What are antidepressant drugs and how do they work? In cases of depression where psychotherapy alone fail at treating the condition, people seek alternatives, often of which takes on the form of a pill. What many people fail at realising is that antidepressants are not panaceas. While they do relieve depression in some people, these prescription drugs carry risks and should only be taken under the supervision of a medical practitioner. The result of ingesting these antidepressants varies according to people’s age, severity of depression, and history of illness. Furthermore, it is important to watch out for possible drug interactions when taking antidepressants in conjunction with other medications.
Types of Antidepressants
Antidepressants are available in three main forms, they are: selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). The SSRIs are a form of antidepressants which includes drugs like Prozac and Zoloft, as implied by the name; they work through inhibition of the presynaptic serotonin transporter receptor. TCAs were introduced in the 1950s and works through prevention of the nerve cell’s ability to reuptake serotonin and norepinephrine, Elavil is an example of this form of antidepressant. Finally, we look at MAOIs, which are amongst the earliest form of antidepressants developed works through inhibition of monoaxine oxidase, an enzyme which plays a large role in the determination of one’s mood by its effect on neurotransmitters. The drugs Nardil and Parmate are commercially available examples of MAOIs.
Long-term Use
How long should one stay on antidepressants without running the risk of negative reactions?
A recent meta-analysis concluded that the relief which antidepressants provide do not last beyond their term of usage. This means that once patients stop taking these drugs, there is a high chance that they might suffer a relapse. As such, doctors usually prescribe antidepressants according to severity of each individual case, which may last as long as five years or indefinitely. The study also concluded that the chances of a relapse in depression bore no relation to the duration of prior treatment. Furthermore, a gradual loss in the therapeutic value of antidepressants is observed over prolonged periods of use. This led doctors to implement pharmacotherapy in the treatment o acute episode and psychotherapy in the patient’s residual phase of depression.
Drug Interactions
As with any other forms of medication, one should always check beforehand for possible drug interactions to prevent potentially lethal combinations. Antidepressants are no exception, especially so as these mood-altering drugs produce psychoactive effects which greatly affects one’s mental health. To illustrate, MAOIs are known to create a lethal hypertensive reaction when taken in conjunction with foods which contain high levels of tyramine. This substance can be found in normally harmless foods like cheese and cured meats and yeast extracts. The same may happen with other over the counter drugs, therefore one should always thoroughly check for possible interactions prior to ingestion of any drugs just be sure.
Medication Failure
Estimates suggest that approximately 30% of the patients on antidepressants do not respond well to the medication. The lack of improvement often translates to patients receiving higher doses of different medication. But is this a good thing? Studies show that secondary administration of drugs will sometimes create an absence of depression symptoms known as the state of remission. However, more research has to be done on the possibilities of depression reoccurrences in patients. Although it is uncertain another possible issue with medication failure points towards the relation of pregnancy and medication failure. A study conducted by the Journal of American Medical Association (JAMA) has produced findings disclaiming the common belief that hormonal changes during pregnancy serve as a natural barrier for mothers against depression. However, much critique on the subject remains due to the prevalence of studies conducted under the influence of the industries.
Side Effects
Antidepressants carry a wide range of side effects, varying accordingly to the class of antidepressant consumed one should expect different experiences when using these drugs. Common side effects experienced when using SSRIs include nausea, diarrhoea, headaches, loss of libido, and erectile dysfunction. TCAs produce several side effects ranging from having a dry mouth to blurred vision, drowsiness, dizziness, tremors, sexual problems, skin rash, and weight gain or loss. Although the side effects of MAOIs are rarer in nature, they appear to be relatively serious in incidences, of which they do occur one may experience liver inflammation, heart attack, stroke, and seizures. Do note that serotonin syndrome occurs as a side effect of MAOIs and SSRIs when they are combined.
As observed, the most volatile period of suicide incidents in patients on antidepressants is immediately after treatment has commenced. While this appears to be a paradox, antidepressants may reduce the symptoms of depression such as psychomotor retardation before actual improvements in mood is observed. Studies have indicated that suicidal tendencies is a relatively common component of the initial phases of antidepressant therapy and the occurrences in younger patients such as teenagers and pre-adolescents appear more frequently.
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Further Reading :
I would like to know where (if possible) I can find peer-reviewed studies of longitudinal use of antidepressants? I’m curious because (1) I was on 20 mg. paroxetine for about 6 years, without interruption or questionning by my GP, only learning from a psychiatrist in 2006 I had “plateaued” (reason why I didn’t understand why I had become depressed again) and (2) I’m noticing a new disclaimer on SSRI commercials on TV to “report any unusual behavior changes” that I find extremely coincidental with meeting more and more individuals who are cautiously admitting when first on SSRI, particularly Paxil, they experienced unusual behavioral changes. I’m also interested in lack of motivation without concern about this deficit on job, family, and social responsilities and issues. I’ve shared this with many people on Paxil, too, yet have not found it on any lists of symptoms of use or discontinuation. Do these studies exist? Are they possibly “in the works” somewhere I can’t find??? How did drug companies know to add the “unusual behavior changes” warning on these commercials recently? Are doctors prescribing without attention to follow-up to monitor a need for plateau effect, creating a risk I haven’t seen anywhere in my searches yet? I also wonder why knowledge of discontinuation/ withdrawal syndrome and symptoms has taken so long for family practitioners (and psychiatrists in my experience) to let patients know about this? Many of us went for several years being told we were hysterical or hypochondriacs when presenting with these symptoms…yet, I’ve found in professional journal searches that this information was known as early as 1996! I often wonder if it is really wise to inform the public that SSRI use can be “indefinite”, when we really don’t know the truly long-term consequences. As far as how long to be on SSRIs or typical treatment period–I have found variations Internet and university library searches (so far) from 1-6 weeks before effect can be felt or noticed, typical treatment lasting 6-8 months to 2 years–and withdrawal symptoms lasting likewise, from a few days to a few months! I’m very disturbed by what is beginning to feel like a free experimentation by drug companies who successfully achieved approval of these drugs and getting them on the market with limited (indeed, if ANY) studies on long-term effects beyond 18 mos. to 5 years. Instead, it appears patients who are using these drugs long-term as “free and unwitting” research subjects, with no ethical consequences. I’m even more baffled why and how prescribing physicians accepted this powerful mental health psychopharmacological treatment with no better information that what we’ve had!