Antidepressants - A Medical Boon or Bane

What Are Antidepressants?

Antidepressants help to treat different kinds of depression and anxiety problems. They help to relieve the symptoms of severe depression, such as feeling low and exhausted, anxiety, and sleep problems, and prevent suicidal thoughts. It is done by correcting the chemical imbalance of neurotransmitters in the brain, which are responsible for changes in mood and behavior.

What Are the Different Types of Antidepressants?

Antidepressants relieve depression by affecting neurotransmitters such as serotonin, norepinephrine, and dopamine, which aid communication between the brain cells. Each antidepressant type works in different ways.

The three most commonly used antidepressants:

• Selective serotonin reuptake inhibitors (SSRIs).

• Selective serotonin noradrenaline reuptake inhibitors (SNRIs).

• Tricyclic antidepressants (TCAs).

Selective Serotonin Reuptake Inhibitors - These are the most commonly prescribed antidepressants with fewer side effects. These drugs fight depression symptoms by decreasing serotonin reuptake in the brain. They include Sertraline, Fluoxetine, Citalopram, Escitalopram, Paroxetine, and Fluvoxamine.

Selective Serotonin Noradrenaline Reuptake Inhibitors -These help to improve serotonin and norepinephrine levels in the brain and may reduce depression symptoms. They include Desvenlafaxine, Duloxetine, Levomilnacipran, and Venlafaxine.

Tricyclic Antidepressants -They are prescribed when no other antidepressants work as they tend to cause more side effects and include Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, and Trimipramine.

The other antidepressants may include

Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, and Trimipramine.

The other antidepressants include

Dopamine reuptake blockers.

5-HT1A receptor antagonists.

Tetracyclic antidepressants.

5-HT2 receptor antagonists.

5-HT3 receptor antagonists.

Monoamine oxidase inhibitors (MAOIs).

Noradrenergic antagonists.

How Do Antidepressants Work?

Antidepressants increase the levels of specific neurotransmitters in the brain and prevent their breakdown and reabsorption into the neurons. It helps keep the levels of neurotransmitters high and improves communication between the brain's nerve cells. As a result, it helps to lift mood and behavior.

The drugs may take four to eight weeks to reduce the symptoms of depression and may be combined with other medicines to improve mental health conditions and severe depression.

What Conditions Are Treated by Antidepressants?

Antidepressants are used to treat depression, generalized anxiety disorder, agitation, obsessive-compulsive disorders (OCD), manic-depressive disorders, childhood enuresis (bedwetting), major depressive disorder, diabetic peripheral neuropathic pain, neuropathic pain, social anxiety disorder, post-traumatic stress disorder (PTSD).

What Is the Dosage of Antidepressants?

Antidepressants are usually taken in tablet form, which may have to be taken once or twice daily. The dosage is usually started at the lowest possible dose to reduce the risk of side effects. It may also vary depending on the type of antidepressant prescribed and the severity of your depression.

It takes around seven to ten days before you begin to notice the effects of the antidepressants. It is advised to contact your doctor if you do not notice any improvement after four weeks. The doctor may recommend an increase in dose or prescribe a different antidepressant.

The recommended course of treatment depends on the benefits of the antidepressant against its side effects, and the medicines are taken for at least six months after you feel better.

Missed Dose:

Miss no dose, as they can make your treatment less effective. Taking it as soon as you remember is recommended if you miss a dose. Avoid taking double doses of antidepressants as it may cause an increased risk of side effects.

What Are the Side Effects of Antidepressants?

Antidepressants cause mild side effects, which may get better over time. The most common side effects include

• Nausea.

• Vomiting.

• Diarrhea.

• Dizziness.

• Drowsiness.

• Urinary hesitancy.

• Weight gain.

• Sleepiness.

• Dry mouth (xerostomia).

• Tremor.

• Blurred vision.

• Urinary retention.

• Abdominal cramps.

• Inability to have sex.

Do not stop antidepressants suddenly, as they may lead to withdrawal symptoms such as dizziness, headache, irritability, psychosis, and seizures if discontinued abruptly.

What Are the Precautions to Be Taken When Taking Antidepressants?

All antidepressants carry black box warnings as there is an increased risk of suicidal thoughts or behavior in young adults and children, especially in the first few weeks.

• Pregnancy - Antidepressants are not recommended during pregnancy, especially during the early stages, and maybe a risk to the pregnant woman and the fetus.

• Children - The use of antidepressants is not recommended in children and young people under 18 as it may trigger thoughts about suicide and acts of self-harm in this age group.

• Driving and Operating Machinery - Antidepressants can cause dizziness, drowsiness, and blurred vision and should be avoided while driving or operating machinery.

• Liver Disease - Therapy with antidepressants induce hepatotoxicity in elderly patients and those on multiple medicines.

• Allergic Reactions - Allergic reactions may occur with antidepressants, either because the person is allergic to an active ingredient of the medicine or may be allergic to fillers, dyes, or other inactive ingredients in the pill.

• Diabetes - People taking long-term antidepressants have an increased risk of developing type 2 diabetes ( when the body does not use insulin properly).

• Alcohol - Combining alcohol consumption with antidepressants can affect your judgment, coordination, and motor skills. Drinking alcohol with antidepressants can further worsen the symptoms of depression.

What Are Various Interactions With Antidepressants?

Drug Interactions:

The following drugs may interact with antidepressants:

• Benzodiazepines.

• Warfarin.

• Metoprolol.

• Buspirone.

• Antiepileptics such as Phenytoin, Carbamazepine.

• NSAIDs like Aspirin.

• Monoamine oxidase inhibitors (MAOIs) like Moclobemide.

• Clozapine.

• Tramadol.

• Lithium.

• Selegiline.

• St John’s Wort.

• Antiarrhythmic drugs like Quinidine and Amiodarone.

• Ritonavir.

Interactions with Disease:

• Bipolar Disorder - Patients with bipolar disorder (a disorder associated with episodes of mood swings) may experience mania or hypomania, so they should be given antidepressants with caution.

• Diabetes - Many antidepressants are associated with weight gain, increased insulin resistance, and the risk of diabetes. All antidepressants significantly lower blood sugar.

• Epilepsy - Antidepressants are not recommended in patients with unstable epilepsy or seizure disorders. The drugs can increase episodes of seizures and should be avoided.

• Kidney Disease - Therapy with antidepressants can deteriorate kidney function and should be cautiously administered. Patients with kidney disease may require small doses as they often get more side effects.

• Bleeding Disorder - The use of antidepressants may cause altered platelet function, increased time, and gastrointestinal hemorrhage and should be administered cautiously in patients with bleeding or a hemorrhagic diathesis.

• Liver Disease - The liver primarily metabolizes antidepressants. It may be required to adjust the doses in patients with impaired hepatic function.

• Glaucoma - Some antidepressants, such as Fluoxetine and Paroxetine, may affect eye angle resulting in increased intraocular pressure and angle-closure glaucoma.

Interaction With Food:

• Tyramine - Do not mix antidepressants like monoamine oxidase inhibitors (MAOIs) with food that contain tyramine. These foods include cheese, processed meats, chocolates, red wine, and smoked fish, and they cause increased blood pressure.

• Dairy Foods - Dairy products such as milk, cheese, and yogurt may interfere with the absorption of antidepressants.

• Caffeinated Beverages - Large amounts of caffeine may cause symptoms like palpitations, restlessness, and insomnia. It is best to avoid consuming caffeinated beverages while taking antidepressants.

Conclusion:

Antidepressants may take several weeks for a person to notice the effects of the medicine. Discuss with the doctor to find the right drug and therapeutic dose for your depression. However, a healthy and balanced diet and connecting with family and friends can help to reduce depression and its recurrences.