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ANTIDEPRESSANTS

WHAT ARE ANTIDEPRESSANTS?

Antidepressants are drugs that relieve the symptoms of depression. They were first developed in the 1950s and have been used regularly since then. There are almost thirty different kinds of antidepressants available today and there are four main types:






  • Tricyclics
  • MAOIs (Monoamine oxidase inhibitors)
  • SSRIs (Selective Serotonin Reuptake Inhibitors)
  • SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors)

HOW DO ANTIDEPRESSANTS WORK?

Depression is continually being research but it is thought that antidepressants work by increasing the activity of certain chemicals that work in our brains called neurotransmitters. They pass signals from one brain cell to another. The chemicals most involved in depression are thought to be Serotonin and Noradrenaline.

WHAT ARE ANTIDEPRESSANTS USED FOR?

  • Severe anxiety and panic attacks
  • Obsessive compulsive disorders (OCD)
  • Chronic pain
  • Eating disorders
  • Post-traumatic stress disorder (PTSD)
  • Moderate to severe depressive illness (Antidepressant are not used for mild depression)

If you are not certain why an antidepressant has been suggested for you or prescribed to you, ask your physician.

DO ANTIDEPRESSANTS WORK?

Research indicates that in 3 months of treatment, the proportions of people with depression who will be much improved are: 50 percent and 65 percent if given an antidepressant compared with 25 - 30 percent if given an inactive "dummy" pill, or placebo.

Some people given placebo tablets improve, which is common with all tablets that affect how people feel. The effect is similar with painkillers. Antidepressants are helpful and just like many other medicines, some of the benefit is due to the placebo effect.

WHAT IS THE DIFFERENCE BETWEEN THE OLDER AND NEW ANTIDEPRESSANTS?

The older medicines (Tricyclics) are just as effective as the newer ones (SSRIs) although the newer ones seem to have fewer side-effects. A major advantage for the newer medicines is that they are not so dangerous if someone takes an overdose.

WHAT ARE THE SIDE EFFECTS OF ANTIDEPRESSANTS?

Your physician should go over ALL the side effects of an antidepressant. You should also receive a flyer or pamphlet with all prescriptions from the drug manufacturer. Always remind your physician of any medical conditions you have or have had in the past. Listed below are the side effects you might experience with the different types of antidepressant:

TRICYCLICS

These commonly cause a dry mouth, a slight tremor, fast heartbeat, constipation, sleepiness, and weight gain. Particularly in older people, they may cause confusion, slowness in starting and stopping when passing water, faintness through low blood pressure, and falls. If you have heart trouble, it may be best not to take one of this group of antidepressants. Men may experience difficulty in getting or keeping an erection, or delayed ejaculation. Tricyclic antidepressants are dangerous in overdose.

SSRIs

During the first couple of weeks of taking them, you may feel sick and more anxious. Some of these medications can produce nasty indigestion, but you can usually stop this by taking them with food. More seriously, they may interfere with your sexual function. There have been reports of episodes of aggression, although these are rare.

The list of side effects can be upsetting and there is more information about these on the pamphlets that come with the medication. However, most people get a small number of mild side-effects (if any). The side effects usually wear off over a couple of weeks as your body gets used to the medication. It is important to have this whole list, though, so you can recognise side effects if they happen. You can then talk them over with your doctor. The more serious ones - problems with urinating, difficulty in remembering, falls, confusion - are uncommon in healthy, younger or middle-aged people. It is common, if you are depressed, to think of harming or killing yourself. Tell your doctor - suicidal thoughts will pass once the depression starts to lift.

SNRIs

The side effects are very similar to the SSRIs, although Venlafaxine should not be used if you have a serious heart problem. It can also increase blood pressure, so this may need to be monitored.

MAOIs

This type of antidepressant is rarely prescribed these days. MAOIs can give you a dangerously high blood pressure if you eat foods containing a substance called Tyramine. If you agree to take an MAOI antidepressant your physician will give you a list of foods to avoid.

DRIVING AND OPERATING MACHINERY

Some antidepressants make you sleepy and slow down your reactions - the older medications are more likely to do this. Some can be taken if you are driving. Remember, depression itself will interfere with your concentration and make it more likely that you will have an accident. If in doubt, check with your physician.

ARE ANTIDEPRESSANTS ADDICTIVE?

Antidepressant medications do not cause the addictions that you get with tranquilizers, alcohol or nicotine, meaning that you do not need to keep increasing the dose to get the same effect. Research also indicates that you will not crave the medication once you stop taking it. There is some research up for debate on this topics. Even thought not having the symptoms of addiction described, up to a third of people who stop SSRIs and SNRIs have withdrawal symptoms.

Withdrawal symptoms include:

  • Stomach upsets
  • Flu like symptoms
  • Anxiety
  • Dizziness
  • Vivid dreams at night
  • Sensations in the body that feel like electric shocks (see references)

In most people these withdrawal effects are mild, but for a small number of people they can be quite severe. They seem to be most likely to happen with Paroxetine (Seroxat) and Venlafaxine (Efexor). It is best to taper off the dose of an antidepressant rather than stop it suddenly and ALWAYS talk with your physician first before doing such.

Some people have reported that, after taking an SSRI for several months, they have had difficulty managing once the drug has been stopped and so feel they are addicted to it. Most physicians would say that it is more likely that the original condition has returned.

The Committee of Safety of Medicines in the UK reviewed the evidence in 2004 and concluded 'There is no clear evidence that the SSRIs and related antidepressants have a significant dependence liability or show development of a dependence syndrome according to internationally accepted criteria.'

ANTIDEPRESSANTS AND FEELINGS OF SUICIDE

There is some evidence of increased suicidal thoughts (although not actual suicidal acts) and other side effects in young people taking antidepressants. So, SSRI antidepressants are not licensed for use in people under 18. However, the National Institute for Clinical excellence has stated that Fluoxetine, an SSRI antidepressant, can be used in the under-18s.

There is no clear evidence of an increased risk of self-harm and suicidal thoughts in adults of 18 years or over. But, individuals mature at different rates. Young adults are more likely to commit suicide than older adults, so a young adult should be particularly closely monitored if he or she takes an SSRI antidepressant.

ANTIDEPRESSANTS AND PREGNANCY

It is always best to take as little as possible in the way of medication during pregnancy, especially during the first 3 months. There is recent evidence of an increase in congenital malformations in babies of mothers who took antidepressants during this time. However, some mothers do have to take antidepressants during pregnancy and the risks need to be balanced. There is also some evidence that babies of mothers taking antidepressants may experience withdrawal symptoms soon after birth. Just as adults, this seems to be more likely if Paroxetine is the antidepressant being taken. Until more is known, physicians have been advised to consider alternative treatment in pregnancy.

ANTIDEPRESSANTS AND BREAST FEEDING

Women commonly become depressed after giving birth - this is called post-natal depression. It usually gets better with counselling and practical support. If this happens to you or someone that you know, it can be exhausting. This can stop you from breast-feeding, upset your relationship with your baby and even hold back your baby's development. In this case, antidepressants can be helpful.

HOW DO ANTIDEPRESSANTS EFFECT THE BABY?

It is thought that the baby will get only a small amount of antidepressant from mother's milk. Babies older than a few weeks have very effective kidneys and livers. They are able to break down and get rid of medicines just as adults do, so the risk to the baby is very small. Some antidepressants are better than others in this regard and it is worth discussing this with your physician or pharmacist. Keep in mind all the advantages of breast-feeding, it seems best to carry on with it while taking antidepressants.

WHAT IS THE RECOMMENDATION FOR TAKING ANTIDEPRESSANTS?

Stay in touch with your doctor in the first few weeks. With some of the older Tricyclic drugs it's best to start on a lower dose and work upwards over the next couple of weeks. If you don't go back to the physician and have the dose increased, you could end up taking too little. You usually don't have to do this with the SSRI medications. The dose you start with is usually the dose you carry on with. It doesn’t help to increase the dose above the recommended levels.

Try not to be put off if you get some side effects. Many of them wear off in a few days. Don't stop the medications unless the side effects really are unpleasant. If they are, get an urgent appointment to see your doctor. If you feel worse it is important to tell your doctor so that he can decide if the medicines are right for you. Your doctor will also want to know if you get increased feelings of restlessness or agitation.

Take them every day - if you don't, they won't work.

Wait for them to work. They don't work straight away. Most people find that they take 1-2 weeks to start working and maybe up to 6 weeks to give their full effect.

Persevere - stopping too early is the commonest reason for people not getting better and for the depression to return.

Try not to drink alcohol. Alcohol on its own can make your depression worse, but it can also make you slow and drowsy if you are taking antidepressants. This can lead to problems with driving - or with anything you need to concentrate on.

KEEP THEM OUT OF THE REACH OF CHILDREN

Tempted to take an overdose? Tell your physician as soon as possible and give your medications to someone else to keep for you. Tell your doctor about any major changes in how you feel when the dose of antidepressant is changed.

HOW LONG WILL I HAVE TO TAKE ANTIDEPRESSANTS?

Antidepressants don't necessarily treat the cause of the depression or take it away completely. Without any treatment, most depressions will get better after about 8 months. If you stop the medication before 8 or 9 months is up, the symptoms of depression are more likely to come back. The current recommendation is that it is best to take antidepressants for at least six months after you start to feel better. It is worthwhile thinking about what might have made you vulnerable, or might have helped to trigger off your depression. There may be ways of making this less likely to happen again.

If you have had two or more attacks of depression then treatment should be continued for at least two years.

WHAT IS THE RECOMMENDATION IF DEPRESSION RETURNS?

Some people have severe depressions over and over again. Even when they have got better, they may need to take antidepressants for several years to stop their depression coming back. This is particularly important in older people, who are more likely to have several periods of depression. For some people, other drugs such as Lithium may be recommended. Psychotherapy may be helpful in addition to the tablets.

HOW DO ANTIDEPRESSANTS EFFECT MY LIFE?

Depression is unpleasant. It can seriously affect your ability to work and enjoy life. Antidepressants can help you get better quicker. They can be prescribed by your physician and besides the side effects listed in the pamphlets that should come with your prescription, they should have very little impact on your life. Those on these medications, particularly the newer ones, should be able to socialize, carry on at work, and enjoy their normal recreational activities.

If you have been depressed for a long time, others who know you well (for example your partner) may have got used to you being like this. Some people in this situation have reported that, as they get better and developed a more positive outlook, their partners had difficulty in adjusting to the change. This can cause friction and is something that people need to be aware of and discuss openly if it happens.

WHAT IF I DON'T TAKE MY ANTIDEPRESSANT PRESCRIPTION?

It's tough to gaugue because so much depends on why the antidepressant has been prescribed to you in the first place and how bad your depression is and how long you have had it. It's generally accepted that most depressions resolve themselves naturally within about 8 months. If your depression is mild it is best to try some of the other treatments mentioned by your physician.

WHAT ALTERNATIVE TREATMENTS ARE AVAILABLE FOR DEPRESSION?

It is not enough just to take the medications. It is important to find ways of making yourself feel better, so you are less likely to become depressed again. These can include finding someone you can talk to, taking regular exercise, drinking less alcohol, eating well, using self-help techniques to help you relax and finding ways to solve the problems that have brought the depression on.

TALK THERAPY

There are a number of effective talking treatments for depression. Counseling is useful in mild depression. Problem solving techniques can help where the depression has been caused by difficulties in life. Cognitive Behavioral Therapy was developed to treat depression and helps you to look at the way you think about yourself, the world and other people. Exercise and self-help books based on Cognitive Behavioral Therapy can be effective treatments for depression. It's also good to talk things over with your family or friends.

HERBAL REMEDIES TO TREAT DEPRESSION

There is also a herbal remedy for depression called Hypericum. This is made from a herb, St Johns Wort, and is available without prescription. You MUST talk with your physician before self-medicating. You may believe you have a mild form of depression, when it could be moderate. There is a big difference between mild and moderate depression. Hypericum, or St John's Wort, is widely used as an antidepressant in Germany. It seems to be as effective as antidepressants in milder depression, although there is little published evidence for its effectiveness in moderate to severe depressions.

LIGHT THERAPY

You may find that you get depressed every winter but cheer up when the days become sunnier. This is called seasonal affective disorder (SAD). If so, you may find a light source helpful - this is a source of bright light which you have on for a certain time each day and which can make up for the lack of light in the winter.


DISCLAIMER: **This web site's goal is to provide you with information that may be useful in attaining optimal health. Nothing in it is meant as a prescription or as medical advice. You should check with your physician before implementing any changes in your exercise or lifestyle habits, especially if you have physical problems or are taking medications of any kind.