Antidepressants
Antidepressants are an umbrella term for a diverse group of medications aimed at managing mood disorders. They make up a vital aspect of mental health treatment and are frequently used for non-psychiatric conditions as well. The first antidepressant was introduced to medicine more than 70 years ago, and science has come a long way since.
Today, there are over 25 different FDA-approved antidepressants. Over a dozen of these are commonly prescribed, reflecting the ongoing advancements in psychiatric pharmacotherapy. Antidepressants are usually reserved for moderate-to-severe depression when therapy has been insufficient.
Table of Contents
- How They Work
- What They Are Used For
- Types of Antidepressants
- Latest Research
- Special Considerations
How They Work
Antidepressants have different mechanisms of action depending on their type. The mechanism of action explains the pharmacological effect of these medications. In short, they target different neurotransmitters in the brain and slowly improve symptoms.However, it's not exactly known how they accomplish their positive effect on depression. Previously, it was thought that they compensated for decreased serotonin levels in the brain, though recent research does not support this theory. This does not mean antidepressants are ineffective; just that further research is needed to explain how these medications are advantageous in mood disorders.
What Are Antidepressants Used For?
Antidepressants have been proven effective in several different conditions, not just as a treatment for depression.
Mood Disorders
Antidepressants are most commonly prescribed to alleviate symptoms of depression, but they are also effective in treating anxiety disorders, such as generalized anxiety disorder, social anxiety disorder, and panic disorder.
Obsessive-Compulsive Disorder
Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are commonly used to manage the symptoms of obsessive-compulsive disorder (OCD), a condition characterized by intrusive, unwanted thoughts and repetitive behaviors.
Premenstrual Dysphoric Disorder
Antidepressants, particularly SSRIs, may be used to alleviate symptoms of premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome characterized by mood swings, irritability, and physical symptoms.
Chronic Pain Conditions
Certain antidepressants, particularly tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are prescribed to manage chronic pain conditions such as neuropathic pain, fibromyalgia, and migraines.
Sleep Disorders
Some antidepressants, such as Trazodone and Mirtazapine, possess sedative properties and are occasionally prescribed off-label to treat insomnia or improve sleep quality in individuals with depression or anxiety disorders.
Attention-Deficit/Hyperactivity Disorder
In some cases, certain antidepressants, such as Bupropion, may be used off-label to manage symptoms of ADHD. While not typically considered first-line treatment for ADHD, these medications may be considered when other options have been ineffective or when comorbid conditions are present.
Types of Antidepressants
1. Selective Serotonin Reuptake Inhibitors
They are the most widely prescribed antidepressants due to their high tolerability. SSRIs modulate the serotonin levels in the brain. Notable examples include Citalopram, Escitalopram, Fluoxetine, Paroxetine, and Sertraline.
2. Serotonin and Noradrenaline Reuptake Inhibitors
These antidepressants act on both serotonin and noradrenaline. SNRIs include medications like Duloxetine and Venlafaxine.
3. Atypical Antidepressants
This category encompasses medications with different kinds of mechanisms that do not fit into any other category, such as Bupropion, Mirtazapine, and Trazodone.
4. Tricyclic Antidepressants
TCAs were among the earliest antidepressants developed, some of them are still in use to this day, including drugs like Amitriptyline, Clomipramine, and Nortriptyline.
5. Monoamine Oxidase Inhibitors
Less commonly prescribed due to dietary and medication interactions, MAOIs like Phenelzine and Tranylcypromine are reserved for specific cases.
Latest Research
Although SSRIs are known for being well-tolerated, many people still experience side effects that keep them from taking the medication. As such, new alternatives are constantly being researched.
In 2020, Esketamine was FDA-approved for the treatment of major depressive disorder with acute suicidality. In recent years, a lot of studies have been done on psychotropic drugs, namely Lysergic acid diethylamide (LSD) and Psilocybin, have been studied for their potential positive effects on depression.
The most recently FDA-approved medication for depression is Auvelity, which was introduced to the market in late 2022. It's a combination drug containing both Bupropion and Dextromethorphan.
Special Considerations
Chronic Diseases
If you have chronic medical conditions, like liver or kidney failure, your medication might need to be adjusted to keep you safe. This also holds true for certain cardiovascular diseases, such as hypertension and long QTc syndrome.
Pregnancy
During pregnancy, it's essential to weigh the pros and cons of taking antidepressants, ensuring both your mental health and your baby's health are looked after.
Adolescents and Children
Children and adolescents taking antidepressants need special attention too, with close monitoring for any side effects and exploring other options like counseling if needed. FDA-approved treatment options are limited, compared to adults.
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Last update: February 12, 2024
Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness, seek immediate medical attention.