Frequently Asked Questions About Antidepressants

Antidepressants are a group of psychotropic drugs used primarily for the treatment of depression but also used for other mental disorders. They are affecting the level of neurotransmitters, in particular, serotonin, norepinephrine, and dopamine. In a depressed patient, they improve mood, reduce or relieve anguish, lethargy, apathy, anxiety, irritability, and emotional stress, increase mental activity, normalize sleep phase structure and duration, and appetite. The majority of antidepressants do not improve the mood of people who do not suffer from depression.

The medications from this group can be prescribed for the treatment of:
– Different severity depressions of psychotic and non-psychotic nature with different clinical symptoms and causes (endogenous, exogenous-organic, somatic, intoxication, psychogenic).
– Anxiety and obsessive-phobic disorders, bipolar disorders (depressive phase);
– Alcohol and drug withdrawal;
– Anorexia nervosa and bulimia nervosa;
– Psychosomatic disorders;
– Chronic pain syndrome;
– Diseases of the gastrointestinal tract.
– Various forms of neurosis and other non-psychotic disorders.

Different antidepressants have different contraindications for use but there are some that are common:
– Intolerance of the active substance;
– Severe cardiovascular diseases;
– Glaucoma;
– Bowel and bladder atony;
– Prostate adenoma;
– Young age (below 18 years).
– Pregnancy and breastfeeding.

Although the medications differ in their effects, some common possible negative effects are feeling jittery, sleepiness, dry mouth, nausea, and difficulty achieving orgasm. Usually, the side effects associated with antidepressants are fading over time, i.e. within one week of use. However, if you have severe side effects and they don’t go away or if you have an allergy, suicidal thoughts, worsening of depression, or heart disease symptoms, you must get in touch with your doctor right away without waiting for the symptoms to go away.

Usually, the antidepressive and other effects of the medications start to be manifested noticeably within a week to four weeks after the therapy start depending on the type of antidepressant.

It depends on the severity of your condition and should be decided by your therapist. Usually, the minimal course is six months. It can be 6 to 9 months or more if you have recurring depression. Such long courses are needed to avoid relapses.

There are two major ways of coping with depression: psychotherapy/counseling and the use of antidepressants. Mild to moderate depression is preferably treated with psychotherapy and the medications are added if no desired effect is achieved. In severe cases, it is necessary to take the medications from the start of the treatment.
Following your doctor’s recommendations and taking your time to get used to a prescribed antidepressant you increase your chances of getting rid of depression.

If the chosen medication doesn’t seem to improve your condition, you must consult your doctor and ask for the change in your therapy. Your doctor may increase your daily dosage, replace the drug or recommend counseling.

There are three major groups of antidepressants: with stimulating effect, with sedating effect and combined. Based on your symptoms, your therapist should choose a suitable treatment.
– Stimulating antidepressants are suitable for people who due to depression also suffer from apathy, lethargy, sleepiness, chronic fatigue, and so on. In people who also have panic disorder, anxiety, and other disorders for which excessive stimulation is harmful may start suffering from hallucinatory-delusional disorders, anxiety, suicidal tendencies. The medications from this group include Imipramine by Abbott that is used for used in melancholy, adynamic, apathetic depressions, sometimes in phobias and obsessions, in small doses to cope with bedwetting in children. Another formulation with a stimulating effect is Fluoxetine (Prozac) that is used for the same symptoms and is used once a day in the morning.
– Sedative antidepressants combine the antidepressive and general soothing action. They have an anti-anxiety effect, eliminate restlessness, minimize irritability and agitation, and deepen night's sleep. The medications from this group include Amitriptyline and Tianeptine.
– Antidepressants with a balanced action combine antidepressive effect with anti-anxiety and stimulating effects. This group includes Clomipramine (Anafranil) that is widely used in the treatment of depressions of different severity and with different clinical features, as well as in the treatment of anxiety-phobic and obsessive-compulsive disorders. It is administered in tablets, intramuscularly and intravenously. Another widely prescribed medication from the group is Pyrazidol that is especially indicated for use in children, adolescents, and elderly patients.

As you can see from the answer to the previous question, there are different-action antidepressants: some of them have a stimulating effect, some – sedative, and others a combined effect. We cannot recommend the best medication for you as only a qualified specialist in a face to face conversation can assess your symptoms and chose the right drug.

Although we have pointed out several times that the correct antidepressant can be chosen only by a specialist based on your symptoms, we can certainly say that some of the medications from this class are safer than the others. The modern antidepressants are even sold without Rx in some countries as it is considered that they have very low addiction potential, mild effect on the nervous system, and minimal adverse effects. These medications are mostly suitable for mild to moderate depression as a severe depression requires a more controlled use of medications.

The mild-action antidepressants include:
– Maprotilin: it is appointed for endogenous, involutional, psychogenic and neurotic depressions, exhaustion, somatogenic, latent, and menopausal depression. Action: decrease in apathy, improvement of mood, removal of psychomotor inhibition. Side effects: headache, lethargy, drowsiness, hearing loss, hallucinations, tachycardia, arrhythmia, vomiting, nausea, dry mouth, urticaria, swelling, weight gain, sexual disorders, stomatitis.
– Prozac (Analogues: Fluoxetine, Plow, Fluval): it is indicated for depression, bulimia nervosa, obsessive-compulsive disorders. Action: relieves emotional overloads, obsessive thoughts; soften anorexia nervosa; eliminate premenstrual disorders; reduce anxiety and panic. Side effects: at the beginning of treatment and with the increase of doses can cause anxiety, drowsiness, pain in the head, nausea. Contraindications: hypersensitivity, pregnancy, lactation.
– Paxil (Analogs: Rexetine, Adepress, Plizil, Paroxetine hydrochloride, and others): it is indicated for depression of all types in adults and in children aged from 7 years. Action: in the first weeks of treatment, symptoms of depression are reduced, suicidal thoughts are eliminated. The drug prevents the recurrence of depression. Adverse reactions: sluggishness, insomnia, loss of appetite, tachycardia, nausea, constipation, convulsive seizures, sweating. Contraindications: hypersensitivity to Paroxetine and components of the drug, pregnancy, lactation.
– Deprim (Analogs: Helarium, Doppel-Hertz Nervotonic): it is indicated for chronic fatigue syndrome, depression, and emotional exhaustion. Action: increases working capacity, mental and physical activity, sleep normalization. Side effects: dry mouth, changes in the gastrointestinal tract, rapid fatigue. Contraindications: children under 6 years, Individual intolerance. With extreme caution should be taken during pregnancy and lactation.

This class of antidepressants prevents the recapture of neurotransmitters (mainly norepinephrine and serotonin) by the presynaptic membrane. This type of antidepressants is indicated for the therapy of moderate to severe depression with psychomotor and somatic symptoms, such as disorders of sleep and appetite. They quickly normalize sleep and have potent analgesic activity and therefore are also used in chronic pain syndrome.
Since tricyclic antidepressants are a long used group of antidepressants, they are the most studied medications for depression treatment. Their high effectiveness is certainly proven. They are commonly appointed for severe depression with suicidal tendencies. However, tricyclic antidepressants also have a lot of drawbacks that make them not the first-line choice for individuals who are first treated for depression.

Their disadvantages include:
– High number of potential adverse effects and therefore bad tolerability;
– High toxicity in an overdose;
– Many contraindications for use which makes them unsuitable for elderly and weakened patients;
– Proven severe negative effect on fetus development when used during pregnancy;
– Very small range of safe dosages which makes impossible to qualitatively adjust dosages.
– Cross-resistance, i.e. if a patient is insensitive to one drug of this group, there is little point in prescribing another.

The most known and frequently used tricyclic antidepressants are:
– Nortriptyline (Pamelor);
– Desipramine (Norpramine);
– Maprotiline (Ludiomil);
– Amitriptyline (Elavil);
– Imipramine (Tofranil, Melipramin, Imizin);
– Clomipramine (Anafranil).

SSRIs are a pharmacological group of antidepressive formulations of the latest generation indicated for the therapy of anxiety and different types of depression. This group is a relatively new and well-tolerable. In contrast to tricyclic antidepressants, they provoke minimum to none adverse reactions such as postural hypotension, sedation, and the risk of cardiotoxic effect in an overdose is significantly lower. This group in all countries is appointed most frequently.
SSRIs are the first-line antidepressive medications that can be advised to be used in general medical practice. They can be used at home including by the patients who have contraindications for the use of TA such as heart rhythm disturbance, angle-closure glaucoma, etc.

The primarily used SSRIs today are:
– Fluoxetine (Prozac);
– Sertraline;
– Paroxetine;
– Citalopram (Celex);

The medications from the group block the re-capturing of norepinephrine and serotonin by the presynaptic membrane. This is a new group formulation that was started to be produced in the 1990s. The adverse reactions typical for this group are alike to the ones that can be provoked by SSRIs but are even milder. For instance, this group of formulations and in particular Duloxetine and Bupropion, almost never cause fat gain and sexual dysfunctions.

The most popular medications from the group are:
– Bupropion (Wellbutrin);
– Venlafaxine (Effexor);
– Duloxetine (Cymbalta).

MAO inhibitors neutralize the effect of an enzyme called monoamine oxidase that can lower the content of free norepinephrine and serotonin.  The inhibitors don’t allow it to happen. They block the enzyme’s effect thus contributing to the elevation of the described neurotransmitters levels. When changing the level of norepinephrine, these formulations have many adverse reactions that impact the cardiovascular system. During their use, patients should limit products that contain tyramine, since MAO inhibitors interact with tyramine and provoke elevated arterial tension. Tyramine is found in such foodstuffs as soy sauce, beef and chicken liver, sausages, blue cheese, fish and dried meat, raisins, yogurt, figs, and others. You also must not consume alcohol if you are using any of the antidepressive formulations.

The most frequently used MAO inhibitors are:
– Tranylcypromine (Parnat);
– Phenelzine;
– Selegiline (Eldepril).

It is a group of modern antidepressive formulations that are in general well tolerated, have much less adverse reactions than other groups and are not less effective than the previously described ones. Their main disadvantage is the high price.
The effect of this group is due to the diminishing of the absorption by the presynaptic nerve cell of norepinephrine, which increases its concentration in free form. They also neutralize certain serotonin receptors, which helps to enhance the "beneficial" serotonin neurotransmission. The most frequent adverse reactions from this group of pills are dry mouth, sleepiness, fat gain, and raised appetite. However, they are usually mildly pronounced.

The most prescribed noradrenergic and specific serotonergic antidepressants are:
– Mirtazapine (Remeron);
– Nefazodone (Serzon);
– Trazodone (Desyrel);
– Mianserin (Lerivon).

Yes, you can. But you need to check the instruction or talk to your therapist before matching your formulation with others even if you plan to use over-the-counter products because they can lower the effect of each other or enhance each other’s negative effects.

No. These formulations do not cause dependency although if you harshly cease taking them you can start suffering from withdrawal syndrome and even the aggravation of depressive disorder manifestations.

Some of the formulations from this class indeed can promote weight gain but the enhanced appetite usually normalizes within a couple of weeks of use. If you see that you started gaining weight and cannot control your appetite, inform your therapist and ask for a replacement of the formulation.

This is one of the misapprehensions about this group of formulations. In fact, antidepressants improve patients’ mood and do not make them insensitive. Throughout the first weeks of use of an antidepressive formulation, you can still feel withdrawn and numb but it is not because of the pills but because of your depression. However, some medications with a sedative effect that are designed for people with anxiety indeed can have a bit of a numbing effect. If you don’t need that, talk about it with your therapist and tell that you need rather a stimulating than sedating antidepressant.

Although most of the labels of antidepressants contain warnings that people who use them can have suicidal thoughts and tendencies, it’s not the drugs that cause it. These thoughts appear as a result of depression. However, for some reason, at the beginning of the therapy, they can enhance. Therefore, the FDA requires this warning to be included in the label. If you started using an antidepressant and believe that your suicidal tendencies intensified or you developed them for the first time using the pills, immediately notify your physician as you need to adjust your therapy or even change the used antidepressant.

It is possible to die overdosing on any medication but some are more dangerous than others. For instance, since tricyclic antidepressants have more adverse effects than SSRIs and others, they are more dangerous when overdosed because they cause negative heart events so you must be careful and stick to your doctor’s recommendations.

Antidepressants work best when you keep a constant level in your system so you have to try to never miss a dosage. To do so, set an alarm to remind you to take the prescribed dosage at the same time every day. If for some reason you have missed your dosage, take it immediately when you remembered but if it’s time for the new one already, do not take a double dosage or you can overdose.

It's best not to consume alcoholic beverages while on an antidepressant due to several reasons:
– It enhances the depressive effect on the central nervous system;
– Alcohol can interfere with your therapy and make your symptoms harder to treat.
– It may seem that alcohol improves your mood for a little while, but it will only make your depression symptoms worse in the long run.
– It is extremely dangerous to drink alcohol with tricyclic antidepressants as the negative effect on the heart is significantly amplified and you can die.

No, a true mental disorder as depression is cannot be cured by natural remedies. You may try to improve your overall lifestyle through a healthier diet, exercising, taking supplements and vitamins. But if you want to use any natural remedy, keep in mind that it can negatively interact with an antidepressant you are prescribed to use so you have to discuss the possibility of their combined use with your health provider.