Antidepressants

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Antidepressants are medications that can help relieve symptoms of depression, anxiety disorders, seasonal affective disorder (seasonal depression), dysthymia, mild chronic depression, and other conditions.

This type of medicine works by increasing neurotransmitters in the brain that are responsible for mood and behavioral changes.

Antidepressants were first produced in the 1950s and its use has become increasingly common in the last 20 years.

According to the Centers for Diseases Control and Prevention (CDC), the use of antidepressants increased from 1999 to 2014. Between 2011 and 2014, 12.7% of people aged 12 and over, 8.6% of men, and 16.5% of women took antidepressant medications in the past month. A quarter of people who take antidepressant medications have been doing so for 10 years or more.

Types of Antidepressants

There are several types of antidepressants, including:

Selective serotonin reuptake inhibitors (SSRI)

SSRIs are the most common type of antidepressants used as prescription medications. SSRIs are in greater demand compared to other antidepressants, as they cause fewer side effects. Overdoses also tend to be less serious.

Serotonin and noradrenaline reuptake inhibitors (SNRI)

SNRIs are designed more effectively than SSRIs. However, it is still uncertain if SNRIs are more effective treatments for depression – as some people respond better to SSRIs, while others respond better to SNRIs.

Noradrenaline and specific serotonergic antidepressants (NASSA)

NASSA may be effective for some people who are unable to use SSRIs. The side effects of NASSA are similar to those of SSRIs, but cause fewer sexual problems. However, this medication may cause sleepiness at first.

Tricyclic antidepressants (TCA)

TCA is an old type of antidepressant. It is usually no longer recommended as the first line of treatment for depression as it may cause more danger when an overdose occurs. TCA also causes more severe side effects compared to SSRIs and SNRIs.

TCAs may also be recommended for oher mental health conditions, such as OCD and bipolar disorder.

Monoamine oxidase inhibitors (MAOI)

MAOIs are also older types of antidepressants that have rarely been used for medical purposes.  MAOIs can cause potentially serious side effects, so it is recommended as prescription medications only.  

Dosing Considerations for Antidepressants

Your doctor will likely prescribe the lowest possible dose of antidepressants to ease your symptoms. This is done to lower the risk of side effects. Your doctor may gradually increase the dose if necessary.

Antidepressants usually come in tablets. Depending on the type of antidepressant your doctor prescribes and the severity of your depression, you will usually need to take 1 to 3 tablets a day.

It usually takes about 7 days before you can see the effects of antidepressants. Call your doctor if you do not see any improvement after 4 weeks. Your doctor may recommend increasing your dose or trying other types of antidepressants.

The use of antidepressants is usually recommended for at least 6 months. This prevents the condition from recurring after medication discontinuation. Some people who have relapses are advised to continue taking the medications indefinitely.

Missed Dose

It is important not to skip your doses, as it can make your treatment less effective. There may also be withdrawal symptoms due to missed doses. 

If you miss a dose, take your medicine as soon as you remember – unless it is almost time to take your next dose. In this case, it is best if you skip the missed dose. Do not take multiple doses to make up for a missed dose.

How Antidepressant Drugs Work

These medicines are used not only to treat depression, but also for other conditions. The main purposes of using antidepressants may include: 

  • Agitation.
  • Bipolar disorder symptoms.
  • Generalized anxiety disorder.
  • Social anxiety disorder.
  • Depression and major depressive disorder.
  • Enuresis or bed-wetting in children.
  • Obsessive-compulsive disorder (OCD).
  • Post-traumatic stress disorder (PTSD).

Sometimes antidepressants are used off-label. Your doctor may decide that antidepressants should be used for certain medications to be more effective. One study showed that 29% of antidepressants were used for off-label purposes. Off-label uses of antidepressants include:

  • Migraine.
  • Insomnia.
  • Pain.

Contraindications for Antidepressants

Pay attention to how antidepressants should be used if you have certain conditions.

SSRI

SSRIs may not be suitable if you have:

  • Bipolar disorder and you are in a manic phase (periods of overactive and excited behaviour), although it can work during a depressive phase.
  • Bleeding disorders or if you are taking medications that increase the chance of bleeding, for example warfarin.
  • Kidney diseases
  • Type 1 diabetes and type 2 diabetes.
  • Epilepsy. SSRIs should only be used if your epilepsy is under control and should be stopped if your condition worsens.

SNRI

SNRIs may not be suitable if you have a history of heart disease or poorly controlled high blood pressure..

TCA

TCA may not be suitable if you have:

  • Epilepsy.
  • Schizophrenia.
  • Liver disease.
  • Bipolar disorder.
  • History of heart disease.
  • Enlarged prostate gland.
  • Recent heart attack.
  • Porphyria or congenital blood disorders.
  • Angle-closure glaucoma – which causes increased pressure in the eye.
  • Pheochromocytoma or growth in your adrenal glands that causes high blood pressure.

Side Effects of Antidepressants

Symptoms of antidepressant side effects will likely occur during the first 2 weeks, then it will go away over time. Common side effects are nausea and anxiety – depending on the type of medication used.

Inform your doctor right away if the side effects are harmful, such as suicidal thoughts.

Research has linked the following side effects to antidepressant use, especially among children and teenagers:

Excessive mood elevation and behavior activation

This may include mania or hypomania. Antidepressants do not cause bipolar disorder, but they may reveal certain conditions.

Suicidal Thoughts

Some reports say that first-time use of antidepressants can lead to suicidal thoughts. This is caused by medications or other factors, such as how long it takes for the medication to work or undiagnosed bipolar disorder, which may require a different treatment approach.

Antidepressant Withdrawal Symptoms

When you stop taking antidepressants, you will not experience the same withdrawal symptoms as nicotine withdrawal when you quit smoking.

However, nearly 1 in 5 people using SSRIs and SNRIs report some withdrawal symptoms after treatment has stopped. These symptoms last for 2 weeks to 2 months, including:

  • Dizziness.
  • Stomach ache.
  • Anxiety.
  • Flu-like symptoms.
  • Nightmares
  • Electric shock sensation in the body.

In most cases, the symptoms are usually mild. Severe cases are rare and may only occur after you stop taking Seroxat and Effexor. Your doctor must reduce the dose gradually to minimize the risk of withdrawal symptoms.

Consult your doctor or pharmacist through Smarter Health to find out more about the recommended dosage for antidepressants. Smarter Health allows you to access health services whenever you need them.

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