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Antidepressants: What Do You Need To Know Before Starting Them?

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Antidepressants are prescribed medicines that treat clinical depression and similar mental problems. Depression is not feeling sadness or blue once in a while. Instead, it is a more serious mental condition where you simultaneously feel tired, sad, hopeless, and fearful. Not only is your mood affected, but everyday activities also suffer due to depression. 

It can also change your thinking, affect your eating and sleeping schedule, and in some severe cases, it can lead to suicide.

  • Some antidepressants can improve focus and concentration in addition to mood stabilization.
  • Genetic predispositions may affect how individuals respond to certain antidepressants.
  • Antidepressants are sometimes used off-label to treat conditions like irritable bowel syndrome (IBS).
  • Light therapy can enhance the effectiveness of certain antidepressants for seasonal depression.
  • Combining antidepressants with exercise may accelerate mood improvement.
  • Some antidepressants influence gut microbiota, which may also play a role in mood regulation.
  • Older adults may require different dosages of antidepressants due to changes in metabolism

Antidepressants work to boost the activity of certain chemicals in the brain that control mood and stress. By improving the production of chemicals, antidepressants lift your spirit and work to make this activity last longer. 

What Are The Types Of Antidepressants?

Based on how they work in your body, antidepressants are divided into different groups. Within each group, multiple medicines work similarly. 

1. SSRIs

SSRIs or selective serotonin reuptake inhibitors are considered more effective, with fewer side effects during the treatment of depression, which is why they are preferred most of the time. 

Side Effects of SSRIs

  • Nausea/vomiting/diarrhea
  • Insomnia and sedation 
  • Abrupt weight gain
  • Sexual dysfunctionality 

What are the common SSRI drugs?

Citalopram (Celexa)

By increasing the activity of serotonin in the brain, they treat severe depression symptoms and boost energy levels. It is better not to use this drug for a longer time period.

Escitalopram (Lexapro)

It is used to treat anxiety disorders and depression. Generally, doctors prescribe it in combination with other drugs as a part of therapies.

Fluoxetine (Prozac)

This drug treats various mental disorders like Obsessive Compulsive Disorder (OCD), panic attacks, depression, and some eating disorders. 

Fluvoxamine (Luvox)

Fluvoxamine blocks unwanted thoughts, obsessions, and compulsion to perform a task repeatedly.

Paroxetine (Paxil)

This drug uplifts your mood, increases appetite, and improves sleep quality. It is prescribed to treat OCD, panic attacks, and PTSD. It helps decrease fear and depression. 

Sertraline (Zoloft)

It decreases OCD, PTSD, panic attacks, and depression. By increasing serotonin in the brain, it improves mood.

Vilazodone (Viibryd)

 Vilazodone treats Major Depressive Disorder (MDD). However, it can treat depression, panic attacks, and OCD.

What do you need to consider before starting the SSRI medications?

  • SSRIs are primarily used in 1st line therapy or anxiety treatment. 
  • SSRIs are considered the best. These medications may take 4-6 weeks to reach their full effectiveness.
  • Once you have started taking them regularly or as prescribed, you can’t stop abruptly. 

2. SNRIs

Serotonin and norepinephrine reuptake inhibitors or SNRIs are prescribed to treat anxiety and specific types of pain. SNRIs are also used when SSRIs are not working effectively. SSRIs work on only one chemical named serotonin. 

In contrast, SNRIs affect the two most important chemicals of the brain to treat depression – serotonin and norepinephrine.

What are the Common Medications of SNRIs?

Desvenlafaxine (Sevilla)

Desvenlafaxine increases the levels of norepinephrine and serotonin in the brain. It is used to treat depression. 

Duloxetine (Cymbalta)

It is used to treat the symptoms of Generalized Anxiety Disorder (GAD). Duloxetine is also sometimes prescribed to treat chronic pain. 

Levomilnacipran (Fetzima)

It is prescribed to relieve severe depression symptoms. It can also treat Major Depressive Disorder (MAD).

Venlafaxine (Effexor)

 It is used to improve mood and sleep quality. It can treat various conditions like anxiety, depression, Social Anxiety Disorder (SAD), and panic attacks.

What are the side effects of SNRIs?

  • High blood pressure
  • Insomnia or sedation
  •  Anxiety or agitation
  •  Constipation or HR 
  •  Dry mouth

What to consider before taking SNRI medications?

  • SNRIs can take almost four weeks to reach their maximum effectiveness.
  • You cannot stop them abruptly like SSRIs.
  • And you cannot also mix them with other classes of antidepressants such as TCAs or MAOIs. This can cause serotonin syndrome. 

3. TCAs

Tricyclic antidepressants, or TCAs, are one of the first antidepressants and are still used widely to treat depression. But, only when SSRIs and SNRIs are not performing as desired. The reason why TCAs are not the first choice – is because TCAs’ side effects are more severe than other antidepressants.  

What are the Common Medications of TCAs?

Amitriptyline (Elavil)

This is usually used to treat insomnia. Moreover, it can treat sleep disorders and depression.

Amoxapine (Asendin)

 It treats neurotic disorders, reactive depressive disorders, and psychotic depression. Sometimes it is also prescribed to treat anxiety and agitation.

Clomipramine (Norpramin)

It is mainly prescribed to relieve Obsessive Compulsive Disorder (OCD) symptoms

Doxepin

 Doxepin treats anxiety, agitation, and sleep disorders. It works by increasing some chemicals in the Central Nervous System (CNS).

Imipramine (Tofranil)

It helps restore appetite, sleep, and mood. Sometimes it is prescribed to treat depression and anxiety as well. Imipramine can also treat bedwetting in children.

Nortriptyline (Pamelor)

Nortriptyline treats nerve pain. It is sometimes prescribed for sleep disorders, depression, and nocturnal enuresis as well.

Protriptyline (Surmontil)

It is prescribed to treat symptoms of depression under medical supervision. 

What are the side effects of TCAs?

  • Your vision can get blurred
  • There can be an increase or decrease in body weight
  • Constipation and dry mouth are pretty common
  • Tachycardia (fast heartbeat)
  • Orthostatic hypotension (a form of low BP )

What do you need to consider before starting the TCA’s medications?

  • For heart patients, TCAs can be cardiotoxic. 
  • TCAs can be deadly if there happens to be an overdose. 
  • Usually, like other antidepressants, TCAs can take up to 4 weeks to reach their full effectiveness. 
  • And you cannot stop the dose abruptly. 

4. MAOIs

One of the most potent antidepressants, MAOIs or monoamine oxidase inhibitors, are used for depression. MAOIs are antidepressants that prevent the breakdown of serotonin and norepinephrine.

What are the Common Medications for MAOIs?

Isocarboxazid (Marplan)

This is an antidepressant for people who do not show improvements with any other medication. It can also relieve anxiety and uplift your mood.

Phenelzine (Nardil)

This drug treats non endogenous depression. It is recommended when no other medicine is working.

Selegiline (Emsam)

It is mainly prescribed to treat Parkinson’s disease. It is not a cure for PD but may improve the symptoms. 

Tranylcypromine (Parnate)

It is used as an antidepressant when other medicines do not show improvement. 

What are the side effects of MAOIs?

  • Like other antidepressants, MAOIs also give you a headache
  • Insomnia
  • Dry mouth
  • Dizziness
  • N/V/D and constipation 

What do you need to consider before starting the MAOI’s medications?

To reach the full effectiveness of MAOIs, you have to avoid tyramine. It can cause a hypertensive crisis. You can find tyramine in foods like cheese, aged meat, dried/overripe fruits, pickled or fermented foods, beer, or wine. 

5. Atypicals

Atypical antidepressants are the fifth and last class of antidepressants and, most of the time, are prescribed when drugs from other classes do not work for the patient. 

What are the Common Medications of Atypicals?

Bupropion (Wellbutrin)

 It helps Seasonal Affective Disorder symptoms by increasing the activity of certain chemicals in the brain. Sometimes it is also recommended to help quit smoking. 

Fluoxetine/olanzapine (Symbax)

 This is generally recommended to treat schizophrenia and bipolar disorder. When used in combination with some other drugs, it can also treat depression. 

Trazodone (Oleptro)

It helps increase the levels of serotonin in the brain and helps relieve depression. It is also prescribed for Major Depressive Disorder.

Mirtazapine (Remeron)

It increases the activity of certain chemicals in the brain to restore mental balance and treat depression. 

What are the side effects of Atypicals?

  • The patient might feel dizziness
  • Weight gain or loss
  • Dry mouth
  • Insomnia or sedation

What to consider before taking the Atypical medications?

Do not use bupropion in seizures, bulimia, and anorexia. Mirtazapine tends to cause lipids and weight pain.

Who can prescribe you Antidepressants?

You cannot buy antidepressants from any pharmacy without a prescription. It can only be prescribed by:

  • Medical Practitioner
  • A psychiatrist
  • A specialist pharmacist or nurse prescriber

Even your doctor won’t prescribe antidepressants. Many antidepressants will only be prescribed for treating mental health disorders. 

What other things to be aware of if you are on Antidepressants?

  • You do not have a painkiller that will work immediately. With antidepressants, you have to be more patient. If you take them as prescribed, you will see improvement within a month and a half.
  • Antidepressants cause side effects, but they also get better with time as your body adjusts. 
  • Do not cut down or stop the medications even if you don’t feel bad anymore. Sudden quitting can worsen depression. 
  • And lastly, avoid the use of alcohol and other drugs as they can be dangerous sometimes. 

Takeaway

Although antidepressants have been the primary treatment for depression for over 60 years, many people still don’t know what they are. And it’s not their fault! Antidepressants can be tricky to understand and use, and even the experts can make mistakes. 

This guide will get you up to speed on antidepressants and show you how to pick the right ones for you. While many people have been on antidepressants for years, others have stopped taking them entirely. If that sounds like you, you may want to think about why you’re not feeling better after a few weeks or months. If things go well, you should see improvement in your mood within a few weeks.

Antidepressants: What Do You Need To Know Before Starting Them?

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