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:
- 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:
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.
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.
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.
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
- 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.