antidepressants

Let’s Talk About Antidepressants

Antidepressants are medicines used to treat a variety of depression and anxiety disorders. Most clinical physicians will use antidepressants to help treat disorders including, but not limited to: 

Prevalence Of Antidepressant Use  

Studies suggest that almost 13% of the U.S. population (over age 12) have taken an antidepressant medication within the past month. The use of antidepressant medication has increased by over 60% in the last two decades. Almost 19% of people over age 60 are using antidepressants… 16% of people ages 40–59, 8% of adults ages 20–39… and a little over 3% of young people ages 12–19. 

In some instances, people with depression and anxiety disorders are also treating other medical conditions. For instance, almost 21% of people with Type 1 diabetes and 27% with Type 2 diabetes show symptoms of depression. However, almost two thirds of these patients are undertreated for their depression symptoms.  

How Antidepressants Work 

In general, antidepressant medications start working within 2–4 weeks after first use. This means some patients will not feel an immediate relief of their symptoms. However, when patients stay the course of treatment, people report:

  • Being able to enjoy everyday activities
  • Having more energy
  • Better quality sleep
  • Improved appetite

Antidepressant medications also help reduce anxiety, fatigue and negative thoughts. 

Courses of treatment can last for up to eight months, with regular assessment. It is important to consult with your doctor about your symptoms, treatment and side effects. Antidepressants affect brain chemistry, which is a serious matter. Changes in doses or medications can have serious adverse effects (i.e. relapse). Consult with your physician about any changes and lapses of your medications. 

A History Of Antidepressants 

The monoamine hypothesis states that patients with depression show depleted levels of serotonin, dopamine and norepinephrine. 

It was with a little luck and a lot of observation that the first antidepressant medication was discovered while studying new methods to treat tuberculosis. Hoffmann-La Roche Ltd USA developed a compound called isoniazid to treat TB. It proved to significantly improve mortality rates. Further studies led to the discovery of iproniazid. Patients being treated with iproniazid reported several “side effects” of euphoria, improved sleep patterns and an increase in appetite. Loomer, Saunders and Kline published the results of a study treating depression patients with iproniazid, with 70% of patients showing “significant improvements.” Although iproniazid was used to treat TB, many physicians started using it off label to treat patients with depression. 

Thus, iproniazid became the first successful pharmacological treatment for depression and is classified as a MAO inhibitor… In 1958 an antitubercular compound sold under the trade name Marsilid was used off-label to treat people suffering from depression. (Bunney & Davis, 1965; Delgado, 2000; Hirschfeld, 2000; Schildkraut, 1965.)

Since this first discovery, antidepressants have come a long way. 

Antidepressants Today

Most antidepressant medications operate to regulate certain brain chemicals called neurotransmitters: serotonin, dopamine and norepinephrine. Now there are generally five different classes of antidepressant medications available to select from, and each has its own specific pathway of treatment. 

  1. Selective serotonin reuptake inhibitors (SSRIs)
    SSRIs are typically one of the first antidepressant medications to be prescribed. As the name suggests, these regulate serotonin. They sometimes have fewer side effects—and can be used at higher doses—than other medications. Typically, SSRIs include trade names such as Paxil, Prozac, Zoloft, Celexa and Lexapro. 
  2. Cyclic antidepressants
    These were one of the first types of antidepressant medications developed. However, they have been replaced with more recent medications that have fewer side effects. According to the Mayo Clinic, cyclic antidepressants generally “block the absorption (reuptake) of the neurotransmitters serotonin and norepinephrine, increasing the levels of these two neurotransmitters in the brain. Cyclic antidepressants also affect other chemical messengers, which can lead to a number of side effects.” Some common trade names of these are Norpramin, Tofranil, Pamelor, Vivactil and Surmontil.
  3. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
    These antidepressant medications focus on both serotonin and norepinephrine neurotransmitters. SNRIs block the reabsorption (reuptake) of the neurotransmitters serotonin and norepinephrine in the brain. Some commonly prescribed SNRIs include Cymbalta, Effexor XR, Pristiq, Khedezla and Fetzima.
  4. Monoamine oxidase inhibitors (MAOIs)
    MAOIs generally are used as a last resort medication after other treatments are not successful. MAOIs are prescribed under the trade names Parnate, Nardil and Marplan. But these can have very serious side effects. In fact, strict dietary considerations are advised when taking some MAOIs, including an avoidance of wine and cheeses. This is why they are closely monitored and used as a last resort in many cases. 
  5. Atypical antidepressants
    These antidepressants generally do not fit into any of the above categories of medications. However, they still regulate the levels of one or more neurotransmitters, such as dopamine, serotonin or norepinephrine. 

These types of antidepressants include Wellbutrin, Forfivo XL, Aplenzin, Remeron and Trintellix.

Side Effects Of Antidepressants

Since the class of categories of antidepressants is vast, the side effects are specific to each medication. Below we provide a general list of side effects associated with some of the antidepressant medications cited above. 

  • Dry mouth 
  • Rashes
  • Low sodium or low blood sugar
  • Sexual dysfunction
  • Headaches
  • Anxiety
  • Nausea
  • Constipation or diarrhea
  • Weight loss
  • Sweating
  • Sedation
  • Dizziness
  • Seizures
  • Insomnia
  • Arrhythmia, or irregular heartbeat
  • Abdominal cramps
  • Blurred vision or increased eye pressure

Antidepressant medications are shown to work overtime to help the symptoms of depression and anxiety. However, finding the right medication and dose that works for each individual is what we strive to accomplish at Best Day Psychiatry and Counseling. Remember, what might work for one person may not work for you. If you are experiencing symptoms of depression or anxiety, please feel free to contact us immediately. Our physicians are always here to help you and your family.


How We Can Help You

Best Day Psychiatry and Counseling is here to help you have a better day and find a better way. We treat a wide range of psychiatric conditions for both children and adults. Contact us today, we’re ready to help:

Fayetteville: (910) 323-1543 Fuquay-Varina: (919) 567-0684 Raleigh: (919) 670-3939