Types of Antidepressants

Types of Antidepressants:

There are three major types of antidepressants. These types include Tricyclic Antidepressants (TCAs), Monoamine Oxidase Inhibitors (MAOIs), and Selective Serotonin Reuptake Inhibitors (SSRIs). There is also a newer form of antidepressant that is being used called Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). All of these drugs have an effect on certain chemicals in the brain. These chemicals called neurotransmitters are associated with depression. When there is an abnormality in neurotransmitters and their activity, it can affect mood and often behavior.

It is important to note that after starting an antidepressant, it can be hard to stop taking them, and sometimes withdrawal symptoms can occur. These symptoms can include anxiety, agitation, irritability, aggression, insomnia, nausea, dizziness, loss of coordination, stomach pain, stomach cramping, tremors or muscle spasms and mood swings. Only a physician should stop or change the dosage of any form of antidepressant. Whether it is a Tricyclic, an SSRI or a MAOI, seek medical advice before starting or stopping any antidepressant drug. To avoid antidepressant withdrawal symptoms, patients should not try to stop taking them “cold turkey.” Instead, a medical practitioner will need to taper the dosage gradually. It is important to allow at least one to two weeks between each reduction period.


Tricyclic Antidepressants (TCAs):

Tricyclic Antidepressants are known to block the reuptake of certain neurotransmitters, which include norepinephrine and serotonin. It also has an effect on the reabsorption of dopamine as well. Tricyclics block the cell receptors, and this can account for some of the side effects associated with this type of antidepressant. This type of antidepressant is the oldest class used. While Tryciclic antidepressants are effective, they are not typically the first choice of practitioners. This group of antidepressant includes such drugs as Amitriptyline, Amoxapine, Doxepin, Nortriptyline, Protriptyline, Trimipramine and Desipramine. Some of these come in forms that are injected while others are an oral solution that must be mixed with some type of liquid.

Although Tricyclics are a helpful form of antidepressant, there are still several side effects to consider. These side effects include drowsiness, dry mouth, blurred vision, constipation, retention of urine, dizziness, increased heart rate, confusion, headache, low blood pressure, light sensitivity, weight gain, nausea, weakness and impaired sexual functioning.

TCAs are not considered addictive medications; however, if they are stopped abruptly or if several doses are missed, withdrawal-like symptoms can occur. These symptoms can include nausea, headache, lethargy, dizziness and flu-like symptoms.

People that have narrow-angle glaucoma, an enlarged prostate, or certain types of heart disease should avoid tricyclic antidepressants. Also, if there is a history of seizures or thyroid problems TCAs should be taken with caution. Patients with diabetes that are taking this type of antidepressant may need to check their blood sugar more often as TCAs may affect blood sugar levels.


Selective Serotonin Reuptake Inhibitors (SSRIs):

SSRIs are drugs that alter the amount of serotonin, a chemical that is present in the brain. This type of antidepressant is a newer form and is considered the current “standard” for treatment. It is thought that a cause of depression is an imbalance in the amount of serotonin in the brain. Serotonin is a chemical that transmits signals between neurons. An SSRI medication works to prevent the reuptake of serotonin and allows for a correction in the imbalance of this chemical. This form of antidepressant also affects neurotransmitters such as dopamine and norepinephrine as well. All three chemicals are involved in mood stabilization. Some of the medications that are included in this type of antidepressants include Paxil, Zoloft and Prozac.

While SSRIs typically have fewer side effects than Tricyclics do, they do not come without the possibility for adverse effects. Some problems that may be experienced with SSRIs include insomnia, decreased appetite, decreases in sexual function, anxiety, dry mouth and drowsiness. These side effects may cease once a person has been taking them for a period of time, but some of the side effects may persist. Sexual side effects are noticeable in both men and women that have been or are currently taking SSRIs. More specifically, women find it hard to achieve orgasm, and often men notice a delay in ejaculation. The drugs that are in this group are Celexa, Lexapro, Cipralex, Prozac, Prozac Weekly, Luvox, Luvox CR, Paxil and Zoloft.

SSRIs are thought to be safer than the first generation antidepressant drugs such as the TCAs; however, they may not work for every patient or as well as some of the TCA antidepressants work.


Monoamine Oxidase Inhibitors (MAOIs):

A third form of antidepressant is Monoamine Oxidase Inhibitors (MAOIs). This type of antidepressant works on the neurotransmitters serotonin, norepinephrine and dopamine. These antidepressants inhibit the metabolic degradation of these neurotransmitters. MAOIs increase the level of all three of these neurotransmitters in the brain. This type of antidepressant is most helpful for those people that do not respond well, if at all, to other treatments.

MAOIs can interact with certain foods, so people taking this type of drug must adhere to a strict diet. The foods that MAOIs interact with include cheese, wine and other foods containing tryamine. Because of the potential of fatal reactions between these foods and other medications, it is important to consult a physician when taking this form of antidepressant.

MAOIs do have potential side effects associated, which are another reason why they are not as frequently used as other types of antidepressants. These side effects include dry mouth, dizziness, upset stomach, muscle twitching, drowsiness and trouble sleeping. High blood pressure is among the side effects that could be potentially fatal when using MAOIs and combining them with certain foods and other medications.

Due to the risks involved with the older generation MAOIs, a new form has recently been introduced. Reversible inhibitors of monoamine oxidase type-A are a form of antidepressants that act on a more selective and shorter -lived manner. They also do not require a special diet.

The list of common MAOIs includes: Marplan, Nardil, Parnate, Zelapar, Eldepryl, Aurorix and Manerix. Another type of MAOI that has more recently been used is Emsam. This drug is a patch that is applied to the skin. Due to the fact that it can be offered in lower dosages than its oral counterpart, there are fewer side effects and it does not require a special diet.


Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):

A new form of antidepressant that is being used more recently is Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). This form of antidepressant is being used to treat depression by increasing the amount of serotonin and norephinephrine in the brain.

Some of the SNRIs that are used to treat depression include Effexor, Effexor XR, Pristiq and Cymbalta. Care should be taken when using these drugs because there are possible side effects with this form of antidepressant. When taking Effexor or Effexor XR, it is important to understand that they have the potential to raise blood pressure. Pristiq can have sexual side effects, while it is believed that Cymbalta may help relieve physical pain as well as help with depression.

Since these are a fairly new type of antidepressant that is being used to treat depression, it is important to speak with a professional about the risks and side effects of each different type of SNRI.


Mood Stabilizers:

Another form of medication that is used to treat conditions with depression involved is mood stabilizers. This form of medication can be used in conjunction with an antidepressant and is most frequently used when treating such conditions as bipolar or major depression. In some cases, these drugs may be used in place of antidepressants.

The medications that are included in the list of mood stabilizers are Lithane, Depakote and Eskalith. While these are not the only mood stabilizers used, they are the more common ones that are prescribed.


Antipsychotics:

Antipsychotics are rarely used. When they are used, they are generally used to treat patients with major depression in conjunction with psychotic episodes. Due to their potential side effects, they are used with caution and patients should discuss these side effects with a physician.

Some side effects that are associated with this type of drug include upset stomach, weight gain, drowsiness, fevers, seizers, rapid heart rate, a drop in white blood cell count, and movement disorders. When taking an antipsychotic, the risk of suicidal thoughts or actions is greater than when taking an antidepressant.

Zyprexa, Clozaril, Risperdal, Seroquel and Geodon are all brand names for antipsychotics that are used to treat psychotic episodes and mania.
Patients should report any side effects or changes in mood, thoughts of suicide or problems with their physician when taking this type of medication.

To sum up, there are three major types of Antidepressants: MAOIs, TCAs and SSRIs. A new form of antidepressant that is being used more recently is SNRIs. Mood stabilizers and antipsychotics are also two types of medications to consider when discussing drugs that help to counter act the effects of depression. It is important to consider the risks and side effects of any medication when considering taking them.