Antidepressants
TheSite.org identifies the different antidepressant drugs available and explores their pros and cons.
How do antidepressants work?
Depression is associated with low levels of certain chemicals in the brain, notably serotonin and noradrenaline. Most antidepressant drugs are designed to increase the levels of these chemicals in the brain. Antidepressants are not a quick-fix solution as they can take between two to four weeks before they start to work. A minimum course of six months' treatment is usually recommended in order to ensure that a relapse does not occur. Antidepressants can be very effective at lifting people's mood and alleviate the distressing symptoms of depression; however, they do not address any underlying emotional or psychological cause of why a person became depressed in the first place. Due to this, many people are referred for talking treatments as well as being prescribed drug treatment.
Who takes them?
Antidepressant drugs are used primarily in the treatment of depression, but are also used to treat other conditions such as anxiety, panic attacks, obsessive-compulsive disorder and phobias.
Are there any possible side effects?
Drugs can affect people differently; what works well for one person may not for another. Some people may experience adverse effects from a medication while others have little or no problem. Common side effects of antidepressant drugs can include dry mouth, blurred vision, nausea, sweating, constipation or diarrhoea, sexual problems, rashes, anxiety, tremor, dizziness, or drowsiness. Less common side effects include hallucinations, suicidal thoughts, mania, convulsions and movement disorders. A frequent side effect of Prozac is that it can interfere with your ability to orgasm. Of course if you aren't in a relationship, you may not mind, but if you are, sex may be an important way for you to get pleasure, so you may decide to ask to switch to another brand. If you experience worrying side effects, it is important to discuss these concerns with your doctor (GP), who could try prescribing you a different drug that may not have adverse effects for you. Alcohol and recreational drugs should be avoided as they can interact with the medication or cause it to be less effective.
Can they cause dependence?
Although it is generally claimed that antidepressants do not cause dependence, it is usually recommended that the drugs be withdrawn gradually. Stopping taking drugs suddenly can cause a 'discontinuation syndrome' with physical symptoms such as nausea, vomiting, diarrhoea, flu-like symptoms or sleep problems. People can also experience 'rebound depression'; a recurrence of the depressed feelings as a result of not withdrawing from antidepressants slowly.
What are the choices?
There are many different drugs that can be prescribed depending on an individual's particular situation, their diagnosis and the severity of their symptoms. Some can have sedative effects, others can stimulate; some are prescribed widely, others usually only within a hospital environment. Your doctor will probably recommend which drug they think is likely to work well for you, but remember you have the right to make an informed decision about which treatment to have, and whether or not to accept the treatment a doctor suggests. Below is a list of commonly available antidepressants and the conditions they are usually recommended to treat. Remember, drugs tend to have two names, a generic name for the drug itself, and a brand name given by a particular manufacturer.
SSRIs (Serotonin Specific Re-uptake Inhibitors)
- Citalopram (Cipramil): depression, panic disorder
- Escitalopram (Cipralex): depression, panic disorder
- Fluoxetine (Prozac): depression, obsessive-compulsive disorder
- Fluvoxamine (Faverin): depression, obsessive-compulsive disorder
- Paroxetine (Seroxat): depression, anxiety, panic, social phobia
- Sertraline (Lustral): depression, obsessive-compulsive disorder
SNRI (Serotonin-Noradrenaline Re-uptake Inhibitor)
Venlafaxine (Efexor): depression, anxiety
NARI (Noradrenaline Re-uptake Inhibitor)
Reboxetine (Edronax): depression
NaSSA (Noradenergic & Specific Serotonergic Antidepressant)
Mirtazepine (Zispin): depression
MAOIs (Monoamine Oxidase Inhibitors)
- Phenelzine (Nardil): depression
- Isocarboxazid (Isocarboxazid non-proprietary): depression
- Tranylcypromine (Tranylcypromine non-proprietary): depression
Reversible MAOI
Moclobemide (Manerix): depression, social phobia
Tricyclic antidepressants
- Maprotiline (Ludiomil): depression
- Mianserin Hydrochloride (Mianserin): depression
- Trazodone (Molipaxin): depression, anxiety
Other antidepressant drugs
- Flupenthixol (Fluanxol): depression, psychosis
- Tryptophan (Optimax): hospital treatment of severe depression
Herbal supplements
St John's Wort (Hypericum perforatum): depression
Who shouldn't take antidepressants?
If you fall into one of the following categories, consultation with your doctor is especially important, and you may be advised to avoid medication altogether:
- Pregnant women: the mother's needs will always be taken into consideration, but every alternative should be explored before prescribing antidepressants;
- Breastfeeding mums: there is a possible risk to an unborn child, and breastfeeding mums can pass any drugs they are taking to their babies through their breast milk;
- Children: guidelines on depression in children and young people recommend that antidepressants should only be given to children in combination with psychological therapies;
- Those on other medication: antidepressants can interact with a number of different types of drug, and some combinations can be dangerous, so make sure your doctor is aware of any other drugs you are taking;
- Heavy drinkers: taking antidepressants could be detrimental as alcohol is a depressant and the two interact badly.
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