Clinical depression is typically treated with medication known as antidepressants. These medications are effective by balancing the brain’s natural chemicals. Neurotransmitters, such as dopamine, norepinephrine, and serotonin effect emotional responses to stimuli, which in turn effects moods. Antidepressants control these chemicals.
Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed medications for depression. Examples include:
- Sertraline (Zoloft)
- Escitalopram (Lexapro).
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Citalopram (Celexa)
Other common antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications, including duloxetine and venlafaxine work in a similar way to SSRIs. Bupropion works on dopamine receptors. Unlike other medications, this drug does not fit into the specific SSRI and SNRI grouping.
SNRIs and SSRIs are a newer class of antidepressant. While they do have some side effects, their side effects are mild and fewer than older antidepressants. However, these older medications, tetracyclics, tricyclics, and monoanamine oxidase inhibitors (MAOIs) are sometimes the best solution for some people despite their many side effects.
What are the side effects?
All medications have some side effects. Antidepressants typically don’t have as many that last for very long. However, any unusual reactions or long-term side effects should be reported to your doctor immediately.
Common side effects of SSRIs and SNRIs include:
- Agitation or feeling jittery
- Sexual problems which may include reduced sex drive or problems enjoying and having sex
- Sleeplessness or drowsiness, this may occur during the first few weeks of treatment. If the sleeplessness or drowsiness does not go away after a few weeks adjustments may need to be made to the dosage or time the pill is taken.
Patients taking tricyclic antidepressants may experience the following side effects.
- Sexual problems, which may include a reduced sex drive, problems having sex, and problems enjoying sex.
- Blurred vision
- Bladder problems, which includes difficulty emptying the bladder or weakened urine stream. Men with enlarged prostate may need to speak with their doctor prior to taking this medication.
- Dry mouth
Patients who take MAOIs must pay close attention to both medications and food while they are on this antidepressant. Medications or food that contains tyramine may be dangerous if mixed with the MAOIs. Medications such as decongestants and cold medicines can contain tyramine. Foods such as wine, pickles, and cheese may also contain the chemical.
The danger with mixing tyramine and MAOIs is that it can cause an increase in blood pressure leading to a potential stroke. Patients who must take MAOIs should request a complete list of food and medication that they should avoid from their physician. Those taking an MAOI may benefit from the newly developed skin patch to help avoid this potential mixing. For more information patients should speak with their physician.
How to take antidepressants.
Patients who have been prescribed antidepressants need to follow the dosing directions carefully. This type of medication needs to be taken in a specific dosage and at the specific time of day that the doctor prescribes. The dose should also be taken for the length of time the doctor recommends. It can take up to one month for patients to see results from this medication.
As with most psychological medications, it is important not to stop antidepressants without the instructions of your doctor. Even if the person is feeling better, the medication should not be stopped as stopping antidepressant medication too soon can lead to the depression returning. While antidepressants are generally not habit-forming, abruptly stopping medication without tapering the dosage down can lead to withdrawal symptoms. The physician will adjust the dosage to lower and lower dosages when it is time for medication to cease.
There are times when depression medication does not work the first time. While it does take time for the antidepressants to build up in the system, hard to treat depression’s may require a change in medication. It is best to be open and honest with the attending physician to ensure that the correct prescription is given.
Can herbal medications be used?
While St. John’s wort has been used for many centuries as a herbal remedy there is no real proof that it helps clinical depression. The national institutes of health performed a study to determine if St. John’s wort is an effective treatment for depression. Out of 340 people who were diagnosed with depression, one third took St. John’s wort instead of an antidepressant. In the study, one third also took a sugar pill while the remaining third took an SSRI. The St. John’s wort patients had no greater affect than those taking the sugar pill.
Those considering taking St. John’s wort should speak with their physician prior to adding the herbal supplement to their daily regimen. Studies have concluded that this herbal supplement can interfere with other medications such as oral contraceptives and those medications treating HIV. Anyone who’s taking medication for heart disease, seizures, or recently had an organ transplant should also speak to their physician prior to taking St. John’s wort.
Antidepressant FDA warnings
While antidepressants are relatively safe they may have side effects that affect young people. In a 2004 study the FDA looked at data concerning children and teens taking antidepressants. According to research 4% of the nearly 4400 participants involved either thought about or attempted suicide. Only 2% of the participants who were receiving sugar pills instead of the antidepressants had similar thoughts or actions.
Because of this study, the FDA has placed a warning on antidepressants that are used to treat children and young adults. The warning simply states that there may be an increased risk of suicidal thinking or attempts. The FDA urges anyone who has increased thoughts of suicide to speak with their physician immediately.
The warning has been extended to all patients of all ages during the first few weeks of treatment. The FDA suggests that family members or caretakers should monitor patients for increased suicidal thinking or behavior or other changes in behavior such as withdrawal from normal situations, agitation, and sleeplessness. As usual, caretakers should report any significant changes to the doctor.