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Antidepressant Medication Guide & Risks

A Guide To Antidepressants

While Americans have experienced a mental health crisis long before the Coronavirus pandemic, a year and a half of loss, stress, isolation, and treatment disruption have only further aggravated mental health issues [1].

Millennials ages 24 to 39 have been hit especially hard by the mental health crisis, specifically by the rise of major depression, as findings by the Blue Cross Blue Shield organization found that major depression had the highest prevalence rate, or the likelihood of a person having a disease, among health conditions affecting millennials [2].

However, in an almost beautifully tragic way, the rising levels of those diagnosed with major depression disorders in recent years have led to increased de-stigmatization seeking mental healthcare and of the use of mental health tools such as taking prescribed antidepressants and attending therapy. Antidepressants are a valuable tool in the fight against depression; here is some information to help you understand them.

What Are Antidepressants?

According to American Psychiatric Association guidelines[3], antidepressant medications are the first-choice treatment for major depressive disorder (MDD). Antidepressants can also be useful in treating different types of anxiety conditions such as generalized anxiety disorder, phobias, PTSD, and more.

There are many different types of orally administered antidepressants that can vary in how they work inside the brain and your body. Some are better for treating certain conditions and symptoms while some work in combination with other medications. But they all come with potential side effects.

People can also respond differently than others to even the same antidepressant. Some people may have no troubling side effects, while others may have one or more serious side effects. This is why you may need to try a few different medications before you find the right fit.

Choosing The Antidepressant That's Right For You

Due to the wide variety of antidepressants and the varying efficacy of particular antidepressants amongst people even sharing the same exact symptoms and onset, it’s important to find the right prescription for yourself. It may take a few or more attempts to find the right medication for your depression or other disorder.

When prescribing an antidepressant that’s likely to work well for you, your doctor may consider these subjects:

Your Particular Symptoms

Symptoms of depression can vary from person to person and one antidepressant may relieve certain symptoms better than another one can. For example, if one of your symptoms is having trouble sleeping it may be wise to choose an antidepressant that’s slightly sedating.

Possible Side Effects

Like symptoms of depression, the side effects of antidepressants will vary from person to person. While some are manageable and the overall decrease of symptoms are worth the side effects, some side effects may outweigh the benefits of the medications. Major side effects can be rare and vary from medication to medication but it’s important to know the risks and therefore should always be discussed with your physician or pharmacist.

Whether It Worked For A Close Relative

Due to similar brain chemistry and genetic make-up, it can be good to ask close relatives who have been prescribed antidepressants, such as a parent or sibling, which medications have worked for them as they might work similarly for you[4].

Interaction With Other Medications

When consulting with your psychiatrist or physician it’s important to let them know any and all medications you may be taking as some antidepressants can cause dangerous reactions when taken with other medications.

Pregnancy Or Breastfeeding

While the risk of birth defects or other issues for babies of mothers who take antidepressants is low, certain medications may be discouraged during pregnancy. Work with your doctor to find the best way to manage your depression while you’re expecting or planning on becoming pregnant.

Cost and Health Insurance Coverage

While the risk of birth defects or other issues for babies of mothers who take antidepressants is low, certain medications may be discouraged during pregnancy. Work with your doctor to find the best way to manage your depression while you’re expecting or planning on becoming pregnant.

Types Of Antidepressants

Here’s a look at the main types of antidepressants and some of the side effects commonly associated with them. If you take a certain type, you probably won’t experience all of the side effects associated with it. You might also experience other side effects, including some serious ones, that aren’t listed here – in which case you should immediately head to your nearest local hospital and consult your prescribing physician.

SSRIs

SSRIs or Selective Serotonin Reuptake Inhibitors are among the most commonly prescribed antidepressants as physicians often start by prescribing an SSRI[4]. These medications generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants are. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).

Common side effects include: headaches, nausea, trouble sleeping, dizziness, diarrhea, weakness and fatigue, anxiety, stomach upset, dry mouth, sexual problems such as low sex drive, erectile dysfunction, or ejaculation problems.

SNRIs

SNRIs or Serotonin and Norepinephrine Reuptake Inhibitors differ from SSRIs as they target an additional neurotransmitter called Norepinephrine. Examples of SNRI medications include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima).

Common side effects include: headaches, nausea, insomnia, drowsiness, dry mouth, dizziness, loss of appetite, constipation, sexual problems such as low sex drive, erectile dysfunction, or ejaculation problems, weakness and fatigue, sweating.

Tricyclic Antidepressants

Tricyclic antidepressants or TCAs are an older group of antidepressants. Like SNRIs, they help to increase levels of norepinephrine and serotonin in your brain. But they also decrease the effects of another neurotransmitter called acetylcholine.

This impact on acetylcholine increases the risk of certain side effects. As a result, TCAs are typically only used if SSRIs and SNRIs don’t work well for you. Some common TCAs include amitriptyline (Elavil), clomipramine (Anafranil), Desipramine (Norpramin), and nortriptyline (Pamelor).

Side effects often include: seizures, insomnia, anxiety, arrhythmia, or irregular heartbeat hypertension, rash, nausea and vomiting, abdominal cramps, weight loss, constipation, urinary retention, increased pressure on the eye, sexual dysfunction.

MAOIs

MAOIs or Monoamine Oxidase Inhibitors are antidepressants that were commonly prescribed before the introduction of SSRIs and SNRIs. They work by inhibiting the action of the brain enzyme monoamine oxidase. Monoamine oxidase helps break down serotonin which in turn leads to better serotonin circulation. This can lead to more stabilized moods and less anxiety.

MAOIs are typically used if SSRIs have not worked for you in the past[3]. They also tend to interact with foods and medications more than other antidepressants. Examples of MAOIs include phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan).

Side effects include: blurred vision, rash, seizures, edema or swelling of limbs, weight loss or weight gain, sexual dysfunction, diarrhea, nausea, and constipation, anxiety, insomnia and drowsiness, headache, dizziness, arrhythmia, or irregular heart rhythm, fainting or feeling faint when standing up, hypertension, or high blood pressure.

SARIs

Serotonin antagonists and reuptake inhibitors, also known as serotonin modulators or phenylpiperazine antidepressants, work by helping increase the amount of available serotonin in circulation. SARIs such as Trazadone are especially helpful in improving sleep and is the second most prescribed drug prescribed for treating insomnia[5].

Common side effects of SARIs include: drowsiness, dry mouth, headaches, dizziness, nausea, fatigue, vomiting, blurred vision, diarrhea, constipation, low blood pressure, confusion.

Atypical Antidepressants

Some antidepressants simply don’t fit into any of the main groups, usually because of the way they work. These are known as atypical antidepressants.

Bupropion

Bupropion, branded as Wellbutrin, doesn’t work like most other antidepressants that increase serotonin. It instead works to increase two different neurotransmitters – norepinephrine and dopamine. Side effects of bupropion can be similar to other antidepressants.

However, compared with other antidepressants, it is less likely to cause weight gain and cause sexual side effects. It can sometimes even be prescribed with other antidepressants to lessen sexual side effects. Wellbutrin is also often used to help people quit smoking.

Side effects can include: trouble sleeping, headaches, irritability or agitation, dry mouth, constipation, loss of appetite, weight loss, nausea, vomiting, sweating, dizziness, anxiety.

Mirtazapine

Mirtazapine or Remeron increases the effects of three neurotransmitters in your brain – norepinephrine, serotonin, and dopamine – in different actions than other antidepressants.

Side effects include: drowsiness, dry mouth, increased appetite, weight gain, high cholesterol, constipation, weakness and fatigue, dizziness.

Vilazodone

Vilazodone, known as Viibryd is another atypical antidepressant that increases serotonin activity in the brain in ways both similar and different than typical SSRIs. It is sometimes referred to as a serotonin partial agonist reuptake inhibitor. It is less likely to cause weight gain than other antidepressants but can sometimes cause sexual side effects, albeit at a lower frequency than SSRIs or SNRIs.

Common side effects from vilazodone can include: diarrhea, nausea, dizziness, dry mouth, trouble sleeping, vomiting.

How To Make Antidepressants Work For You

Taking antidepressants is more than just taking a pill – it’s an involved change in lifestyle that means you are taking steps to improve your overall life condition. It also means adhering to a few rules of thumb and creating good habits.

Here are some tips to get the best results from taking an antidepressant:

  • Be patient — antidepressants take time to be effective, anywhere from 3 to 6 weeks or more.
  • Take your antidepressants consistently — take the correct dose of your medication at the same time as often as prescribed for best results.
  • See if the side effects improve — Many antidepressants will cause side effects that improve with time. These symptoms often go away as your body gets used to the antidepressant.
  • Explore other options if it isn’t working — if side effects outweigh the benefits of the medication or if you see no significant improvement in symptoms after several weeks, talk to your doctor about either changing the dose, trying a new medication, or augmenting the medication with another.
  • Don’t discontinue the antidepressant without consulting your physician — if the medication is not working for you, it may create more issues than the ones you’re currently facing if you suddenly discontinue use. Consult your prescribing physician if you think you’d like to stop or change medications.
  • Avoid alcohol and recreational drugs — while they may seem like they lessen symptoms of depression, alcohol and drugs generally worsen symptoms in the long run and make it harder to treat by creating new pathways for things to go awry in your everyday life.

Going Off Antidepressants

Taking antidepressants should never be seen as a permanent solution as their intention, as well as your prescriber and mental healthcare physicians, are to relieve your depression symptoms while simultaneously helping you address and heal the cause of your depression. There are some concerns you should speak about with your doctor when discontinuing antidepressants.

Antidepressant Discontinuation Syndrome

About 20% of patients develop antidepressant discontinuation syndrome following an abrupt stoppage of or marked reduction in the dose of an antidepressant taken continuously for one month[6].

Symptoms of antidepressant discontinuation syndrome include:

  • lethargy
  • headache
  • fatigue
  • achiness
  • sweating
  • insomnia
  • nausea
  • imbalance
  • tingling sensations
  • hyperarousal

Symptoms are usually mild and may occur following treatment with any type of antidepressant. Symptoms occur within two to four days after drug cessation and usually the last one to two weeks (occasionally may persist up to one year).

The onset of this syndrome is usually combated by tapering the user off of the antidepressant in a gradual manner. Some antidepressants may be easier than others to taper off of while some may take longer. Take this into consideration when consulting a doctor with what’s right for you.

Antidepressants Can Help You Beat Your Depression

Antidepressants are a heavily researched and proven way to help combat the symptoms of depression. Combined with a will to beat depression and other mental health services such as therapy, you can beat this.

We hope our guide to antidepressants, while not comprehensive, helps you understand antidepressants and that you consider them as yet another tool in your fight against the major depressive disorder. Please feel free to call our staff at SoCal Mental Health as we are here to help you in this fight.

Sources

  1. National Institute of Mental Health. Mental Illness. Retrieved December 10th, from https://www.nimh.nih.gov/health/statistics/mental-illness
  2. Blue Cross Blue Shield (2019, April 24). A Focus on Millennial Health Trends. Retrieved December 10th, from https://www.bcbs.com/the-health-of-america/reports/the-health-of-millennials
  3. American Psychiatric Association (2010, October). Treating Major Depressive Disorder. Retrieved December 10th, from https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd-guide.pdf
  4. Mayo Clinic (2019, December 31). Antidepressants: Selecting one that’s right for you. Retrieved December 10th, from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273
  5. Holshoe J.M. (2021). Antidepressants and Sleep. Retrieved December 11th from https://www.sciencedirect.com/topics/medicine-and-dentistry/serotonin-2-antagonist
  6. Gabriel M., Sharma V. (2017, May 29). Antidepressant discontinuation syndrome. Retrieved December 11th, from https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5449237/