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SNRIs raise levels of serotonin and norepinephrine, two neurotransmitters in the brain that play a key role in stabilizing mood. Examples include duloxetine Cymbalta , venlafaxine Effexor and desvenlafaxine Pristiq. Selective serotonin reuptake inhibitors SSRIs are the most commonly prescribed antidepressants. They are effective in treating depression, and they have fewer side effects than the other antidepressants.
SSRIs block the reuptake, or absorption, of serotonin in the brain. This makes it easier for the brain cells to receive and send messages, resulting in better and more stable moods.
Examples include citalopram Celexa , escitalopram Lexapro , fluoxetine Prozac, Sarafem , fluvoxamine Luvox , paroxetine Paxil and sertraline Zoloft. There have been reports that people who use SSRIs and SNRIs, and especially those under the age of 18 years, may experience thoughts of suicide, especially when they first start using the drugs.
Tricyclic antidepressants TCAs are so named because there are three rings in the chemical structure of these medications. They are used to treat depression, fibromyalgia, some types of anxiety, and they can help control chronic pain.
Examples include amitriptyline Elavil , amoxapine- clomipramine Anafranil , desipramine Norpramin , doxepin Sinequan , imipramine Tofranil , nortriptyline Pamelor , protriptyline Vivactil and trimipramine Surmontil. It inhibits the action of monoamine oxidase, a brain enzyme. Monoamine oxidase helps break down neurotransmitters, such as serotonin. If less serotonin is broken down, there will be more circulating serotonin. In theory, this leads to more stabilized moods and less anxiety.
MAOIs are generally saved for cases where other antidepressants have not worked because MAOIs interact with several other medications and some foods. These are used to treat anxiety disorders, some personality disorders , and depression.
More serious adverse reactions include seizures, white blood cell reduction, fainting, and allergic reactions. Common effects are nausea and anxiety, but this will depend on the type of drug used, as mentioned above. If the side effects are very unpleasant, or if they include thinking about suicide, the doctor should be informed at once. In addition, research has linked the following adverse effects with antidepressant use, especially among children and adolescents.
This may include mania or hypomania. It should be noted that antidepressants do not cause bipolar disorder , but they may unmask a condition that has not yet revealed itself.
There have been a few reports of a higher risk of having suicidal thoughts when first using antidepressants. This could be due to the drugs or other factors, such as the time taken for the medication to work, or possibly an undiagnosed bipolar disorder which may require a different approach to treatment. Unlike some drugs, it is not necessary to keep raising the dose to get the same effect with antidepressants. They were designed to be a more effective antidepressant than SSRIs.
However, the evidence that SNRIs are more effective in treating depression is uncertain. However, they may also cause more drowsiness at first. TCAs are an older type of antidepressant. They're no longer usually recommended as the first treatment for depression because they can be more dangerous if an overdose is taken.
Exceptions are sometimes made for people with severe depression that fail to respond to other treatments. Examples of TCAs include amitriptyline , clomipramine, dosulepin , imipramine, lofepramine and nortriptyline. Some types of TCAs, such as amitriptyline, can also be used to treat chronic nerve pain. SARIs are not usually the first choice of antidepressant, but they may be prescribed if other antidepressants have not worked or have caused side effects.
They can cause potentially serious side effects so should only be prescribed by a specialist doctor. Other treatments for depression include talking therapies such as cognitive behavioural therapy CBT. People with moderate to severe depression are usually treated using a combination of antidepressants and CBT. Antidepressants work quickly in reducing symptoms, whereas CBT takes time to deal with causes of depression and ways of overcoming it.
Regular exercise has also been shown to be useful for those with mild depression. Read more about alternatives to antidepressants. The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you're taking. They do not make you euphoric, but simply help you react more realistically in your emotional responses.
You may notice, for example, that you take in your stride little things that used to worry you or get you down. Taking antidepressant medication is one important step in getting better but is rarely enough on its own. As well as medication, effective treatment for depression and anxiety-related disorders may include education about the illness and how to deal with it, and psychological therapies such as Cognitive Behavioural Therapy CBT , for example.
For some people, ongoing clinical support in the community, rehabilitation, accommodation and employment support are also helpful. Antidepressants, like most medications, can change the way you feel.
This means that if you stop taking the medication you may start to feel the way you did before the treatment. Some people confuse this with being addicted. Antidepressants are not addictive and you will not become dependent on them.
However, it is important to talk to your doctor before you stop taking them. It is always advisable to reduce the dose slowly, with close monitoring, to minimise possible discomfort as your body adjusts to the lower dose. It is also important that the medication is monitored carefully in the first couple of months, as some people may experience an increase in symptoms if the antidepressant is not effective.
There are many types of antidepressant medication available: an older group known as tricyclics , and newer groups known as SSRIs and SNRIs which tend to have fewer side-effects and a wider safety margin than older ones if the wrong dose is taken. Different medications work for different people. While there is usually a period of trial and adjustment, there are some things you and your doctor can talk over to help decide which is most likely to be right for you.
Some things you should discuss with your doctor are:. These medications are not generally recommended for treatment of depression in children and adolescents, but they may be prescribed in certain circumstances. It is important to discuss this issue with the treating doctor, and ensure effects are monitored if an antidepressant is prescribed. If a child or adolescent is currently being treated with an SSRI, they should not have the medication ceased abruptly, but reduced gradually by the doctor if it needs to be stopped.
People over 65 taking antidepressants may also be at greater risk of falls and fractures. Certain antidepressants may interact adversely with some medications for physical illnesses. That is why it is important to tell your doctor if you are on any other medication.
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