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Different types of antidepressants

Different types of antidepressants

Antidepressant medications are used to treat or alleviate clinical depression. Some antidepressants are also used to treat anxiety disorders or other conditions. They influence neurotransmitters to correct chemical imbalances in the brain.[1]

Research has found both benefits and drawbacks to antidepressants.[2][3] Some people respond well to them while others don't. Different antidepressants work for different people. Effective treatment for depression varies for each person and may include a combination of antidepressants, therapy, and/or lifestyle changes.

Around 1/3 of people find that their depression disappears, 1/3 see an improvement, and 1/3 see no effect.[4]

Use for depression[]

Antidepressants are a slightly more effective than placebos for short-term depression treatment in adults, but not much more.[5][6] The placebo effect may account for most of it.[7][8] The effectiveness is controversial.

They are not recommended as a first-line treatment for mild depression unless the patient requests them. However, they are recommended as a first-line treatment for moderate to severe depression.[9] (A first-line treatment means they are the first treatment to try.)

Classes of antidepressants[]

Common antidepressants[]

SSRI[]

SNRI[]

NDRI[]

How antidepressants work[]

Antidepressants are believed to have an effect on neurotransmitters, particularly serotonin and norepinephrine.

  • Selective serotonin reuptake inhibitorss (SSRIs) specifically prevent the reuptake of serotonin (increasing the level of serotonin in the synapses of the brain).
  • Monoamine oxidase inhibitors (MAOIs) block the destruction of neurotransmitters by enzymes which normally break them down.
  • Tricyclic antidepressants (TCAs) prevent the reuptake of various neurotransmitters, including serotonin, norepinephrine, and dopamine.

Although these drugs are effective in treating depression, exactly how they do it and why is not well understood. Curiously, when a person begins taking antidepressants, the level in their blood increases to optimal levels in only a few days and begins affecting neurotransmitter activity immediately. Changes in mood, however, often take four weeks or more to appear.

Antidepressant process[]

Starting antidepressants[]

Experienced doctors can recommend which antidepressants are most likely to work based on a patient's symptoms, potential side effects, and family history (e.g. if a relative found a certain pill helpful).[10] Still, it may take multiple tries to find a medication that works.

It can take a long time for antidepressants to kick in. Some people see improvement in a few weeks, but others may take 6+ weeks.[10]

It is important to have regular check-ups when starting antidepressants. Some people experience negative side effects that may mean they need to slow down or stop the medication. This should be done according to a doctor's advice due to the potential for withdrawal effects.[10]

Suicide risk[]

Some people, especially those under 25, experience an increase in suicidal thoughts or behavior when starting antidepressants. Anyone starting antidepressants should be supervised for worsening depression or unusual behavior. Talk to a doctor or contact emergency services if you or a loved one is struggling.[10][11]

Stopping antidepressants[]

Main article: Going off medsPeople may stop medications for reasons like side effects, being unable to afford them, or wanting to try something different.[12][13]

Stopping medication must be done under the guidance of a health professional. Some medications need to be slowly reduced instead of stopped "cold turkey." In some cases, stopping may lead to a relapse, sometimes severe enough to require hospitalization.[12]

Withdrawal symptoms may mimic anxiety or depression. However, this doesn't mean someone is addicted.[14] Withdrawal symptoms will ease over time.

Side effects and risks[]

See also: Side effect

Antidepressants can often cause side effects. Some of these are manageable, while others may lead to a person choosing to stop taking the medication (which should be done with help from a doctor).

In patients with bipolar disorder, antidepressants may trigger a manic episode. Not all patients realize they have bipolar disorder instead of unipolar depression.[15][16] Bupropion is the least likely to do this.[17]

While side effect lists can look scary, most people experience a few or no side effects. Some people find that the side effects are worth the benefits.

General risks include:

  • Dementia risks in older adults[18]
  • Emotional blunting (reduced emotional intensity, indifference, and lack of motivation)[19][20][21]
  • QT prolongation in the heart (tricyclics and SSRIs)[22]
  • Slightly increased risk of diabetes[23]
  • Suicidal thinking or behavior in young people[10][24]
  • Weight gain[25][26] or loss[27][28]

SSRIs and serotonin[]

  • Bone density loss (generally small)[29][30]
  • Sexual issues (loss of sex drive, difficulty with orgasm, and erectile dysfunction), which almost always stop after the person stops taking the medication[31][32]
  • Too much serotonin in the brain can cause serotonin syndrome. Signs can include agitation, confusion, mania, mood swings, and sleep issues.[33][34]

MAOIs[]

  • If people on MAOIs eat foods with high levels of tyramine (e.g. old cheese, cured meats, or yeast extracts), people can experience hypertension, sometimes severe or life-threatening.[35]

History[]

Like many psychiatric drugs, antidepressants were discovered by accident. The first useful antidepressant group, Monoamine Oxidase Inhibitors (MAOI) were discovered in the early 1950s, and were originally developed to treat tuberculosis. The next group were the Tricyclic antidepressants. They were effective and safer than the MAOIs but still quite dangerous in overdose. They are still used today but have been largely replaced by Selective Serotonin Reuptake Inhibitors (SSRI). The first SSRI was fluoxetine (Prozac).

The three main classes of antidepressants have similar abilities to improve depressed mood, but the newer types are generally considered to have less severe side-effects and be less risky if taken in overdose.

Alternatives[]

Some people see benefits from supplements like:

Supplements can have side effects and medication interactions, including serious ones, just like medications can.[36] It's best to talk to a doctor before making dietary changes.

References[]

  • Roberto Delle Chiaie, Paolo Pancheri and Pierluigi Scapicchio. (2002). Efficacy and tolerability of oral and intramuscular S-adenosyl- L-methionine 1,4-butanedisulfonate (SAMe) in the treatment of major depression: comparison with imipramine in 2 multicenter studies. Am J Clin Nutr, 76 (5): 1172S-1176S
  • Mischoulon D, Fava M. (2002). Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. Am J Clin Nutr, 76 (5): 1158S-61S.
  • Hypericum Depression Trial Study Group (2002). Effect of Hypericum perforatum (St John's Wort) in Major Depressive Disorder: A Randomized Controlled Clinical Trial. JAMA, 287 (14):1807-1814.
  1. ↑ Clinical Psychopharmacology for Neurologists pp. 45–71 Springer (2018). ISBN 978-3-319-74602-9
  2. ↑ "Efficacy of selective serotonin reuptake inhibitors and adverse events: meta-regression and mediation analysis of placebo-controlled trials". The British Journal of Psychiatry 208 (2): 114–119. February 2016. Template:Citation/identifier. Template:Citation/identifier. 
  3. ↑ [[[:Template:Hide in print]] "Should antidepressants be used for major depressive disorder?"]. BMJ Evidence-Based Medicine 25 (4): 130. August 2020. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  4. ↑ [[[:Template:Hide in print]] "Prevalence and outcome of partial remission in depression"]. Journal of Psychiatry & Neuroscience 27 (4): 241–247. July 2002. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  5. ↑ "The most effective antidepressants for adults revealed in major review". NIHR Evidence (National Institute for Health and Care Research). 3 April 2018. Template:Citation/identifier. https://evidence.nihr.ac.uk/alert/the-most-effective-antidepressants-for-adults-revealed-in-major-review. 
  6. ↑ [[[:Template:Hide in print]] "Comparative efficacy and acceptability of twenty-one antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis"]. Lancet 391 (10128): 1357–1366. April 2018. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  7. ↑ [[[:Template:Hide in print]] "Antidepressants and the Placebo Effect"]. Zeitschrift für Psychologie 222 (3): 128–134. January 2014. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  8. ↑ [[[:Template:Hide in print]] "Efficacy of antidepressants"]. The BMJ 336 (7643): 516–517. March 2008. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  9. ↑ Depression in adults: treatment and management (29 June 2022).
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Antidepressants: Selecting one that's right for you, Mayo Clinic
  11. ↑ [[[:Template:Hide in print]] "Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration"]. The BMJ 339: b2880. 2009. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  12. ↑ 12.0 12.1 Amatenstein, Sherry. When Patients (Disastrously) Go Off Their Psych Medications, Health Central
  13. ↑ How to Get Off Antidepressants the Safe Way, Cleveland Clinic
  14. ↑ Going off antidepressants, Harvard
  15. ↑ "Antidepressant-induced mania: An overview of current controversies". Bipolar Disorders 5 (6): 407–20. 2003. Template:Citation/identifier. Template:Citation/identifier. 
  16. ↑ Benazzi F (1997). "Antidepressant-associated hypomania in outpatient depression: a 203-case study in private practice". J Affect Disord 46 (1): 73–7. Template:Citation/identifier. Template:Citation/identifier. 
  17. ↑ "A systematic review of manic/hypomanic and depressive switches in patients with bipolar disorder in naturalistic settings: The role of antidepressant and antipsychotic drugs". Eur Neuropsychopharmacol 73: 1–15. April 2023. Template:Citation/identifier. Template:Citation/identifier. 
  18. ↑ [[[:Template:Hide in print]] "Association between Antidepressants and Dementia Risk in Older Adults with Depression: A Systematic Review and Meta-Analysis"]. J Clin Med 12 (19): 6342. October 2023. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  19. ↑ [[[:Template:Hide in print]] "Emotional Blunting, Cognitive Impairment, Bone Fractures, and Bleeding as Possible Side Effects of Long-Term Use of SSRIs"]. Clin Neuropsychiatry 16 (2): 75–85. April 2019. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  20. ↑ [[[:Template:Hide in print]] "Emotional Blunting in Patients With Major Depressive Disorder: A Brief Non-systematic Review of Current Research"]. Front Psychiatry 12: 792960. 2021. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  21. ↑ "SSRI-induced apathy syndrome: a clinical review". J Psychiatr Pract 10 (3): 196–9. May 2004. Template:Citation/identifier. Template:Citation/identifier. 
  22. ↑ [[[:Template:Hide in print]] "Evaluating the risk of QTc prolongation associated with antidepressant use in older adults: a review of the evidence"]. Therapeutic Advances in Drug Safety 9 (6): 297–308. June 2018. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  23. ↑ [[[:Template:Hide in print]] "The risk of new-onset diabetes in antidepressant users – A systematic review and meta-analysis"]. PLOS One 12 (7): e0182088. 31 July 2017. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. "In our meta-analysis we found an association between exposure to ADs and new-onset diabetes, with a relative risk of 1.27. When we restricted the analysis to the studies to high NOS score the association between ADs and diabetes was even stronger. The results are in line with those from two previous meta-analyses that reported a 1.5-fold increase of diabetes among AD users.". 
  24. ↑ [[[:Template:Hide in print]] "Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration"]. The BMJ 339: b2880. 2009. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  25. ↑ "Mirtazapine: An antidepressant with noradrenergic and specific serotonergic effects". Pharmacotherapy 17 (1): 10–21. 1997. Template:Citation/identifier. Template:Citation/identifier. https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1002/j.1875-9114.1997.tb03674.x. Retrieved 17 January 2020. 
  26. ↑ mirtazapine (Rx) – Remeron, Remeron SolTab. WebMD.
  27. ↑ "Meta-analysis: pharmacologic treatment of obesity". Ann. Intern. Med. 142 (7): 532–46. April 2005. Template:Citation/identifier. Template:Citation/identifier. 
  28. ↑ Effexor Medicines Data Sheet. Wyeth Pharmaceuticals Inc (2006).
  29. ↑ [[[:Template:Hide in print]] "Use of serotonin reuptake inhibitors and risk of subsequent bone loss in a nationwide population-based cohort study"]. Scientific Reports 11 (1): 13461. June 2021. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  30. ↑ "Effect of selective serotonin reuptake inhibitors on bone mineral density: a systematic review and meta-analysis". Osteoporosis International 29 (6): 1243–1251. June 2018. Template:Citation/identifier. Template:Citation/identifier. 
  31. ↑ "Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors". The Journal of Sexual Medicine 5 (1): 227–233. January 2008. Template:Citation/identifier. Template:Citation/identifier. 
  32. ↑ [[[:Template:Hide in print]] "Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases"]. The International Journal of Risk & Safety in Medicine 29 (3–4): 125–134. 4 June 2018. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  33. ↑ [[[:Template:Hide in print]] "Serotonin syndrome: a brief review"]. CMAJ 168 (11): 1439–1442. May 2003. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  34. ↑ "The serotonin syndrome". The New England Journal of Medicine 352 (11): 1112–1120. March 2005. Template:Citation/identifier. Template:Citation/identifier. http://toxicology.ucsd.edu/art%203%20serotonin%20syndrome.pdf. 
  35. ↑ [[[:Template:Hide in print]] "Hypertensive crisis and cheese"]. Indian J Psychiatry 51 (1): 65–6. 2009. Template:Citation/identifier. Template:Citation/identifier. Template:Citation/identifier. Template:Hide in print. 
  36. ↑ 36.0 36.1 Fulghum, Debra. St. John's Wort for Depression: Benefits, Risks, and Usage, WebMD
  37. ↑ Farnsworth, Carolyn. What to know about SAM-e for depression, Medical News Today
  38. ↑ Schimelpfening, Nancy. Using 5-HTP to Treat Depression, VeryWell Mind
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 This page uses content from Wikipedia. The original article was at Antidepressant. The list of authors can be seen in the page history. As with Depression Wiki, the text of Wikipedia is available under the Creative Commons License.


Antidepressants edit
Monoamine oxidase inhibitors: Harmaline • Nialamide • Selegiline • Isocarboxazid • Iproniazid • Iproclozide • Moclobemide • Phenelzine • Toloxatone • Tranylcypromine

Dopamine reuptake inhibitors: Bupropion • Amineptine

Norepinephrine reuptake inhibitors: Atomoxetine • Reboxetine • Viloxazine • Maprotiline

Serotonin-norepinephrine reuptake inhibitors: Desipramine • Duloxetine • Milnacipran • Nefazodone • Venlafaxine

Selective serotonin reuptake inhibitors: Alaproclate • Etoperidone • Citalopram • Escitalopram • Fluoxetine • Fluvoxamine • Paroxetine • Sertraline • Zimelidine

Selective serotonin reuptake enhancers: Tianeptine

Tricyclic antidepressants: Amitriptyline • Clomipramine • Desipramine • Dothiepin • Doxepin • Imipramine • Lofepramine • Nortriptyline • Protriptyline • Trimipramine • Iprindole • Opipramol

Tetracyclic antidepressants: Maprotiline • Mianserin • Mirtazapine • Amoxapine

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