Guide To The Most Common Antidepressants
Antidepressants are prescription medications primarily used to treat clinical depression. Doctors may prescribe these medicines for patients experiencing major depression, and they can also be beneficial for individuals who have depression that occurs in conjunction with anxiety or depression that is the result of bipolar disorder or cyclothymic disorder. Antidepressants are generally taken by mouth, and most patients take them at least once per day. Doctors can adjust the dosage depending on the patient's needs, and they may recommend attending counseling sessions in addition to taking the medication. Patients should have their mood and progress monitored periodically by their physician, and they should report any side effects or new symptoms they experience. Patients who wish to discontinue antidepressants will need to speak to their doctor about how to appropriately taper the medication, as stopping it abruptly could lead to withdrawal symptoms.
The major types of antidepressants in use today are described below.
Selective Serotonin Reuptake Inhibitors
Selective serotonin reuptake inhibitors (SSRIs) are currently the most widely prescribed type of antidepressant medication. These medicines work by increasing the level of serotonin in the brain, and they are beneficial for patients with moderate to severe depression. Examples of SSRIs include fluoxetine, sertraline, paroxetine, citalopram, and escitalopram. In addition to treating depression, SSRIs may be prescribed to treat anxiety. Selective serotonin reuptake inhibitors are a newer form of antidepressant, and they generally have fewer side effects than older antidepressants. However, patients taking SSRIs should still be aware of the potential side effects, including headache, dry mouth, nausea, vomiting, insomnia, and dizziness. Some patients could notice restlessness, agitation, or changes in weight (either weight loss or gain). The side effects are most likely to occur within the first month of treatment, and patients who find the side effects of a particular SSRI too troublesome may be able to successfully tolerate another on. Since this kind of medication could increase the risk of bleeding, patients should inform their doctor about any anticoagulants they take before SSRIs are prescribed, and it may be necessary to avoid over-the-counter nonsteroidal anti-inflammatories during treatment.
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Tricyclic Antidepressants
Tricyclic antidepressants were first discovered in the 1950s. These medicines increase the levels of serotonin and norepinephrine in the brain, and they are used to treat depression, bipolar disorder, obsessive-compulsive disorder, chronic pain, and insomnia. Amoxapine, nortriptyline, imipramine, and amitriptyline are currently some of the most frequently prescribed tricyclic antidepressants. Before taking this type of antidepressant, patients should let their doctor know if they have recently had a heart attack or if they have glaucoma, liver disease, diabetes, cardiovascular issues, or a history of seizures. Tricyclics may not be safe for patients with these conditions, and precautions may be necessary if they are used in patients under twenty-five years old or over sixty-five years old. Potential side effects associated with these medications include a racing heartbeat, sweating, urinary retention, blurry vision, and dizziness. Some patients could also experience weight gain, constipation, tremors, restlessness, and low blood pressure upon standing. In elderly patients, tricyclic antidepressants could cause confusion. This kind of antidepressant should not be used with monoamine oxidase inhibitors (MAOIs), and alcohol consumption should be avoided during treatment.
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Serotonin And Norepinephrine Reuptake Inhibitors
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are antidepressants that increase serotonin and norepinephrine. In addition to depression treatment, these drugs may be prescribed to treat chronic pain, especially pain that stems from the body's nerves. They are used to treat diabetic neuropathy, fibromyalgia, low back pain, and pain from osteoarthritis, and they are beneficial in the treatment of social phobia, panic disorder, anxiety, bipolar disorder, and major depressive disorder. Examples of SNRIs include venlafaxine, duloxetine, and levomilnacipran. Patients taking serotonin and norepinephrine reuptake inhibitors could experience side effects such as constipation, dry mouth, nausea, fatigue, and loss of appetite. These drugs could increase blood glucose levels in diabetic patients, and they may cause low blood pressure upon standing. In rare cases, patients who use SNRIs have reported seizures. Serotonin and norepinephrine reuptake inhibitors may also reduce the levels of sodium in the blood, especially in the elderly and patients who take diuretics. Duloxetine could worsen existing liver issues, and venlafaxine and levomilnacipran may increase blood pressure in certain patients. Patients who use these medicines may need to have their blood pressure, blood glucose, and liver function monitored regularly.
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Monoamine Oxidase Inhibitors
Like tricyclics, monoamine oxidase inhibitors (MAOIs) were introduced in the 1950s. These medications are typically prescribed today after selective serotonin reuptake inhibitors and other antidepressants have been tried first. Examples of MAOIs include tranylcypromine, isocarboxazid, selegiline, and phenelzine. The effects of monoamine oxidase inhibitors often take up to three weeks to be felt by the patient, and they are generally continued for at least six months after the patient's depression resolves. MAOIs are especially beneficial for patients who have atypical depression. Those with this condition have features that are inconsistent with other recognized types of depression; these may include a heavy feeling in the arms and legs, excessive drowsiness, and an improvement in symptoms if a positive event occurs in the patient's life. While taking MAOIs, patients should not consume any foods or drinks containing tyramine, including alcohol. Doing so could cause a dangerous and sudden increase in blood pressure. Patients should also avoid over-the-counter cough and cold remedies that contain dextromethorphan. Potential side effects of monoamine oxidase inhibitors include weight gain, hypertension, dizziness, lightheadedness, dry mouth, diarrhea, and difficulty urinating.
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Atypical Antidepressants
Atypical antidepressants include any antidepressants that work differently than SSRIs, SNRIs, MAOIs, and tricyclic antidepressants. Many types of atypical antidepressants work by increasing levels of dopamine and norepinephrine in the brain, and they are often used in the treatment of depression and anxiety. They are often considered in cases of treatment-resistant depression that has not responded to other antidepressants. In addition, doctors might choose to prescribe atypical antidepressants for patients trying to quit smoking, as the drugs have been shown to reduce nicotine cravings. Vortioxetine, trazodone, bupropion, and esketamine are some of the most commonly prescribed atypical antidepressants in use today. Patients who take these medications should be aware of potential side effects such as dry mouth, dizziness, constipation, diarrhea, and weight gain. Esketamine, a new nasal spray intended for use in patients with treatment-resistant depression, must be administered by a psychiatrist or a primary care doctor, and bupropion should not be used by patients who have a history of seizures or eating disorders. Patients should check-in regularly with their healthcare team during treatment with atypical antidepressants. If troublesome side effects occur, it may be possible to switch to another medication in the same drug category.