Antidepressant Medications Anti-depressant Drugs
Antidepressant Medications Anti-depressant Drugs Introduction
The kind of depression
that will most likely benefit from treatment with medications is more than just
"the blues." It's a condition that's prolonged, lasting 2 weeks or
more, and interferes with a person's ability to carry on daily tasks and to
enjoy activities that previously brought pleasure. The depressed person will
seem sad, or "down," or may show a lack of interest in his surroundings.
He may have trouble eating and lose weight (although some people eat more and
gain weight when depressed). He may sleep too much or too little, have difficulty
going to sleep, sleep restlessly, or awaken very early in the morning. He may
speak of feeling guilty, worthless, or hopeless. He may complain that his thinking
is slowed down. He may lack energy, feeling "everything's too much,"
or he might be agitated and jumpy. A person who is depressed may cry. He may
think and talk about killing himself and may even make a suicide attempt.
Some people who are depressed have psychotic symptoms, such as delusions (false
ideas) that are related to their depression. For instance, a psychotically depressed
person might imagine that he is already dead, or "in hell," being
punished. Not everyone who is depressed has all these symptoms, but everyone
who is depressed has at least some of them.
A depression can range in intensity from mild to severe. Antidepressants are
used most widely for serious depressions, but they can also be helpful for some
milder depressions. Antidepressants, although they are not "uppers"
or stimulants, take away or reduce the symptoms of depression and help the depressed
person feel the way he did before he became depressed. Antidepressants are also
used for disorders characterized principally by anxiety. They can block the
symptoms of panic, including rapid heartbeat, terror, dizziness, chest pains,
nausea, and breathing problems. They can also be used to treat some phobias.
The physician chooses the particular antidepressant to prescribe based on the
individual patient's symptoms. When someone begins taking an antidepressant,
improvement generally will not begin to show immediately. With most of these
medications, it will take from 1 to 3 weeks before changes begin to occur. Some
symptoms diminish early in treatment; others, later. For instance, a person's
energy level or sleeping or eating patterns may improve before his depressed
mood lifts. If there is little or no change in symptoms after 5 to 6 weeks,
a different medication may be tried.
Some people will respond better to one than another. Since there is no certain
way of determining beforehand which medication will be effective, the doctor
may have to prescribe first one, then another, until an effective one is found.
Treatment is continued for a minimum of several months and may last up to a
year or more. While some people have one episode of depression and then never
have another, or remain symptom-free for years, others have more frequent episodes
or very long-lasting depressions that may go on for years. Some people find
that their depressions become more frequent and severe as they get older. For
these people, continuing (maintenance) treatment with antidepressants can be
an effective way of reducing the frequency and severity of depressions. Those
that are commonly used have no known long-term side effects and may be continued
The prescribed dosage of the medication may be lowered if side effects become
troublesome. Lithium can also be used for maintenance treatment of repeated
depressions whether or not there is evidence of a manic or manic-like episode
in the past. Dosage of antidepressants varies, depending on the type of drug,
the person's body chemistry, age, and, sometimes, body weight. Dosages are generally
started low and raised gradually over time until the desired effect is reached
without the appearance of troublesome side effects.
There are a number of antidepressant medications available. They differ in
their side effects and, to some extent, in their level of effectiveness. Tricyclic
antidepressants (named for their chemical structure) are more commonly used
for treatment of major depressions than are monoamine oxidase inhibitors (MAOIs);
but MAOIs are often helpful in so-called "atypical" depressions in
which there are symptoms like oversleeping, anxiety, panic attacks, and phobias.
The last few years have seen the introduction of a number of new antidepressants.
Several of them are called "selective serotonin reuptake inhibitors"
(SSRIs). Those available at the present time in the United States are fluoxetine
(Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft).
(Luvox has been approved for obsessive-compulsive disorder , and Paxil has been
approved for panic disorder.) Though structurally different from each other,
all the SSRIs' antidepressant effects are due to their action on one specific
neurotransmitter, serotonin. Two other antidepressants that affect two neurotransmitters
serotonin and norepinephrine have also been approved by the FDA. They are venlafaxine
(Effexor) and nefazodone (Serzone). All of these newer antidepressants seem
to have less bothersome side effects than the older tricyclic antidepressants.
The tricyclic antidepressant clomipramine (Anafranil) affects serotonin but
is not as selective as the SSRIs. It was the first medication specifically approved
for use in the treatment of obsessive
compulsive disorder (OCD). Prozac and Luvox have now been approved for use
Another of the newer antidepressants, bupropion (Wellbutrin), is chemically
unrelated to the other antidepressants. It has more effect on norepinephrine
and dopamine than on serotonin. Wellbutrin has not been associated with weight
gain or sexual dysfunction. It is contraindicated for individuals with, or at
risk for, a seizure disorder or who have been diagnosed with bulimia or anorexia
Side Effects of Antidepressant Medications
1. Tricyclic Antidepressants
There are a number of possible side effects with tricyclic antidepressants
that vary, depending on the medication. For example, amitriptyline (Elavil)
may make people feel drowsy, while protriptyline (Vivactil) hardly does this
at all and, in some people, may have an opposite effect, producing feelings
of anxiety and restlessness. Because of this kind of variation in side effects,
one antidepressant might be highly desirable for one person and not recommended
for another. Tricyclics on occasion may complicate specific heart problems,
and for this reason the physician should be aware of all such difficulties.
Other side effects with tricyclics may include blurred vision, dry mouth, constipation,
weight gain, dizziness when changing position, increased sweating, difficulty
urinating, changes in sexual desire, decrease in sexual ability, muscle twitches,
fatigue, and weakness. Not all these medications produce all side effects, and
not everybody gets them. Some will disappear quickly, while others may remain
for the length of treatment. Some side effects are similar to symptoms of depression
(for instance, fatigue and constipation). For this reason, the patient or family
should discuss all symptoms with the doctor, who may change the medication or
dosage. Tricyclics also may interact with thyroid hormone, antihypertensive
medications, oral contraceptives, some blood coagulants, some sleeping medications,
antipsychotic medications, diuretics, antihistamines, aspirin, bicarbonate of
soda, vitamin C, alcohol, andtobacco. An overdose of antidepressants is serious
and potentially lethal. It requires immediate medical attention. Symptoms of
an overdose of tricyclic antidepressant medication develop within an hour and
may start with rapid heartbeat, dilated pupils, flushed face, and agitation,
and progress to confusion, loss of consciousness, seizures, irregular heart
beats, cardiorespiratory collapse, and death.
2. The Newer Antidepressants
The most common side effects of these antidepressants are gastrointestinal
problems and headache. Others are insomnia, anxiety, and agitation. Because
of potentially serious interaction between these medications and monoamine oxidase
inhibitors, it is advisable to stop taking one medication from 2 to 4 or 5 weeks
before starting the other, depending on the specific medications involved. In
addition, some SSRIs have been found to affect metabolism of certain other medications
in the liver, creating possible drug interactions.
3. Monoamine Oxidase Inhibitors (MAOIs)
MAOIs may cause some side effects similar to those of the other antidepressants.
Dizziness when changing position and rapid heartbeat are common. MAOIs also
react with certain foods and alcoholic beverages (such as aged cheeses, foods
containing monosodium glutamate (MSG), Chianti and other red wines), and other
medications (such as over-the-counter cold and allergy preparations, local anesthetics,
amphetamines, insulin, some narcotics, and antiparkinsonian medications). These
reactions often do not appear for several hours. Signs may include severe high
blood pressure, headache, nausea, vomiting, rapid heartbeat, possible confusion,
psychotic symptoms, seizures, stroke, and coma. For this reason, people taking
MAOIs must stay away from restricted foods, drinks, and medications. They should
be sure that they are furnished, by their doctor or pharmacist, a list of all
foods, beverages, and other medications that should be avoided. Precautions
to be observed when taking Antidepressants When taking antidepressants, it is
important to tell all doctors (and dentists) being seen not just the one who
is treating the depression about all medications being used, including over-the-counter
preparations and alcohol. Antidepressants should be taken only in the amount
prescribed and should be kept in a secure place away from children. When used
with proper care, following doctors' instructions, antidepressants are extremely
useful medications that can reverse the misery of a depression and help a person
feel like himself again.
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