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Antidepressants / Anti Anxiety MedicationsInformation, Articles, Resources
Antidepressants were first developed in the 1950s and have been used on a regular basis since then. Antidepressants are medications used treat depression. Depression is a disorder that affects your thoughts, moods, feelings, behavior and physical health. People used to think it was "all in your head" and that if you really tried, you could "pull yourself out of it." Depression is not a weakness, and you can't treat it on your own. It's a medical disorder with a biological or chemical basis. Most people with depression get better with treatment that includes antidepressants. Most antidepressants are believed to work by slowing the removal of certain chemicals (serotonin and norepinephrine) from the brain. These chemicals are called neurotransmitters and are needed for normal brain function. Antidepressants help relieve the symptoms of depression by making these natural chemicals more available to the brain and thus restoring the brain's chemical balance. Antidepressants are used to treat mental depression as well as chronic pain, childhood bed wetting, anxiety, panic disorder, eating disorders, cigarette addiction, obsessive compulsive disorder, obesity, social anxiety disorder, and premenstrual depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you're severely depressed, initial treatment usually is with medications or electroconvulsive therapy. Antidepressants can have an effect on many other medicines. If you're going to take an antidepressant, tell your doctor about all the other medications you take, including over the counter medicines and herbal supplements (such as St. John's wort). What are antidepressants? Antidepressants are the third most prescribed drugs in the United States. Antidepressants are drugs that relieve the symptoms of depression. There are almost thirty different kinds of antidepressants available today and there are four main types:
How do antidepressants work? Neurotransmitters are the chemicals which transmit signals between the cells in our brains. In depression, some of the neurotransmitter systems, especially those of serotonin, dopamine and norepinephrine, don't seem to be working properly. Antidepressants affect neurotransmitters, in particular, antidepressants boost the amounts of serotonin and norepinephrine. This gradually causes changes in how your brain cells behave. It can take several weeks before you can tell if the drugs are affecting your mood. The problem is that the drugs also affect other brain cells, disrupting nerve signals and causing side effects. Are antidepressants addictive? Antidepressant drugs don't cause the addictions that you get with tranquillisers, alcohol or nicotine, in the sense that: You don't need to keep increasing the dose to get the same effect. You won't find yourself craving them if you stop taking them. However, stopping taking antidepressant abruptly may cause withdrawal symptoms. These include: stomach upsets, flu-like symptoms, anxiety, dizziness, headache, nausea. It is generally best to taper off the dose of an antidepressant rather than stop it suddenly. Antidepressants are put into groups based on which chemicals in the brain they affect. Antidepressants and Weight gain Weight gain is a reported side effect of nearly all antidepressants. Weight gain is a relatively common problem during both acute and long-term treatment with antidepressants, and it is an important contributing factor to noncompliance. However, it is not clearly known how antidepressant medications cause weight gain. Tricyclic antidepressants (TCAs) appear to slow metabolism and may promote carbohydrate cravings 4. Because tertiary tricyclic antidepressants (e.g. amitriptyline, imipramine, and doxepin) are stronger histamine blockers than are secondary tricyclics (e.g. desipramine and nortriptyline) the tertiary tricyclic drugs are more likely to cause weight gain. Mirtazapine (Remeron) may be placed between the SSRIs and the TCAs in terms of relative risk for weight gain. Weight gain is the most commonly reported side effect of this antidepressant. It is likely to be related to weight gain in both the short term and the long term through blockade of histamine H1 and serotonin 2C receptors. The weight gain may occur even during the first 4 weeks of treatment with mirtazapine 5. Selective Serotonin Reuptake Inhibitors (SSRIs) cause less weight gain than tricyclic antidepressants. Weight gain is less likely with SSRIs when they are used for 6 months or less. SSRIs-induced weight change is probably related to alteration in serotonin 2C receptor activity, appetite increase, carbohydrate craving, or recovery from clinical depression 1, 2, 3. Paroxetine (Paxil) appears to cause the greatest incidence of weight gain than the other SSRIs. Venlafaxine (Effexor) appears to be a weight-neutral antidepressant. Bupropion (Wellbutri) is unlikely to cause weight gain, and is commonly associated with weight loss. Its chemical structure is similar to that of diethylpropion (Tenuate), an appetite suppressant. A number of clinical studies have shown it's weight loss potential. The results of the 48-week double-blind, placebo- controlled trial have shown, that bupropion SR is associated with a 24-week weight loss of 10.1% and sustained weight losses at 48 weeks 6. Antidepressants and Sexual side effects The SSRIs as a class produce a variety of sexual side effects, including impotence, anorgasmia, decreased libido. SSRIs-induced sexual dysfunction is common but remains highly unrecognized and underreported. Only 14% of depressed patients taking SSRIs for depression spontaneously report sexual dysfunction; however, if queried directly, nearly 60% of patients report sexual dysfunction. The incidence of sexual dysfunction in men is higher than in women, but women's sexual dysfunction is more intense than men's. Suggested causes include increased serotonin, particularly affecting 5HT2 and 5HT3 receptors; decreased dopamine; blockade of cholinergic and alpha-1 adrenergic receptors; inhibition of nitric oxide synthetase; and elevation of prolactin levels. Some evidence exists to support the claim that paroxetine (Paxil) causes the highest rates of sexual side effects. According to the study paroxetine is associated with more delay of orgasm or ejaculation and more impotence than fluoxetine (Prozac) and sertraline (Zoloft). In most cases, once the drug is stopped, sexual functioning comes back to normal. However this may not be true for everyone and antidepressant-induced SD may turn into Post SSRI Sexual Dysfunction (PSSD). If sexual functioning remains abnormal, this should be brought to the attention of your physician. Selective serotonin reuptake inhibitors (SSRIs) Selective serotonin reuptake inhibitors (SSRIs) are a newer class of antidepressant medications. SSRIs relieve symptoms of depression by blocking the reabsorption (reuptake) of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which enhances neurotransmission - the sending of nerve impulses - and improves mood. SSRIs are called selective because they seem to affect only serotonin, not other neurotransmitters. Some SSRIs are available in extended-release forms or controlled-release forms, often designated with the letters XR or CR.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) SNRIs were developed more recently than SSRIs, and there are relatively few of them. Their efficacy as well as their tolerability appears to be somewhat better than the SSRIs. Serotonin and norepinephrine reuptake inhibitors are a type of antidepressant medication that increases the levels of both serotonin and norepinephrine by inhibiting their reabsorption into cells. Although the precise mechanism of action isn't clear, it's thought that these increased levels enhance neurotransmission and thereby improve and elevate mood. Medications in this group are sometimes known as dual reuptake inhibitors. Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs) Norepinephrine and dopamine reuptake inhibitors (NDRIs) are a type of antidepressant medication that increases the levels of both norepinephrine and dopamine by inhibiting their reabsorption into cells. The precise mechanism of action isn't clear. But it's thought that these increased levels help enhance neurotransmission - the sending of nerve impulses - and thereby improve and elevate mood. Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL) is the only NDRI approved by the Food and Drug Administration specifically to treat depression. Tricyclic antidepressants Tricyclic antidepressants (TCAs) inhibit the reabsorption of serotonin and norepinephrine, and to a lesser extent, dopamine. They also block certain cell receptors, which accounts for many of their side effects. They're called tricyclic because of their chemical structure. They were among the earliest of antidepressants, hitting the market in the 1960s, and they remained the first line of treatment for depression through the 1980s, before newer antidepressants arrived. Alpha-2 receptor blockers - Noradrenergic and specific serotonergic antidepressants (NaSSAs) Depression is associated with reduced levels of monoamines in the brain. Noradrenergic and specific serotonergic antidepressants (NaSSAs), such as mirtazapine, have a dual mechanism of action that increases the concentration of 5-HT and noradrenaline in the synaptic cleft to within the normal range. NaSSAs bind to and inhibit both noradrenaline a2-autoreceptors and noradrenaline a2-heteroeceptors. This action prevents the negative feedback effect of synaptic noradrenaline on 5-HT and noradrenaline neurotransmission, and neurotransmission sustained. Remeron (mirtazapine) is a new antidepressant that enhances both noradrenergic and serotonergic activity and is currently the only member of the noradrenergic and specific serotonergic antidepressant (NaSSA) class. Trazodone Trazodone hydrochloride is an antidepressant chemically unrelated to tricyclic, tetracyclic, or other known antidepressant agents. Trazodone hydrochloride is a triazolopyridine derivative. Trazodone hydrochloride is indicated for the treatment of depression. Azaspirodecanedione anxiolytics References
Medications
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