Antidepressants and All You Need to Know
Antidepressants belong to the categories of drugs which are used to reduce the symptoms of depressive disorders by correcting the chemical imbalance of the neurotransmitters in the brain. Their goal is to correct the chemical imbalance of brain neurotransmitters which are responsible for changes in mood and behaviors.
The development of antidepressants was traced back to the 1950s, and their use has grown more and more over the past 20 years. According to the Centers for Disease Control and Prevention (CDC), the percentage of people aged 12 and over using antidepressants in the United States increased from 7.7% in 1999-2002 to 12.7% in 2011-2014.
Types of Antidepressants
There are five types of antidepressants and they are listed below:
- SNRIs and SSRIs
Serotonin and noradrenaline reuptake inhibitors (SNRIs). These types of antidepressant are used primarily for the treatment of the following health conditions such as depression, mood disorders and possibly hyperactivity disorder, obsessive-compulsive disorder, anxiety disorders, menopausal symptoms, fibromyalgia and chronic neuropathic pain.
SNRIs have been found to increase the level of both serotonin and norepinephrine and these are the two neurotransmitters in the brain that play a key role in mood stabilization. Examples of these neurotransmitters include duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq).
The most widely recommended antidepressants are the selective serotonin reuptake inhibitors (SSRIs). Selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective when it comes to the treatment of depression and have fewer side effects than other antidepressants.
The reuptake or the absorption of serotonin is blocked by SSRIs. SSRIs facilitate receiving and sending of messages from brain cells, which leads to better and more stable moods. They are referred to as “selective” due to the fact that they seem to have a major effect on serotonin, not other neurotransmitters.
Side effects of SSRIs and SNRIs
- hypoglycemia, or low blood sugar
- low sodium
- dry mouth
- constipation or diarrhea
- weight loss
- sexual dysfunction
- a headache
- anxiety and agitation
- abnormal thinking
Examples of SNRIs and SSRIs antidepressants include citalopram (Celaxa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft).
It has been shown that individuals who make use of SSRIs and SNRIs, especially those that are below the age of 18 years, may have suicidal thoughts, especially when it’s the first time they are making use of these medications.
Tricyclic Antidepressants (TCAs)
This is a type of older antidepressant. This type of antidepressant is no longer recommended as the first line of action when it comes to the treatment of depression and this is due to the fact that they can become lethal and harmful when an overdose is taken. They also cause more unpleasant side effects when compared to SSRIs and SNRIs antidepressant.
There are some cases where exceptions are made for individuals who are living with severe depression who do not respond to other treatments. TCAs can also be recommended for other mental health problems, such as OCD and bipolar disorder. Amitriptyline (Tryptitol), Clomipramine (Anafranil), Imipramine (Tofranil), Lofepramine (Gamanil) and Nortriptyline (Allegron) are examples of TCAs. Some TCAs types, such as amitriptyline, can also be used to treat chronic nervous system disorders
Side effects of Tricyclics
- arrhythmia, or irregular heartbeat
- nausea and vomiting
- abdominal cramps
- weight loss
- urinary retention
- increased pressure on the eye
- sexual dysfunction
Some Monoamine Oxidase Inhibitors (MAOIs)
MAOIs are the first class of antidepressants to be developed. It inhibits the action of monoamine oxidase which is a brain enzyme. Monoamine oxidase streamlines the breakdown of neurotransmitters for example serotonin.
If fewer serotonins are disintegrated, more serotonin will circulate. Theoretically, this leads to more stabilized moods and reduced anxiety. Doctors presently make use of MAOIs in the event that SSRIs failed to work. MAOIs are kept generally in cases where other antidepressants did not work; this is due to the fact that MAOIs have the ability to interact with many other drugs and some foods.
Side effects of MAOIs
- blurred vision
- weight loss or weight gain
- sexual dysfunction
- diarrhea, nausea, and constipation
- insomnia and drowsiness
- arrhythmia, or irregular heart rhythm
- feeling dizzy or feeling faint when you stand up
- hypertension, or high blood pressure
the following are the examples of MAOIs phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan) and selegiline (EMSAM, Eldepryl).
Noradrenaline and Specific Serotonergic Antidepressants (NASSAs)
NASSAs have been shown to be effective for some individuals that find it very difficult to take SSRIs. It can be very difficult to differentiate between the side effects of NASSA and SSRIs as they look similar, but they are thought to cause fewer sexual problems. However, they may also cause drowsiness at the beginning.
Side effects of Noradrenaline and Specific Serotonergic Antidepressants (NASSAs)
- dry mouth
- weight gain
- drowsiness and sedation
- blurred vision
Seizures decreased white blood cells, unconsciousness and allergic reactions among others are the most serious adverse reaction you experience when you take (NASSAs).
Examples of (NASSAs) include Mianserin (Tolvon) and Mirtazapine (Remeron, Avanza, Zispin).
How Antidepressants Work
It is believed that antidepressants work by increasing the level of chemicals in the brain; these chemicals are known as neurotransmitters. Some neurotransmitters, such as serotonin and noradrenaline have been confirmed to improve mood and emotion, though this process is not fully understood.
Increase in the level of neurotransmitters can also disrupt nervous system signals, which may explain why some antidepressants can help relieve pain that has lasted for a long period of time.
Although antidepressants can treat the symptoms of depression, they do not always cure their causes. Therefore, they are commonly used in combination with therapy for treating severe depression or other mental health problems which occur as a result of emotional distress.
What Conditions Can Antidepressants Cure?
When it comes to the uses or application of antidepressants, they have been found to be used for the treatment of many conditions. Listed below are the list of conditions which can be cured by antidepressants but the use of antidepressant is not limited solely to the treatment of depression, generalized anxiety disorder, agitation, obsessive-compulsive disorder (OCD), manic-depressive disorders, childhood enuresis, manic-depressive disorders, childhood enuresis (bedwetting), major depressive disorder, diabetic peripheral neuropathic pain, neuropathic pain, social anxiety disorder, posttraumatic stress disorder (PTSD) etc.
The following conditions occur as a result of the improper use of antidepressants and they can include the following: fibromyalgia, chronic urticaria, hot flashes, hyperhidrosis (drug-induced), pruritus (itching), premenstrual symptoms, bulimia nervosa, Tourette syndrome and binge eating disorder among others.
How to Choose the Best Antidepressants That Suits Your Needs?
Are you confused with your choice of antidepressants? By working persistently with your doctor, you and your doctor should find the one who works to enjoy the full enjoyment of life.
Antidepressants are a popular choice for treating depression. Although antidepressants cannot cure depression they are effective in reducing the symptoms of depression. The first antidepressant you give a trial can work well. But if it does not relieve your symptoms or cause side effects that annoy you, you may have to try again.
In this case, you don’t need to relax in the pursuit of the antidepressant that will work for you. There are many antidepressants available and you will probably find one that works well for you. And sometimes, a combination of medications can be a better alternative.
How to Find the Right Antidepressant?
There are several types of antidepressants that act a little differently and have different side effects. When prescribing an appropriate antidepressant, your doctor may put the following into consideration.
Your special symptoms
Symptoms of depression may differ, and the antidepressant may ease some of the symptoms better than the other. For example, if you are asleep, a mild sedative antidepressant may be a good choice.
Possible side effects
Side effects of antidepressants vary from one drug to another and from person to person. Severe side effects such as dry mouth, weight gain, or sexual side effects may complicate the treatment. Contact your doctor and your pharmacist to discuss the possible major side effects with them.
If it has worked for close relatives
The way a drug worked for a first-degree relative, like a parent or brother, can point to how well it works for you. Additionally, if the antidepressant is effective in the past for your depression, it may work again well.
Interaction with other drugs
Some antidepressants may cause dangerous reactions when combined with other medicines.
Pregnancy or breastfeeding
The decision on the use of antidepressants during pregnancy and lactation is based on the risk and benefit balance. Generally, the risk of birth defects and other problems in nursing mothers receiving antidepressants during pregnancy is low. However, certain antidepressants such as paroxetine (Paxil, Pexeva) may be discouraged during pregnancy. Work with your doctor to find the best way to manage depression when planning or planning to become pregnant.
Other Health Conditions
Some antidepressants may cause problems if you have some mental or physical health problems. In addition, some antidepressants can help treat other physical or mental health problems associated with depression. For example, bupropion (Wellbutrin, Aplenzin, Forfivo XL) can help alleviate the symptoms of attention deficit hyperactivity disorder (ADHD) and depression. Other examples include the use of duloxetine (Cymbalta) for the relief of pain symptoms or fibromyalgia, or the use of amitriptyline to prevent migraines.
The costs and health insurance coverage
When it comes to the cost of antidepressants, some of the antidepressants may be expensive so it is always advisable to ask if a generic version is available and discuss its effectiveness. Also, check if your health insurance covers antidepressants and if some limits are imposed.
Side Effects of Antidepressants
All side effects will probably appear in the first two weeks and then progressively disappear. Common effects are nausea and anxiety, but it depends on the type of medication used, as mentioned above. If the side effects are very uncomfortable, or if they involve suicidal thought, immediately contact your doctor.
In addition, studies have linked the following side effects to the use of antidepressants, especially in children and adolescents.
- Excessive mood swings and behavior activation: This may include mania or hypomania. It should be noted that antidepressants do not cause bipolar disorder but can detect a disease that has not yet been detected.
- Suicidal thoughts: There have been some reports of a greater risk of suicidal thoughts at the first use of antidepressants.
This may be caused by medications or other factors such as time needed for the drug to work or possibly undiagnosed bipolar disorder which may need a different approach to treatment.
Unlike some medicines, it is not necessary to continue to increase the dose to achieve the same effect as antidepressants. In that sense, they do not create addiction.
When you stop taking an antidepressant, you will not feel the same type of withdrawal symptoms, for example when you stop smoking.
However, almost one in three people using SSRIs and SNRIs reported withdrawal symptoms after stopping treatment.
Symptoms lasted from 2 weeks to 2 months and included:
- nightmares or vivid dreams
- electric shock-like sensations in the body
- flu-like symptoms
- abdominal pain
In most cases, the symptoms are not that serious. Serious cases are rare and more likely after putting an end to the use of Seroxat and Effexor.
Doctors should gradually reduce the dose to reduce the risk of unpleasant withdrawal symptoms.
How to Make Antidepressants Work For You
Immediately you and your doctor have chosen an antidepressant, you can begin to improve for several weeks, but it may take six weeks or more to be fully effective. With some antidepressants, you can take a full dose immediately. With others, you may need to gradually increase your dose. Talk to your doctor or pharmacist about symptoms of depression while waiting for antidepressants to come into effect.
Take regular antidepressants on a regular basis and the right dose.
If your medicine does not work nor has any unpleasant side effects, contact your doctor before making any changes.
See if the side effects have improved.
Many antidepressants cause side-effects that improve over time. For example, the initial side effects when starting SSRIs may include dry mouth, nausea, constipation, headache, and insomnia, but these symptoms usually disappear when your body adjusts to an antidepressant.
Explore options if it does not work well.
If you have tedious side effects or if the symptoms do not significantly improve after a period of four weeks, ask your doctor to change the dose, try another antidepressant (switching) or add another antidepressant or any other medicine (augmentation). A combination of drugs can work better against an antidepressant.
In many cases, the combination of antidepressants with psychotherapy is more effective than taking the antidepressant itself. It can also prevent the return of your depression after you feel better.
Do not stop taking an antidepressant without prior consultation with your doctor.
Noticeable withdrawal symptoms can occur as a result of some antidepressants unless you try and reduce the dosages slowly. An abrupt termination can cause a sudden deterioration of depression.
Avoid alcohol and recreational drugs.
Alcohol or drugs seems to reduce the symptoms of depression, but in the long term usually, aggravate the symptoms and make it more difficult to treat depression. Talk to your doctor or therapist if you need help with alcohol or drug problems.
How Effective Are Antidepressants?
A lot of individual benefit from antidepressants to some level, but on the other hand, it has been revealed via research that antidepressants cannot be as effective as previously thought in mild depression cases.
However, they are the most effective treatment for rapid relief of symptoms, especially in cases of severe depression.
According to the Royal College of Psychiatrist, it was estimated that 50 to 65% of those treated with depression by using antidepressants will improve, against 25 to 30% of those taking “inactive” tablets (placebo). This is an indication that a lot of individual benefit from antidepressants while this occurs sometimes as a result of a placebo effect.
Dose and Duration of Treatment
Antidepressants are usually taken in the form of tablets. When prescribed, start taking the lowest dose to improve the symptoms.
Antidepressants should usually take about seven days (without missing a dose) before you can feel the benefit. It is important that you do not stop taking them if you have mild side effects early since these effects usually go away quickly.
In the event that you use antidepressants for four weeks and yet you didn’t see any benefit, contact your doctor or mental health specialist and discuss the issue. They may recommend increasing doses or trying another drug.
Treatment usually lasts for a period of six months, although depressed persons may recommend a two-year course. Some people with recurrent depression may be required to take them for an indefinite period of time.
Uses of Antidepressants
These medicines are used not only for the treatment of depression but also for other conditions.
The main or approved use of antidepressants is:
- 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
Sometimes the medication is utilized “off-label”. This indicates that the use of the drug is not approved by the FDA, but the physician may decide to use it, as this may be an effective treatment.
Off-label uses of antidepressants include:
- a migraine
Studies show that 29% of antidepressants are used for an off-label purpose.
How Long Does the Treatment Last?
According to the Royal College of Psychiatry in the UK, 5 to 6 people older than 10 will experience a significant improvement after 3 months. People who use drugs should continue for at least 6 months after they feel better. Those who stop before 8 months of use may see the symptoms return. If you are part of the group who have had one or more relapses, you must continue treatment for at least 24 months. If you regularly experience recurrencem, you may have to use medication for several years.
However, according to a literature review published in 201, it was discovered that prolonged use of antidepressants may exacerbate the symptoms in some people, as this may cause biochemical changes in the body.
In the United States, 8% of women would use antidepressants during pregnancy. Your doctor will help you evaluate the benefits and disadvantages of taking antidepressants during pregnancy. The use of SSRIs during pregnancy is associated with increased risk of loss of pregnancy, premature delivery, low birth weight and birth defects. Possible problems during delivery include excessive bleeding in the mother. After delivery, a newborn may suffer from lung problems known as persistent pulmonary hypertension.
A 69,448 study of pregnancy has shown that the use of SNRIs or TCAs in pregnancy may increase the risk of hypertension or high blood pressure, known as preeclampsia. However, it remains to be seen whether it is due to drugs or depression.
The results published in the JAMA 2006 magazine indicate that around the newborn three of whose mothers took antidepressants during pregnancy presented neonatal abstinence syndrome. The withdrawal symptoms include disturbed sleep, tremors, and high-pitched crying. In some cases, the symptoms were serious.
Based on a research performed in the laboratory, it was revealed that rodents exposed to citalopram, SSRI antidepressants just before and after birth showed significant brain abnormalities and behaviors.
However, in some women, the risk of further treatment is less than the risk of putting an end to the use, for example, in a case where her depression can be triggered an action that might injure herself or the unborn child.
The physician and patient need to fully discuss the potential benefits and disadvantages associated with stopping antidepressants at this stage.
There are some other therapies which can be put into consideration if possible an example of such includes cognitive CBT, meditation or yoga.
Small amounts of some antidepressants come into breast milk, such as sertraline and nortriptyline. A few weeks after birth, infants can break down the active ingredients of the drug into the liver and kidneys as effectively as adults.
The decision on the use of antidepressants at this stage will include several factors:
- Is the infant healthy?
- Were they born preterm?
- Will the mother’s condition deteriorate?
How Many Active Ingredients go into breast milk, depending on the type of medicine?
The study published in the Journal of Clinical Endocrinology and Metabolism has shown that in women who are taking antidepressants during pregnancy, breastfeeding can last longer. It has been revealed by scientist the regulation of dairy glands is done by serotonin, so their ability to produce milk at the right time is associated with hormone production and regulation.
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