Antidepressants: Types, Uses, and Side Effects 

Overview

Antidepressants are medications which may assist in alleviating the symptoms of depression and are used in the treatment of some other conditions. They were improved in the 1950s and have been used regularly since then.  

Types of Antidepressants

There are about thirty different kinds of antidepressants and five main categories: 

• SSRIs (Selective Serotonin Reuptake Inhibitors) 
• SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors) 
• NASSAs (Noradrenaline and Specific Serotoninergic Antidepressants) 
• Tricyclics 
• MAOIs (Monoamine Oxidase Inhibitors)

 SSRIs (Selective Serotonin Reuptake Inhibitors) 

Usually, you may experience some disagreeable side effects when you start consuming SSRIs and SNRIs. 

Selective serotonin reuptake inhibitors (SSRIs) are the popular recommended antidepressants. They may assuage symptoms of moderate to severe depression, are comparatively safe and typically cause limited side effects than other types of antidepressants do. 

SSRIs treat depression by shooting up levels of serotonin in the brain. Serotonin is one of the neurotransmitters that transport signals between brain nerve cells (neurons). 

SSRIs hinder the reabsorption of serotonin into neurons. As a result, more serotonin is available to enhance the transmission of messages between neurons. SSRIs are a selective antidepressant because it primarily affects serotonin, not any other neurotransmitters. 

SSRIs can also be used to treat conditions other than depression, like anxiety disorders. 

Possible side effects of SSRIs  

Headache, Nausea, vomiting or diarrhoea, Drowsiness, Dry mouth, Nervousness, agitation or restlessness, Insomnia, Dizziness 

Sexual problems, like reduced sexual desire, difficulty reaching orgasm (erectile dysfunction), Impact on appetite, leading to weight loss or weight gain. 

SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors) 

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a category of medications that are efficacious in treating depression. SNRIs are also, at times, used to treat other conditions, like anxiety disorders and long-term (chronic) pain, particularly nerve pain. SNRIs may be supportive if you have chronic pain along with depression. 

SNRIs assuage depression by affecting neurotransmitters that are used to communicate between brain cells. Similar to most antidepressants, SNRIs work by eventually carrying out changes in brain chemistry and communication in brain nerve cell circuitry known to manage mood to help alleviate depression. 

SNRIs obstruct the reabsorption of the neurotransmitters serotonin and norepinephrine in the brain. 

Possible Side Effects of SNRIs: 

Dizziness, headache, excessive sweating, nausea, dry mouth, tiredness, constipation, insomnia, changes in sexual function, reduced sexual desire, difficulty reaching orgasm or (erectile dysfunction), and loss of appetite.  

NASSAs (Noradrenaline and Specific Serotoninergic Antidepressants) 

NaSSAs enhance the presence of noradrenaline and serotonin by obstructing some serotonin receptors. Like SSRIs, NaSSAs can cause drowsiness, particularly at the initial stage of treatment. 

However, many doctors use noradrenergic and specific serotonergic antidepressants (NaSSAs), such as mirtazapine, as the last line of treatment when other antidepressants are unsuccessful or are not tolerated.  

Possible side effects of NASSAs 

Sexual dysfunction, antidizziness, dry mouth, increased appetite, weight gain, and constipation. 

TCAs (Tricyclics)  

Tricyclic antidepressants are medications used to treat major depressive disorder (MDD). These medications work by holding back the reabsorption of neurotransmitters, such as serotonin and norepinephrine, which can regulate mood, attention, and pain in individuals. 

TCAs are now given as a second-line treatment for MDD following chosen serotonin reuptake inhibitors (SSRIs). They are utilized to treat anxiety, OCD, panic disorders, chronic nerve pain, and PTSD. 

Despite the fact TCAs exhibit equivocal effectiveness with SSRIs when treating MDD, these medications cause more notable adverse effects because of their anticholinergic activity and low threshold for overdose. 

Due to these factors, TCAs are usually not considered the first-line treatment for MDD, despite they have been proven highly efficient in managing severe or treatment-refractory depression.  

Possible side effects of TCAs 

Blurred vision, Disorientation, Dry mouth, Sweating, Drowsiness, Weight loss or gain, Increased or irregular heartbeat, and Sexual dysfunction. 

MAOIs (Tricyclics)  

MAOIs are not frequently used today because they can lead to serious side effects. They function by blocking monoamine oxidase enzymes, which are accountable for breaking down serotonin, noradrenaline, and dopamine. Neurotransmitters maintain a positive mood, and their levels can remain healthy in the brain by stopping these enzymes from breaking down.  

MAOIs present a risk of interacting with other medications and some food groups like cured meat, fava beans, aged cheese, broad beans, beer, marmite, and soy sauce. This is due to the high presence of tyramine, which can result in dangerously high blood pressure when eaten with MAOI medication, increasing the chances of a fatal stroke. 

MAOIs are only used when other modern antidepressants have proved unsuccessful. They are not appropriate for treating depression or bipolar disorder. Patients with heart disease or high blood pressure should distance themselves from using MAOIs. 

Possible side effects of MAOIs

• Dizziness, drowsiness, sleep problems, nausea, weight gain, sexual dysfunction, muscle pains, contractions, and fluid retention. 
• Doses and duration for taking Antidepressants 
• Antidepressants are usually taken in tablet form. When they’re prescribed, you’ll start on the minimum possible dose necessary to alleviate your symptoms. 
• Antidepressants typically necessitate a duration of 1 or 2 weeks of consistent intake before the onset of their therapeutic effects. It is imperative to continue taking them despite experiencing mild side effects in the initial stages, as these effects tend to dissipate rapidly.  
• If you do not experience any improvement after taking an antidepressant for four weeks, it is advisable to consult your general practitioner or mental health specialist. They may suggest augmenting your dosage or switching to an alternative medication.  
• Following the attainment of relief, a course of treatment is typically sustained for a minimum of 6 months. Individuals with recurrent depression may be advised to continue taking antidepressants indefinitely.  

Coming off antidepressants 

Consult with your physician before discontinuing the use of antidepressants. You must refrain from abruptly ceasing the intake of antidepressants.  

Upon deciding to discontinue antidepressants, your doctor will likely advise a gradual reduction of dosage over several weeks – or even longer if you have been on them for an extended duration.  

This approach aims to mitigate the occurrence of any withdrawal symptoms that may manifest as a consequence of discontinuing the medication. 

Alternatives To Antidepressants  

Cognitive behavioural therapy 

Cognitive behavioural therapy (CBT) is a talking therapy that’s primarily used in treating depression. 

Online CBT 

Computerized or online CBT is a type of CBT that works through a computer screen as a substitute for face-to-face with a therapist. 

Counselling 

Counselling is a type of therapy that assists you in thinking about the complications you’re experiencing in your life and finding ways to deal with them. Counsellors aid you in finding solutions to difficulties but do not tell you what to do. 

Exercise 

Research shows that regular exercise can be a more effective treatment for mild depression than antidepressants. 

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