About Antidepressants

Depression is considered one of the most common psychological disorders that affect adults in the United States. It is estimated that nearly 10% of American adults are affected with different types and degrees of depression, including bipolar disorder and dysthymic disorder. An antidepressant is often the initial treatment of choice when severe or moderate depression is diagnosed. It is meant to help manage or reduce the symptoms of depression but is by no means a cure for the disorder.

Understanding antidepressants:

An antidepressant is a type of drug that is used to deal with certain types of depressive disorders. It is used to stabilize mood and ensure mental stability in patients who suffer from conditions such as clinical depression, bipolar disorder, post-traumatic stress disorder, panic and anxiety attacks and obsessive compulsive disorders.

The history of antidepressants:

Up until the early 1950s, opiates, amphetamine, and extracts from St. John's Wort- in spite of being highly addictive- were commonly used to help treat symptoms of depression. Then in 1951, two physicians from Staten Island began searching for an effective tuberculosis medication via anti-tuberculosis agents isoniazid and iproniazid. The doctors found that their cure worked: their patients' conditions in terms of their tuberculosis drastically improved. However, a secondary effect was observed: curiously enough, patients were also reported as having a renewed vigor as well, hence resulting in the world's official first- even if accidental- antidepressant.

How antidepressants work:

Different types of antidepressants work in different ways and have their own set of side effects. Doctors must first learn the causes and symptoms of their patient's depression before a certain type of antidepressant is recommended. In general, however, an antidepressant is used to regulate the production of neurotransmitters in the brain. Neurotransmitters such as serotonin, dopamine and norepinephrine are chemicals that affect the emotions and moods of a person. An antidepressant can relieve the symptoms of depression and other disorders by influencing how these neurotransmitters are processed in the brain.

Types of antidepressants and their side effects:

The following are several types of antidepressants that are prescribed to treat depression:

Selective Serotonin Reuptake Inhibitors (SSRIs):
SSRIs are the most commonly prescribed antidepressants today. They work by maintaining a good amount of serotonin in the receptor areas of the brain, thus significantly improving the mood of the patient. SSRIs have considerably fewer unpleasant side effects compared to MAOIs and TCAs. Most side effects are temporary and gradually disappear as the patient gets used to the medication, although a few may prove persistent in some people. These side effects include drowsiness, nausea, nervousness, loss of appetite, dry mouth and insomnia. SSRIs can also cause fatigue, restlessness, sweating, diarrhea, constipation and decreased libido. Because there is a lower risk of fatality to a patient who overdoses on SSRIs compared to older types of antidepressant drugs, it is the treatment of choice for those with whom suicide is a serious issue.

Some of the generic names of SSRIs available today include Sertraline, Fluoxetine, Paroxetine, Fluvoxamine and Citalopram.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

SNRIs help the brain manage the amounts of both serotonin and norepinephrine, another important neurotransmitter. Patients who use SNRIs often report side effects similar to those caused by SSRIs. A few examples of SNRIs include Desvenlafaxine, Venlafaxine, Milnacipram and Duloxetine.

Tricyclic Antidepressants (TCAs):

TCAs are some of the older types of antidepressants. Like SSRIs and SNRIs, TCAs are used to inhibit the reuptake of important neurotransmitters, which make them effective in treating the symptoms of depression. They have since been overshadowed by SSRIs and SNRIs, however, due to their unpleasant side effects, some of which include dizziness, drowsiness, blurry vision, constipation, dry mouth and increased heart rate.

Some types of TCA brands include Doxepin, Clomipramine, Amitriptyline, Trimipramine, Imipramine, Notriptyline and Desipramine.

Monoamine Oxidase Inhibitors (MAOIs):

MAOIs work by interfering with monoamine oxidase, an enzyme that causes the breakdown of serotonin, norepinephrine and dopamine; a lack of which can lead to symptoms of depression. However, since MAOIs have shown to have serious interactions with certain foods and drugs, they are often prescribed as a last resort to patients who have failed to show improvement after other courses of treatments. Otherwise, they are rarely used where safer yet effective types of SNRIs and SSRIs work.

Some generic names for MAOIs include Tranylcypromine and Phenelzine.

In some cases, other drugs may be used to complement the prescribed dose of antidepressants. These drugs can include sedatives, tranquilizers, psychostimulants and anti-psychotics, although usually in low doses.

Why treatment with an antidepressant is important:

More than just being an unpleasant and inconvenient disorder, depression can also prove fatal if left untreated. It is a type of disorder that can have a negative effect on a person's personal, social and professional life. The correct diagnosis of the disorder, the appropriate use of an antidepressant where it is necessary, along with other types of therapy can significantly increase the likelihood that the patient's quality of life will improve.

How long do antidepressants work and are they effective?

The most commonly prescribed antidepressants begin to work from two to four weeks after administration. The course of treatment using an antidepressant varies, so a patient may use the medication from a few months to several years. In terms of efficacy, antidepressants have shown to be very helpful in many patients suffering from severe depression, particularly those who have not responded positively to other forms of treatment such as psychotherapy, alternative medicine, and lifestyle changes.

When using an antidepressant, frequent consultation with and monitoring by a medical professional is required, particularly for young patients, the elderly or those with moderate to severe symptoms. The effects of the antidepressant should also be assessed and monitored so the doctor can change the dosage to accommodate the patient or use an alternative drug when and if necessary. This is particularly important if no improvement is observed with the current medication or if the condition worsens.

Side effects:

Like most medications, antidepressants also have certain side effects, which could vary in type and intensity depending on the patient using it. It is important for you and your doctor to understand what these side effects are and how they will affect your daily life. Your response to a type of antidepressant can be unpredictable, given that individuals react to drugs differently. During your consultation, your doctor will help you consider the benefits and risks of each type of antidepressant so you can choose the best option that will fit your needs.

It is also important that your symptoms are carefully diagnosed by your physician before you are prescribed a particular type of antidepressant to ensure that your treatment is successful. If, for example, your symptoms include amnesia, an antidepressant that has a sedating effect will be a better choice than one that includes a stimulant. Certain factors such as your age, medical history, family background, work and social environments should be considered carefully to determine the best type of antidepressant for you.

Withdrawal symptoms:

An antidepressant typically causes withdrawal symptoms if the patient stops taking the medication abruptly. These symptoms can range from the unpleasant to the downright troublesome. Some of these symptoms include nausea, vomiting, stomach cramps, involuntary muscle spasms, fever, fatigue, irritability, anxiety, dizziness, nightmares, difficulty sleeping, depression and aggression. Mood swings caused by sudden withdrawal from antidepressant use are usually more severe than the symptoms of the disorder itself.

When and if considering withdrawal from antidepressant use, always ask for professional advice. Typically, your doctor will recommend gradual dosage reduction over a course of several weeks or months, depending on your case and the type of antidepressant involved. Any changes to the dosage or medication should be closely made under your doctor's supervision.

Is an antidepressant habit-forming?

One of the most common misconceptions about antidepressants is that they are addictive. They are not. Their misuse, however, along with the patient's attempt to correct the symptoms caused by sudden withdrawal, can sometimes lead to dependency.

Is an antidepressant the only answer to depressive disorders?

While the use of antidepressants cannot be discounted in the successful treatment of a depressive disorder, it's also important that the patient and his doctor consider other types of therapy that may be helpful.

Other uses:

Other than treating depression, antidepressants are also used for treatment of ADHD, chronic pain, eating disorders and snoring. In fact, antidepressants may be prescribed for patients as anti-inflammatories and analgesics, even if these patients do not have depression or other related disorders.

Important considerations regarding antidepressants:

When taking an antidepressant, it is critical that patients coordinate closely with their doctors. That way, any adverse effects can be identified and corrective actions implemented immediately. This will help prevent any negative physiological effects on the patient that could affect him in the long term.

It is also important that the recommended dosage of an antidepressant is followed faithfully and that any changes to the type or strength of the medication are closely monitored by a doctor. This helps minimize any unpleasant side effects and makes it easier for a medical professional to keep track of any regression or improvement.