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Controlled substances policyAbout Antidepressants
Antidepressants are prescribed to patients having mental health issues like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and chronic pain due to underlying health conditions. These medications are used to treat clinical depression. However, they are not recommended for mild anxiety or depression, where therapy can help.
What conditions do antidepressants treat?
Antidepressants can be prescribed depending on the patient’s medical history and the severity of the condition he is currently suffering from. For example, your doctor may prescribe you antidepressants if you are suffering from any of the following conditions:
- Long-term pain
- Clinical depression
- Generalized anxiety disorder
- Obsessive-compulsive disorder
How do antidepressants work?
The precise mechanism of action for antidepressants is not clear. However, they are believed to function by elevating neurotransmitters and chemicals in the brain associated with mood and emotions, i.e., serotonin and noradrenaline.
These neurotransmitters may also impact the transmission of pain signals through nerves, providing a potential explanation for the alleviation of chronic pain observed in some cases with the use of antidepressants.
While antidepressants effectively address depression symptoms, they may not directly target the root causes of depression. Consequently, they are often employed in conjunction with therapy, particularly in the treatment of more severe depression or other mental health conditions.
Types of antidepressants
Different classes of antidepressants serve different modes of action and purposes as follows:
1. Tricyclic antidepressants (TCAs)
One of the oldest known antidepressant classes is tricyclic antidepressants, used to treat health conditions like OCD, bipolar disorder, or, in some cases, chronic nerve pain. However, doctors no longer recommend them due to more side effects than the new alternatives like SNRIs and SSRIs. Here are some of examples of drugs that belong to this class:
- Amitriptyline
- Clomipramine
- Dosulepin
- Imipramine
- Lofepramine
- Nortriptyline
2. Monoamine oxidase inhibitors (MAOIs)
This is another older class of antidepressants which is not recommended usually due to many serious side effects of the drug unless deemed fit by your doctor. Here are some of the examples:
- Tranylcypromine
- Phenelzine
- Isocarboxazid
3. Selective serotonin reuptake inhibitors (SSRIs)
This class of antidepressants is widely prescribed and is preferred over traditional classes due to fewer side effects. Even their overdose is less serious than others. One of the frequently prescribed SSRIs is fluoxetine, sold under the brand name Prozac. Others include the following:
- Citalopram (Cipramil)
- Escitalopram (Cipralex)
- Paroxetine (Seroxat)
- Sertraline (Lustral)
4. Serotonin-noradrenaline reuptake inhibitors (SNRIs)
Another class of antidepressants similar to SSRIs is serotonin-noradrenaline reuptake inhibitors (SNRIs), designed to treat depression effectively. For example:
- Duloxetine (Cymbalta and Yentreve)
- Venlafaxine (Effexor)
5. Serotonin antagonists and reuptake inhibitors (SARIs)
This class of antidepressants is only recommended when other options don’t work and aren’t considered the first choice of drugs for the treatment of mental health disorders due to its serious side effects, for example, trazodone (Molipaxin).
6. Noradrenaline and specific serotonergic antidepressants (NASSAs)
This class is recommended for those who are unable to take SSRIs. Although its side effects are similar to SSRIs, they don’t cause as many sexual problems as SSRIs do. They may have a sedative effect, i.e., mirtazapine (Zispin).
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Prescription
- Sertraline , 50mg, once daily.
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Side effects of antidepressants
Different classes of antidepressants can have different side effects. However, depression or the underlying health condition can worsen if left untreated than the side effects of treatment itself. Here are some of the general side effects antidepressants can impose:
- Nausea
- Diabetes
- Headaches
- Suicidal feelings
- Sexual problems
- Decreased alertness
- Serotonin syndrome
- Hypomania or mania
- Gastrointestinal bleeding
- Neuroleptic malignant syndrome
- Tooth decay and oral health issues
Who should not take Antidepressants?
Underlying health conditions in some people may make certain antidepressants unsuitable for use. In the case of Tricyclic Antidepressants (TCAs):
- People with epilepsy
- People with liver disease
- Individuals with a history of heart disease
- Those who have recently experienced a heart attack
- Those diagnosed with an inherited blood disorder known as porphyria
- Men with an enlarged prostate gland (benign prostate enlargement)
- Individuals with bipolar disorder or schizophrenia
- Individuals diagnosed with glaucoma, characterized by increased eye pressure
- People with a growth on the adrenal glands causing high blood pressure (pheochromocytoma)
Similarly, for Selective Serotonin Reuptake Inhibitors (SSRIs):
- Those with a bleeding disorder
- Individuals with kidney disease
- Individuals with type 1 or type 2 diabetes
- Individuals with bipolar disorder during a manic phase (although they may be beneficial for depressive phases)
- People with epilepsy (only recommended if the condition is well-controlled, with discontinuation if epilepsy worsens)
Consultation with a healthcare professional is crucial to determine the most suitable antidepressant based on individual health factors.
FAQs about antidepressants
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