What is Depression? 
Depression is a widespread mental disorder which involves lasting sadness and losing interest in personal hobbies. Medications can be effective in managing these symptoms. A person may question their reason for living and isolate themselves from everything.
It is treated through therapy and medication, particularly when chronic. Many doctors commonly prescribe antidepressants to manage depression.
Note: This article is for informational purposes only. Please consult a medical professional for any medication or medical needs.
What is the Role of Antidepressants?
These are different classes of medicines used to treat depression and other mental disorders. They include Tricyclic antidepressants (TCAs), Atypical antidepressants, Monoamine oxidase inhibitors, Selective Serotonin-Norepinephrine reuptake Inhibitors (SNRIS) and Selective Serotonin Inhibitors (SSRIS).(1)
Antidepressants change the balance of certain chemicals that regulate a person’s emotions and mood. However, depression isn’t always caused by chemical imbalances; it can result from a complex combination of psychological, biological, social factors, or even coping skills.
SSRIS:
Doctors widely prescribe these medications, including drugs like Zoloft, Prozac, and Paxil. They act on Serotonin, a neurotransmitter in the brain responsible for regulating mood. These medications are more tolerable and overall safer than older antidepressants. While their efficacy is similar to or slightly less than TCAs, their fewer side effects make them a safer option. This has been experimentally proven by the percentage of patients who continue treatment with SSRIs while discontinuing the TCA one. They do not cause cardiac problems or trigger seizures like TCA which made their discovery an important milestone in depression treatment. (2)
Doctors prescribe these to a wide range of patients, from children to the elderly, who are sensitive to the adverse effects of TCAs. They are also suitable for patients with comorbidities. Many patients have successfully managed depression with the use of SSRIs.
NSAIDs like Ibuprofen and anti-platelets may interact with SSRIs, so doctors recommend avoiding them. Using another class of antidepressants alongside SSRIs is also discouraged, as it can lead to Serotonin syndrome.
Side effects of SSRIs:
SSRIs are comparatively more tolerable than the other antidepressants because of their high selectivity and lesser interaction with histaminic, dopaminergic, cholinergic or noradrenergic receptors.
Nausea is the most common side effect reported which is due to their interaction with 5-HT3 receptors. Fluvoxamine is reported to cause GI disturbance while fluoxetine and sertraline cause agitation and Insomnia. If used long term the troubling side effects include sexual dysfunction, trouble in sleeping and weight gain.(2)
Serotonin-Norepinephrine reuptake Inhibitors (SNRIs):
SNRIs relieve sadness, reduce irritability, calm anxiety, and manage long-term nerve pain. By altering neurotransmitter levels in the brain, they improve communication among brain cells, leading to changes in brain chemistry. They primarily target Serotonin and Norepinephrine, blocking their reabsorption.
The SNRIs approved by FDA-Food and Drug Administration include:
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- Duloxetine (Cymbalta) — also treats chronic pain and anxiety.
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- Desvenlafaxine (Pristiq)
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- Venlafaxine (Effexor XR). This also treats anxiety and panic disorder.
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- Levomilnacipran (Fetzima)
Safety Issues and Side Effects of SNRIs:
These do not cause any problems in the majority of people but Desvenlafaxine, Venlafaxine, and Levomilnacipran are known to elevate blood pressure while Duloxetine can cause liver problems. The drug interactions known till date include high risk of bleeding when SNRIs are taken with other medicines that cause bleeding like Ibuprofen, Warfarin and Aspirin.
High level of serotonin due to intake of more than one antidepressant or painkiller can cause Serotonin syndrome which is characterized by high fever, agitation, confusion, anxiety, blood pressure imbalance and restlessness.
Withdrawal symptoms:
Abruptly stopping SNRIs can trigger withdrawal symptoms, especially with medications like Desvenlafaxine or Venlafaxine. However, all SNRIs carry a risk of withdrawal if discontinued suddenly.
These may include Flu-like symptoms, tiredness, muscle aches and chills, dizziness, agitation, headache, nausea, diarrhea, and also Insomnia. The right way to stop taking antidepressants is by decreasing the dose after doctor’s consultation. (3)
MAOIs:
These were discovered in early 1950’s and are considered the first ever anti-depressants. This sparked interest among scientists who then researched to modify the anti-depressant effects and develop something way better.(2)
MAOIs treat depression as well as other nervous disorders like social phobia and panic disorder. By inhibiting the breakdown of Norepinephrine, Dopamine, and Serotonin, they affect the cells involved in depression. Although these were the first antidepressants developed, they are no longer the preferred choice due to their side effects and safety concerns.
The MAOIs approved by FDA include Phenelzine, Isocarboxazid, Selegiline, and Tranylcypromine. They are available as oral dosage forms and also skin patches.
Safety Concerns and Side Effects:
The side effects reported by patients after MAOI administration include nausea, dry mouth, diarrhea, drowsiness, constipation and dizziness. If using a skin patch, a reaction might occur in that particular area. Patients are advised to not take MAOIs a few days before operations that require Anesthesia.
Taking other antidepressants like SSRIs alongside MAOIs can trigger serotonin syndrome, so doctors recommend sticking to one medication at a time. Medications such as Meperidine, Tramadol, and Methadone are contraindicated for patients using MAOIs.
Toxicity:
Upon overdose, the patient might experience symptoms within the first 24 to 48 hours. They can be mild or fatal and lead to coma or death. If a patient experiences agitation, tachycardia, flushing, hypertension or hypotension, palpitations, increased deep tendon reflexes twitching, high fever and seizures, he should consult his health care provider.(3)
Tricyclic Antidepressants (TCAs)
TCAs, like MAOIs, inhibit the reuptake of serotonin, norepinephrine, and dopamine by presynaptic vesicles in the brain. However, when compared to SSRIs, many patients stopped using TCAs but continued with SSRIs due to their better tolerance. TCAs are associated with significant side effects, such as cardiac conduction abnormalities and an increased risk of seizures, which are more severe and less tolerable than the minor side effects of other antidepressant classes.
FDA has approved Amoxapine, Amitriptyline, Doxepin, Desipramine (Norpramin), Nortriptyline (Pamelor), Imipramine (Tofranil), Trimipramine and Protriptyline to be used as Antidepressants.
What Are the Alternative Treatment Options for Depression? 
Other treatment options are also available to treat depression like talking therapy, herbal therapy and peer support. Talking therapy includes cognitive behavioral therapy and can be taken if a person doesn’t want to take medications to treat his illness. (4)
If a person has mild depression that can be managed through talking sessions and CBT, medication is usually not preferred due to its multiple side effects. However, if antidepressants are chosen, the individual should consult a doctor before stopping their use to minimize withdrawal symptoms and avoid worsening the depression.
REFERENCES:
1. Melinda. Antidepressant Medication – HelpGuide.org [Internet]. https://www.helpguide.org. [cited 2020 Nov 4]. Available from: https://www.helpguide.org/articles/depression/antidepressant-medication.htm
2. Ferguson JM. SSRI Antidepressant Medications: Adverse Effects and Tolerability. Prim Care Companion J Clin Psychiatry. 2001 Feb;3(1):22–7.
3. Sub Laban T, Saadabadi A. Monoamine Oxidase Inhibitors (MAOI). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 Nov 4]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK539848/
4. Alternatives to antidepressants [Internet]. [cited 2020 Nov 4]. Available from: /information-support/drugs-and-treatments/antidepressants/alternatives-to-antidepressants/
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At Calming Transformations Counseling, our therapists understand medications can help with mental health along with talk therapy. We also serve those with anxiety, stress, depression, or relationship issues, who may be religious. Sessions can be held through online therapy in the states of Florida, Idaho, South Carolina or Utah, or walk and talk therapy in Hillsborough County, Florida. Book an appointment or contact us today to schedule a session and take the first step toward a more peaceful life.
