First of 4 parts reviewing antidepressants looks at different types and basics on how they work
Posted by Eamonn Brady on
Anti-depressants Part 1
I focus on pharmacological treatment options for depression. I will not outline the causes, symptoms etc of depression. Talking therapies such as CBT should be the first line as a treatment option for depression; medication should always be used in tandem with talking therapies.
Antidepressants
The first antidepressants were developed in the 1950s. There are now about thirty different kinds of antidepressants available and there are six main types:
- Tricyclics
- MAOIs (Monoamine oxidase inhibitors)
- SSRIs (Selective Serotonin Reuptake Inhibitors)
- SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors)
- NASSAs (Noradrenaline and Specific Serotonergic Antidepressants)
- Melatonergic agonists
- Serotonin Modulator
How antidepressants work
Antidepressants increase the activity of neurotransmitters neurotransmitters serotonin and noradrenaline in the brain. Melatonergic agonists increase the release of melatonin in the brain which has a positive effect on mood and sleep. (e.g. Agomelatine)
What are they used for?
- Severe anxiety and panic attacks
- Obsessive compulsive disorders
- Chronic pain
- Eating disorders
- Post-traumatic stress disorder.
How well do they work?
After 3 months of treatment, it is estimated that 50% to 65% of patients with depression show improvement when treated with anti-depressants. This compares with 25 to 30% of patients treated with a placebo.
Are newer antidepressants better?
Older tablets such as tricyclic antidepressants are just as effective as the newer ones (SSRIs), but the newer ones generally have less side-effects. Newer antidepressants are less dangerous on overdose. However, older antidepressants still have some benefits. For example, because tricyclic antidepressants cause more drowsiness, they are sometimes prescribed to be taken at night in patients suffering from severe insomnia due to depression.
Are antidepressants addictive?
Antidepressants are not addictive like tranquillisers, alcohol, or nicotine. Therefore, the patient will not need to keep increasing the dose to get the same effect or they will not find themselves craving them when they stop taking them. 1/3 of people who stop SSRIs and SNRIs have withdrawal symptoms which can last between 2 weeks and 2 months. Withdrawal effects include gastrointestinal disturbance, headache, dizziness, sleep disturbance, fatigue, sweating and sensations in the body like electric shocks. In most people these withdrawal effects are mild, but for a small number of people they can be quite severe.
To be continued next week
Call in to Whelehans Pharmacies, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).