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Antidepressants

Antidepressants

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An antidepressant is the name given to a medicine that can help
relieve the symptoms of depression, such as low mood, anxiety, and worthlessness.

Antidepressants are classified into different types depending
on their structure and the way that they work. There are at
least seven types of antidepressant:

  • Monoamine oxidase inhibitors (MAOIs)
  • Norepinephrine and dopamine reuptake inhibitors (NDRIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Serotonin antagonist and reuptake inhibitors (SARIs)
  • Tricyclic antidepressants (TCAs) and tetracyclic
    antidepressants (TeCAs)
  • And the miscellaneous antidepressants.

MAOIs and TCAs were among the first antidepressants developed.
They have largely been superseded by newer antidepressants
(such as the SSRIs) that have fewer side effects, although
these older antidepressants may still suit certain people or be
effective when other antidepressants have been ineffective.

Antidepressants are thought to work by increasing levels of
certain neurotransmitters, such as dopamine, serotonin, and/or
norepinephrine, in the brain.

What are antidepressants used for?

Antidepressants help to relieve the symptoms of depression such
as low mood, irritability, feelings of worthlessness,
restlessness, anxiety, and difficulty in sleeping.

In addition to depression, certain antidepressants may also be
used to treat a range of other conditions, for example:

It is important to note that not all antidepressants are used
to treat the conditions mentioned above.

Antidepressants generally provide some relief of symptoms
within one to two weeks; however, it may take six to eight
weeks of treatment before the full effects are seen.

What are the differences between antidepressants?

There are distinct differences between the different classes of
antidepressants available because they all work in a different
way. In addition, within each class, there are differences
between individual antidepressants with regards to how long
they remain in the body, how they are metabolized, and how much
they interact with other medications.

Monoamine oxidase inhibitors (MAOIs)

MAOIs block the effects of monoamine oxidase enzymes, thereby
increasing the concentration of dopamine, norepinephrine, and
serotonin in the brain.

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

NDRIs block the reuptake of norepinephrine and dopamine,
increasing the concentration of these two neurotransmitters in
the nerve synapse.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs increase levels of serotonin in the brain by preventing
the reuptake of serotonin by nerves.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs block the reuptake of both serotonin and norepinephrine,
increasing the concentration of these two neurotransmitters in
the nerve synapse.

Serotonin antagonist and reuptake inhibitors (SARIs)

SARIs prevent the reuptake of serotonin and affect the binding
of serotonin to certain receptors

Tricyclic antidepressants (TCA) and tetracyclic antidepressants
(TeCAs)

TCAs and TeCAs work by increasing levels of norepinephrine and
serotonin. They may also block the actions of other
neurotransmitters, such as acetylcholine and histamine.

Tricyclics

Tetracyclics

Miscellaneous antidepressants

Increase levels of neurotransmitters by an unknown mechanism of
action that is different from other pre-existing classes of
antidepressant.

Are antidepressants safe?

When taken at the recommended dosage, antidepressants are
considered safe. However, some have been associated with severe
side effects, some potentially fatal, such as:

  • An increase in suicidal thoughts and behaviors,
    particularly in children and young adults under the age of 25
    years. This is most likely to occur when starting therapy
  • An increased risk of seizures in people with a history of seizures
  • Serotonin syndrome – this is caused by excessive levels of
    serotonin in the body and is more likely to occur with higher
    dosages of SSRIs or when SSRIs are administered with other
    medications that also release serotonin. Symptoms include
    agitation,
    confusion, sweating, tremors, and a rapid heart rate
  • The precipitation of a manic episode in people with
    undiagnosed bipolar disorder
  • Duloxetine: A
    severe discontinuation syndrome
  • MAOIs: Very severe drug interactions, very severe food
    interactions, and rarely, rapid but transient increases in
    blood pressure within 30 minutes to two hours of MAOI ingestion
  • Nefazodone:
    Life-threatening liver failure, more common two weeks to six
    months after starting therapy
  • SSRIs and vortioxetine: An increase in the risk of
    bleeding, especially if used with other medications that also
    increase bleeding risk
  • TCAs: An increased risk of arrhythmias, heart attacks,
    stroke, and other cardiovascular effects, particularly in
    people with pre-existing heart disease; and the triggering of
    an angle closure attack in people with angle-closure glaucoma

For a complete list of severe side effects, please refer to the
individual drug monographs.

What are the side effects of antidepressants?

Not everybody experiences significant side effects with
antidepressants, and some antidepressants are more likely to
cause side effects than others. Some of the more commonly
reported side effects include:

Some antidepressants have been associated with a
discontinuation syndrome when they have been stopped suddenly.
For this reason, it is best to withdraw all antidepressants
slowly.

For a complete list of side effects, please refer to the
individual drug monographs.

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