpleasant withdrawal symptoms occuring.
Uses
These drugs are used not only to treat depression, but also to treat a variety of other disorders.
Antidepressants are used to treat a variety of conditions, the majority of which are approved by the FDA.
- agitation
- obsessive-compulsive disorders (OCD)
- childhood enuresis, or bedwetting
- depression and major depressive disorder
- generalized anxiety disorder
- bipolar disorder
- posttraumatic stress disorder (PTSD)
- social anxiety disorder
“Off-label” usage of a medicine occurs from time to time. Although the use has not been approved by the FDA, a doctor may decide that it should be utilised since it may be a successful therapeutic option.
Off-label uses of antidepressants include:
- insomnia
- pain
- migraine
According to studies, antidepressants are used for non-prescribed purposes in 29 percent of cases.
Effectiveness
The benefits of an antidepressant can take many weeks to become seen in a person’s life. Many people discontinue their use of these medications because they believe the medications are ineffective.
There are a variety of reasons why people may not notice an improvement, including:
- the drug not being suited to the individual
- a lack of monitoring by the health provider
- a need for additional therapies, such as cognitive behavioral therapy (CBT)
- forgetting to take the medication at the right time
Maintaining communication with the doctor and attending follow-up appointments increases the likelihood that the medication will be effective. It is possible that the dosage has to be adjusted or that another medicine might be more appropriate.
It is critical to follow the antidepressant’s directions exactly, or else the medication will be of limited benefit.
During the first or second week, the vast majority of people will experience no benefits. The entire effect will not be noticeable until one or two months after taking the medication. The ability to persevere is essential.
What is the duration of treatment?
According to the Royal College of Psychiatry in the United Kingdom, 5 to 6 persons out of every 10 will have a significant improvement after three months of treatment.
It is recommended that people who take medicine continue to do so for at least 6 months after they begin to feel better. Those who discontinue use before 8 months may experience a recurrence of symptoms.
Those who have had one or more recurrences should continue treatment for a minimum of 24 months after the last occurrence.
Those who suffer from recurrent depression may be required to take the medicine for a period of several years.
However, according to a 2011 assessment of the literature, long-term use of antidepressants may aggravate symptoms in certain people because it can cause biochemical changes in the body to occur.
In pregnancy
Antidepressant medications are reported to be used during pregnancy by 8% of women in the United States, according to statistics.
The use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy has been related to an increased risk of miscarriage, preterm birth, low birth weight, and congenital birth abnormalities.
Among the potential complications during delivery is heavy bleeding in the mother..
After birth, the newborn may develop lung difficulties known as chronic pulmonary hypertension, which are caused by high blood pressure in the lungs.
It was discovered in an investigation of 69,448 pregnant women that taking SNRIs or TCAs during pregnancy may raise the chance of developing pregnancy-induced hypertension or high blood pressure, also known as pre-eclampsia, according to the findings of the study. However, it is yet unclear if this is due to the medications or to the despair that she is experiencing.
According to findings published in the journal JAMA in 2006, nearly one in every three newborns whose mothers took antidepressants during pregnancy suffered from neonatal abstinence syndrome. Disrupted sleep, tremors, and high-pitched wailing were some of the withdrawal symptoms experienced. In some cases, the symptoms were extremely distressing.
In a laboratory investigation, researchers discovered that mice exposed to citalopram (an SSRI antidepressant) immediately before and after birth exhibited significant brain abnormalities and behavioural changes.
The danger of discontinuing the medicine, on the other hand, may be lower for certain women than the risk of discontinuing it, for example, if her depression could cause an action that would be harmful to herself or her unborn child.
The doctor and the patient must thoroughly explore the benefits and potential risks of discontinuing antidepressants at this point in time.
Other therapies, such as cognitive behavioural therapy (CBT), meditation, or yoga, should be attempted if at all possible.
Breastfeeding
Some antidepressants, such as sertraline and nortriptyline, have been shown to pass into breast milk in trace levels.
Infants can begin to break down the medication’s active chemicals in the liver and kidneys within a few weeks after birth, and they can do it as efficiently as adults.
Several factors will influence the decision to utilise antidepressants at this time, including:
- Is the infant healthy?
- Were they born preterm?
- Will the mother’s condition deteriorate?
The amount of active components that pass into breast milk varies depending on the type of medicine being administered.
In one study, which was published in the Journal of Clinical Endocrinology and Metabolism, researchers discovered that women who take antidepressants during pregnancy may have a lengthier time until they are able to nurse their children.
The researchers explain that because serotonin regulates the function of the breast glands, the ability of the glands to make milk at the appropriate moment is linked to the generation and regulation of this hormone.
Alternatives to consider
Depression can be treated with cognitive behavioural therapy (CBT) and other methods of counselling and therapy.
St. John’s wort
Hypericum, a supplement derived from the herb St. John’s wort, has been demonstrated to be beneficial for certain persons suffering from depression. It is offered as a dietary supplement over-the-counter.
The medication should, however, only be used after consulting with a physician due to the possibility of side effects.
- Combining St. John’s wort with certain antidepressants can result in a rise in serotonin levels that can be potentially life-threatening.
- It has been shown to exacerbate the symptoms of bipolar illness and schizophrenia in certain individuals. It is not recommended to use St. John’s wort if you have or suspect you have bipolar-related depression.
- Some prescription drugs, including as birth control pills, some heart medications, warfarin, and some HIV and cancer therapies, may be less effective if taken with this supplement, according to some studies.
Telling your doctor or pharmacist that you intend to use St. John’s wort is extremely vital to your health.
There is some evidence to support the use of St. John’s wort to treat depression, however some studies have concluded that it is no more helpful than a placebo in treating depression.
Light box
Light therapy may be beneficial for people who suffer from seasonal affective disorder (SAD), also known as the “winter blues.” A light box is used for this, and it is recommended that you do this first thing in the morning for 20 to 60 minutes.
Vitamin D supplementation may or may not be beneficial in the treatment of SAD. The evidence does not support a conclusion.
Diet and physical activity
Some studies have found that eating a healthy, well-balanced diet, getting lots of exercise, and staying in touch with family and friends can help to lower the risk of depression and recurrences of the condition.
In some cases, depression is a serious condition that requires medical attention. Anyone who is experiencing the signs and symptoms of depression should seek medical treatment.
