What Are Antidepressants?
Antidepressants are medications that correct the imbalances of neurotransmitters in the brain that are responsible for changes in mood and behavior. These help treat symptoms of:
- Depression
- Social anxiety disorder
- Seasonal affective disorder
- Anxiety disorders
- Mild chronic depression
- Dysthymia (persistent mild depression that may lead to major depression)
Antidepressants were first promoted in the 1950s and their use has become more common in the last 20 years. The Centers for Disease Control and Prevention (CDC) has reported that the percentage of people aged 12 years and over who use antidepressants in the U.S. grew from 7.7% in 1999 to 2002 to 12.7% in 2011 to 2014. About twice as many females use antidepressants than males.
What Are The 5 Most Common Antidepressants?
The most common antidepressants can be divided into five main types:
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
SNRIs raise the levels of serotonin and norepinephrine in the brain. Those are two neurotransmitters (chemical messengers in the brain) that play an important part in stabilizing mood.
SNRIs are used to treat major depression, mood disorders, and possibly attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety disorders, menopausal symptoms, fibromyalgia, and chronic neuropathic (nervous disease) pain.
Examples of SNRIs include:
- Cymbalta (duloxetine)
- Effexor (venlafaxine)
- Pristiq (desvenlafaxine)
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are the most commonly prescribed antidepressants. They’re used to treat depression and tend to have fewer side effects than other antidepressants.
SSRIs work to block the reuptake (absorption) of serotonin in the brain. As a result, it becomes easier for the brain cells to send and receive messages. This helps produce better and more stable moods. These medications are “selective” because they seem to mainly affect the serotonin neurotransmitters and not the others.
Examples of SSRIs include:
- Celexa (citalopram)
- Lexapro (escitalopram)
- Prozac, Sarafem (fluoxetine)
- Luvox (fluvoxamine)
- Paxil (paroxetine)
- Zoloft (sertraline)
Possible side effects of both SNRIs and SSRIs include:
- Low blood sugar
- Low sodium
- Nausea
- Rash
- Dry mouth
- Constipation or diarrhea
- Weight loss
- Sweating
- Tremor
- Sexual dysfunction
- Headache
- Insomnia
- Anxiety and agitation
- Sedation
- Suicidal thoughts
There have been some reports that people who use SSRIs and SNRIs may experience thoughts of suicide, particularly when they first start using the drug. This is especially true for people under 18 years old.
This could also be due to other factors, such as the time it takes for the medication to work or or the existence of an undiagnosed bipolar disorder. In either case, this is why the Food and Drug Administration (FDA) requires all antidepressants to have a black-box warning of this possible effect.
Tricyclic Antidepressants (TCAs)
TCAs have three rings in the chemical structure of the medication, hence the name “tricyclic.” They are used to treat depression, fibromyalgia, some types of anxiety, and help control chronic pain. However, doctors will only prescribe TCAs when other medications haven’t relieved your depression.
Examples include:
- Elavil (amitriptyline)
- Anafranil (amoxapine-clomipramine)
- Norpramin (desipramine)
- Sinequan (doxepin)
- Tofranil (imipramine)
- Pamelor (nortriptyline)
- Vivactil (protriptyline)
- Surmontil (trimipramine)
Possible side effects include:
- Seizures
- Insomnia
- Anxiety
- Irregular heartbeat
- Hypertension
- Rash
- Nausea and vomiting
- Abdominal cramping
- Weight loss
- Constipation
- Sexual dysfunction
- Increased pressure on the eye
Monoamine Oxidase Inhibitors (MAOIs)
These antidepressants were more commonly prescribed before the development of SNRIs and SSRIs. Introduced in the 1950s, they were the first drugs used for treating depression.
MAOIs work by inhibiting the action of monoamine oxidase, a brain enzyme. Monoamine oxidase helps break down neurotransmitters such as serotonin. Then, if less serotonin is broken down, there will be more serotonin circulating in the brain. As a result, this leads to more stabilized moods and less anxiety. Doctors tend to use MAOIs if SSRIs haven’t worked. They’re usually saved for situations where other antidepressants have not worked because MAOIs interact with several other medications and some food.
Examples include:
- Nardil (phenelzine)
- Parnate (tranylcypromine)
- Marplan (isocarboxazid)
- EMSAM, Eldepryl (selegiline)
Possible side effects include:
- Blurred vision
- Rash
- Seizures
- Edema
- Weight loss or gain
- Sexual dysfunction
- Diarrhea, nausea, and constipation
- Anxiety
- Headache
- Dizziness
- Hypertension or high blood pressure
- Irregular heartbeat
Noradrenaline and Specific Serotonergic Antidepressants (NASSAs)
NASSAs are used to treat anxiety disorders, personality disorders, and depression.
Examples include:
- Remeron, Avanza, Zispin (mirtazapine)
- Tolvon (mianserin)
Possible side effects include:
- Constipation
- Dry mouth
- Weight gain
- Drowsiness
- Blurred vision
- Dizziness
- Seizures
- Reduction in white blood cells
- Allergic reactions
Do Antidepressants Interact with Other Medications?
It’s important to remember that antidepressants can react unpredictably with other medications. This includes some over-the-counter medicines such as ibuprofen. Make sure you read the patient information that comes with your medicine. If you still have concerns, your doctor or pharmacist should be able to advise you.
Alcohol and Antidepressants
If you’re taking antidepressants, you should be careful about drinking alcohol. This is because alcohol is also a depressant. Therefore, drinking alcohol can make your depression symptoms worse.
If you drink alcohol while taking a TCA, you might become drowsy and dizzy. There is less likelihood of experiencing unpleasant or unpredictable effects if you drink alcohol while taking an SSRI or SNRI antidepressant. However, it is still recommended to avoid alcohol.
Antidepressants and Illicit Drugs
If you are taking antidepressants, you shouldn’t use illegal drugs. This is especially true if you’re taking a TCA because they can cause some unpredictable and unpleasant effects.
You should especially avoid these substances:
- Cannabis (smoking cannabis while taking TCA can make you feel very sick)
- Amphetamines
- Cocaine
- Heroin
- Ketamine
Similar to alcohol, illegal drugs can make symptoms of depression or other mental health conditions worse.
Interactions Between Antidepressants
Never take two different types of antidepressants such as a TCA and an SSRI except under the supervision of your doctor. Taking certain combinations of antidepressants can make you very ill and can even be life-threatening.
Are There Any Alternatives to the Most Common Antidepressants?
Every year, about 16 million adults battle major depression. Many people are helped by taking antidepressants. However, as many as one-third still get depressive symptoms despite medication, not to mention the side effects which we’ve been mentioned. This all leaves many people needing alternatives. Fortunately, there are treatments that can be used to treat depression and other mental health issues instead of antidepressants.
- Ketamine: This is being used in some emergency departments around the country. Ketamine is an anesthetic sometimes used during surgery. It’s given by IV and quickly eases depression but it is only temporary. It is effective at lessening suicidal thoughts in severely depressed people. However, it is expensive and is an experimental treatment for depression.
- Nitrous oxide (laughing gas): This is an anesthetic typically used by dentists. A study of nitrous oxide for depression reported that it improved depression symptoms in less than two and a half hours and lasted from 24 hours to a full week for some of the people in the study. For people experiencing suicidal episodes, it may, like ketamine, temporarily relieve the person and act as a bridge until other treatments start to work.
- Anti-inflammatory medications: Inflammation has been connected to depression for several years. Studies published in JAMA Psychiatry confirms the connection. It was found that painkillers such as celecoxib, ibuprofen, and naproxen reduced symptoms of depression.
Talk Therapies
Cognitive Behavioral Therapy (CBT)
CBT is a type of talk therapy used in the treatment of depression. Most experts agree that people with moderate to severe depression can benefit from treatment with a combination of CBT and the most common antidepressants. Although, you can benefit from CBT alone if you aren’t comfortable taking an antidepressant.
CBT helps you understand your thoughts and the connection to your behavior. It recognizes how events in your past may have shaped you, but it focuses mostly on how you can change the way you think, feel, and behave in the present.
Dialectical Behavior Therapy (DBT)
DBT is a type of CBT. The main difference is that it asks people with depression to recognize and accept their negative behavior and thoughts. Through this practice, individuals come to terms with their negative emotions and learn to cope with stress, and regulate their reactions to it. The National Alliance on Mental Health states that DBT is effective in the treatment of depression.
Psychodynamic Therapy
This method assumes that depression can occur because of unsettled and, usually unconscious, conflicts that often begin in childhood. Psychodynamic therapy is less focused and longer-term than other treatments. It can be useful for finding the connections in past experiences and understanding how they might have contributed to feelings of depression.
Interpersonal Therapy
Interpersonal therapy is usually brief and includes examining social relationships with important people in your life. It may include your partner, friends, family, and coworkers. The goal is to recognize the role these relationships play in your life and find ways of resolving conflicts.
4 Natural Alternatives to Help Beat Depression
Mindfulness meditation can have several beneficial effects such as lowering stress levels and helping you become more aware of your thoughts and reactions. Studies also show that it can help in the treatment of depression.
During this type of meditation, you focus on being aware of what you’re feeling and sensing at the moment. You do this while not trying to interpret or judge what you’re feeling. Practicing mindfulness involves breathing methods, guided imagery, and other practices to relax your mind and body.
Exercise can be effective in both the prevention and treatment of depression. This doesn’t mean Olympic-level training but it does mean putting in about 30 minutes of low-intensity activity every day. Sunshine and fresh air are especially helpful for people with a special form of depression known as seasonal affective disorder (SAD).
Get more sleep because sleep and mood go together. Too little sleep and the mood is destined to fade. And it’s like that whether you have depression or not. This means you should keep consistent bedtimes and wake-up times. Make sure your bedroom is set up for sound sleep — dark, quiet, and uncluttered.
When You Need Professional Help
If you have tried natural alternatives, or someone close to you has no relief, it might be time to consult with medical professionals. The consequences of untreated depression can be extremely serious. Untreated depression frequently leads to alcohol or drug use which may lead to an addiction, and this may ultimately lead to other negative consequences.
Don’t wait until it gets out of control. See your medical professional for an evaluation. If you have already been depending on substances to ease your symptoms, it’s important to treat your substance use disorder. At CNV Detox, we understand individuals who have depression and addiction. This is called a dual diagnosis and we are experienced in helping individuals like you or your loved one.
These are two potentially life-threatening conditions. Contact us now. Nothing gets better on its own, and addiction can only get worse.
