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Antidepressant drugs are not happy pills, and they are not a panacea. They are prescription-only drugs that come with risks as well as benefits, and should only ever be taken under a doctor’s supervision. They are, however, one depression treatment option. Taking medications for depression is not a sign of personal weakness — and there is good evidence that they do help.Whether antidepressant medication is the best treatment option depends on how severe the person's depression is, their history of illness, their age (psychological treatments are usually the first choice for children and adolescents), and their personal preferences. Most people do best with a combination of medications for depression and therapy.
For adults with severe depression, says psychiatrist, Petros Markou, M.D., there is strong evidence that antidepressants are more effective than any other treatment. If depression is mild or moderate, psychotherapy alone may be sufficient, though even in this case, short-term antidepressant drug treatment or herbal therapy can help people get to the point where they can engage in therapy and get some exercise (which is also thought to help improve mood).
Types of Antidepressants
There are many different kinds of antidepressants, including:
Selective serotonin reuptake inhibitors (SSRIs)
Tricyclic antidepressants (tricyclics)
Others
Like most medicines, antidepressant drugs can cause side effects. Not all people get these side effects. Any side effects you have will depend on the medicine your doctor has chosen for you. Your doctor should talk to you about your medicine.
SSRIs
SSRIs are a group of antidepressants that includes drugs such as escitalopram (brand name: Lexapro) citalopram (brand name: Celexa), fluoxetine (brand name: Prozac), paroxetine (brand name: Paxil) and sertraline (brand name: Zoloft). Selective serotonin reuptake inhibitors act only on the neurotransmitter serotonin, while tricyclic antidepressants and MAO inhibitors act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body.
Selective serotonin reuptake inhibitors have fewer side effects than tricyclic antidepressants and MAO inhibitors, perhaps because selective serotonin reuptake inhibitors act only on one body chemical, serotonin. Some of the side effects that can be caused by SSRIs include dry mouth, nausea, nervousness, insomnia, headache and sexual problems. People taking fluoxetine might also have a feeling of being unable to sit still. People taking paroxetine might feel tired. People taking sertraline might have runny stools and diarrhea.
Tricyclics
The tricyclics have been used to treat depression for a long time. They act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body. They include amitriptyline (brand name: Elavil), desipramine (brand name: Norpramin), imipramine (brand name: Tofranil) and nortriptyline (brand names: Aventyl, Pamelor). Common side effects caused by these medicines include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These antidepressants can also affect a person's blood pressure and heart rate.
Other Antidepressants
Other antidepressants exist that have different ways of working than the SSRIs and tricylics. Commonly used ones are venlafaxine, nefazadone, bupropion, mirtazapine and trazodone. Less commonly used are the monoamine oxidase inhibitors (MAOIs).
Some of the most common side effects in people taking venlafaxine (brand name: Effexor) include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased blood pressure, increased heart rate and increased cholesterol levels can also occur.
Nefazodone (brand name: Serzone) can give people headaches, blurred vision, dizziness, nausea, constipation, dry mouth and tiredness.
Bupropion (brand name: Wellbutrin) can cause agitation, insomnia, headache and nausea. Mirtazapine (brand name: Remeron) can cause sedation, increased appetite, weight gain, dizziness, dry mouth and constipation. Some of the most common side effects of trazodone (brand name: Desyrel) are sedation, dry mouth and nausea. MAOI antidepressants like phenelzine (brand name: Nardil) and tranylcypromine (brand name: Parnate) commonly cause weakness, dizziness, headaches and tremor.
Interactions of Antidepressants
Antidepressants Can Affect Other Medications You May Be Taking
Antidepressants can have an effect on many other medicines. If you're going to take an antidepressant, tell your doctor about all the other medicines you take, including over-the-counter medicines and herbal health products (such as St. John's wort). Ask your doctor and pharmacist if any of your regular medicines can cause problems when combined with an antidepressant. When taken together, some medicines can cause serious problems.
Taking an MAOI antidepressant at the same time as any other antidepressants or certain over-the-counter medicines for colds and flu can cause a dangerous reaction. Your doctor will tell you what foods and alcoholic beverages you should avoid while you are taking an MAOI. You should not take an MAOI unless you clearly understand what medications and foods to avoid. If you are taking a MAOI and your doctor wants you to start taking one of the other antidepressants, he or she will have you stop taking the MAOI for a while before you start the new medicine. This gives the MAOI time to clear out of your body.
Another risk of antidepressants is serotonin syndrome, a drug reaction resulting from the over-stimulation of serotonin receptors. This can occur when an antidepressant is taken either with another antidepressant, with certain recreational and other drugs (see below), or more rarely, even when one antidepressant is taken alone. Symptoms include hyperactivity, mental confusion, agitation, shivering, sweating, fever, lack of coordination, seizure, and diarrhoea.
To minimise the risk of serotonin syndrome, there must be a 'washout' period of at least two weeks when switching from one antidepressant drug to another.
Drugs that may induce serotonin syndrome when taken with antidepressants (not a complete list)
ecstasy
cocaine
lithium
St John's wort (Hypericum) - herbal antidepressant
diethylproprion - an amphetamine
dextromethorphan - found in many cough suppressants
Buspar (buspirone) - for anxiety
Selgene, Eldepryl (selegiline) - for Parkinson's Disease
anti-epileptics - Tegretol, Carbium, Teril (carbamazepine)
analgesics - pethidine, Fortral (pentazocine), Tramal (tramadol), fentanyl
anti-migraine drugs - Naramig (naratriptan), Imigran (sumatriptan), Zomig (zolmitriptan)
appetite suppressants - phentermine and fenfluramine
tryptophan - an amino acid
Antidepressants Are Not A Magic Bullet
While antidepressant drugs help people feel better, they cannot solve problems in people's lives. Some mental health professionals worry that people who could benefit from psychotherapy rely instead on antidepressant drugs for a "quick fix." Others point out that the drugs work gradually and do not produce instant happiness. The best approach is often a combination of counseling and medicine, but the correct treatment for a specific patient depends on many factors. The decision of how to treat depression or other conditions that may respond to antidepressant drugs should be made carefully and will be different for different people.
Antidepressants
Medications for Depression
How antidepressants work
Types of antidepressants
Interactions of antidepressants
Serotonin syndrome
Which antidepressant drug is best for me
Antidepressants are medicines used to help people who have depression. With the help of these depression medications, most people can achieve significant recovery from depression.
Antidepressant drugs are not happy pills, and they are not a panacea. They are prescription-only drugs that come with risks as well as benefits, and should only ever be taken under a doctor’s supervision. They are, however, one depression treatment option. Taking medications for depression is not a sign of personal weakness — and there is good evidence that they do help.
Whether antidepressant medication is the best treatment option depends on how severe the person's depression is, their history of illness, their age (psychological treatments are usually the first choice for children and adolescents), and their personal preferences. Most people do best with a combination of medications for depression and therapy.
For adults with severe depression, says psychiatrist, Petros Markou, M.D., there is strong evidence that antidepressants are more effective than any other treatment. If depression is mild or moderate, psychotherapy alone may be sufficient, though even in this case, short-term antidepressant drug treatment or herbal therapy can help people get to the point where they can engage in therapy and get some exercise (which is also thought to help improve mood).
"How do I get better? Well, certainly, for me in recent years it has been through anti-depressant drug therapy - mainly in the beginning, because I think it’s very hard to get into all that positive thinking and raise your self esteem and all those things that you’re supposed to do, if your mood is so low you can’t even think at all. So to take anti-depressants, and most of them are very good, they do help me to shift the mood and then work on other therapies, and work with other people that know how I feel, and all of those things that will, I know, in the time of life not everything is going to solve our problems.
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