Depression Medications
Antidepressants
Antidepressants are used most often for serious depressions, but they can also be helpful for some milder depressions. Antidepressants are not "uppers" or stimulants, but rather take away or reduce the symptoms of depression and help depressed people feel the way they did before they became depressed.
History of Antidepressants
From the 1960s through the 1980s, tricyclic antidepressants (named for their chemical structure) were the first line of treatment for major depression. Most of these medications affected two chemical neurotransmitters, norepinephrine and serotonin.
Though the tricyclics are as effective in treating depression as the newer antidepressants, their side effects are usually more unpleasant; thus, today tricyclics such as imipramine, amitriptyline, nortriptyline, and desipramine are used as a second- or third-line treatment.
Other antidepressants introduced during this period were monoamine oxidase inhibitors (MAOIs). MAOIs are effective for some people with major depression who do not respond to other antidepressants. They are also effective for the treatment of panic disorder and bipolar depression. MAOIs approved for the treatment of depression are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan).
Because substances in certain foods, beverages, and medications can cause dangerous interactions when combined with MAOIs, people on these agents must adhere to dietary restrictions. This has deterred many clinicians and patients from using these effective medications, which are in fact quite safe when used as directed.
The past decade has seen the introduction of many new antidepressants that work as well as the older ones but have fewer side effects. Some of these medications primarily affect one neurotransmitter, serotonin, and are called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa).
The late 1990s ushered in new medications that, like the tricyclics, affect both norepinephrine and serotonin but have fewer side effects. These new medications include venlafaxine (Effexor) and nefazadone (Serzone).
Cases of life-threatening hepatic failure have been reported in patients treated with nefazodone (Serzone). Patients should call the doctor if the following symptoms of liver dysfunction occur - yellowing of the skin or white of eyes; unusually dark urine; loss of appetite that lasts for several days; nausea; or abdominal pain.
Other newer medications chemically unrelated to the other antidepressants are the sedating mirtazepine (Remeron) and the more activating bupropion (Wellbutrin). Wellbutrin has not been associated with weight gain or sexual dysfunction but is not used for people with, or at risk for, a seizure disorder.
Dosage of Antidepressants
Dosage of antidepressants varies, depending on the type of drug and the person's body chemistry, age, and, sometimes, body weight. Traditionally, antidepressant dosages are started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects. Newer antidepressants may be started at or near therapeutic doses.
Side Effects
Each antidepressant differs in its side effects and in its effectiveness in treating an individual person, but the majority of people with depression can be treated effectively by one of these antidepressants.
Antidepressants may cause mild, and often temporary, side effects (sometimes referred to as adverse effects) in some people. Typically, these are not serious. However, any reactions or side effects that are unusual, annoying, or that interfere with functioning should be reported to the doctor immediately.
The most common side effects of tricyclic antidepressants, and ways to deal with them, are as follows:
- Dry mouth - it is helpful to drink sips of water, chew sugarless gum and brush teeth daily.
- Constipation - bran cereals, prunes, fruit and vegetables should be included in the diet.
- Bladder problemsÑemptying the bladder completely may be difficult, and the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be at particular risk for this problem. The doctor should be notified if there is any pain.
- Sexual problems - sexual functioning may be impaired; if this is worrisome, it should be discussed with the doctor.
- Blurred vision - this is usually temporary and will not necessitate new glasses. Glaucoma patients should report any change in vision to the doctor.
- Dizziness - rising from the bed or chair slowly is helpful.
- Drowsiness as a daytime problem - this usually passes soon. A person who feels drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and to minimize daytime drowsiness.
- Increased heart rate - pulse rate is often elevated. Older patients should have an electrocardiogram (EKG) before beginning tricyclic treatment.
The newer antidepressants, including SSRIs, have different types of side effects, as follows:
- Sexual problems - fairly common, but reversible, in both men and women. The doctor should be consulted if the problem is persistent or worrisome.
- Headache - this will usually go away after a short time.
- Nausea - may occur after a dose, but it will disappear quickly.
- Nervousness and insomnia (trouble falling asleep or waking often during the night) - this may occur during the first few weeks; dosage reductions or time will usually resolve them.
- Agitation (feeling jittery) - if this happens for the first time after the drug is taken and is more than temporary, the doctor should be notified.
Any of these side effects may be amplified when an SSRI is combined with other medications that affect serotonin. In the most extreme cases, such a combination of medications (e.g., an SSRI and an MAOI) may result in a potentially serious or even fatal "serotonin syndrome," characterized by fever, confusion, muscle rigidity, and cardiac, liver, or kidney problems.
The small number of people for whom MAOIs are the best treatment need to avoid taking decongestants and consuming certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles. The interaction of tyramine with MAOIs can bring on a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the individual should carry at all times.
Other forms of antidepressants require no food restrictions. MAOIs also should not be combined with other antidepressants, especially SSRIs, due to the risk of serotonin syndrome.
Depression Medication Guidelines
Medications of any kindÑprescribed, over-the-counter, or herbal supplements should never be mixed without consulting the doctor; nor should medications ever be borrowed from another person. Other health professionals who may prescribe a drug - such as a dentist or other medical specialist - should be told that the person is taking a specific antidepressant and the dosage.
Some drugs, although safe when taken alone, can cause severe and dangerous side effects if taken with other drugs. Alcohol (wine, beer, and hard liquor) or street drugs, may reduce the effectiveness of antidepressants and their use should be minimized or, preferably, avoided by anyone taking antidepressants.
Some people who have not had a problem with alcohol use may be permitted by their doctor to use a modest amount of alcohol while taking one of the newer antidepressants. The potency of alcohol may be increased by medications since both are metabolized by the liver; one drink may feel like two.
Although not common, some people have experienced withdrawal symptoms when stopping an antidepressant too abruptly. Therefore, when discontinuing an antidepressant, gradual withdrawal is generally advisable.
Questions about any antidepressant prescribed, or problems that may be related to the medication, should be discussed with the doctor and/or the pharmacist.
Natural & Alternative Methods
It is possible to prevent panic attacs using natural methods. This can be done via hypnosis, self help books, self help courses and natural supplements.
Anti-Depressants
These are not happy pills or panacea, this type of medication should only be prescribed by a medical professional and used accordingly. Taking this kind of medication carries benefits as well as side effects. It is often seen that Anti-Depressants are a quick fix but in actual fact this form of treatment can take up to three months to take effect within your system.
Many different types of Anti-depressants are available to treat depression depending on a person's age and tolerance of the medications.
According to recent pharmaceutical studies family physicians write 60-70% of prescriptions for anti-depressants although they are not specifically trained to diagnose and treat mental illness.
This is due to the excessive expense of using talk therapies such as counseling, which causes insurance companies to put added pressure onto physicians to issue less expensive alternatives such as medication.
Because no specific form of antidepressant has been proven to be any more effective than another, the varied choice of which drug to prescribe any individual person often rests on the different side effects.
When Depression occurs with other medical conditions such as cancer, heart disease, stroke, Parkinson's, Alzheimer's, and diabetes the depression is often overlooked and not treated. Although if the depression is recognized and treated accordingly, a person's quality of life can be greatly improved.
Many of the older type antidepressants are considerably cheaper, but have proven just as effective as the newer ones available to date. But SSRIs have become the most frequently prescribed and this is partly because they are safer when an overdose is taken.
However, if an SSRI form of medication is suddenly discontinued it often produces somatic and psychological withdrawal symptoms known as "SSRI discontinuation syndrome".
Types of Anti-depressants
- SSRIs also known as selective Serotonin re-uptake inhibitors
- MAOIs also known as Monoamine Oxidase inhibitors
- TCAs also known as Tricyclic anti-depressants
- SNRIs also known as Serotonin and Noradrenaline re-uptake inhibators
The SSRIs and other newer medications that affect neurotransmitters such as dopamine or norepinephrine are prescribed more commonly as they generally carry fewer side effects than many other Anti-Depressants. Whilst taking this medication it is known to affect you carrying out tasks that require skill and coordination.
When taking MAOIs, you must be aware of avoiding taking other certain medications that you can buy over the counter such as Sudafed. Alsothis medication has shown effective results when quiting smoking. Also this form of Anti-Depressant is mainly used whilst treating agrophobia it is known for it's calming and sedative compoundment.
Forms of TCA's are one of the oldest medcations for treating Depression and are often still prescribed by GP's for there effectivness but unlike the more newer medications they are known for ther effectivness in overdose. When taking this medication you should avoid alcohol as it increases the risk of accidental injury.
SNRI's are a very modern Anti-Depressant and Venlafaxine is the first and only drug in it's class to be available on prescription in the UK. This medication should not be issued to children of the age of 18 years as it increases the risk of self-harm and suicidal thoughts. There are other SNRI's in development that may not have Venlafaxine's cardiovascular toxicity.
