This article has information on the function of antidepressants, SSRIs such as Prozac and Zoloft, SNRIs such as Cymbalta and Effexor, MAOIs, TCAs (tricyclic antidepressants), NaSSAs, NRIs, NDRIs such as Wellbutrin and Zyban, and more about antidepressants.
We all have hope that depression symptoms are temporary and that there is an instant cure. Depression hurts and leaves a person feeling hopeless and withdrawn from society. Fortunately there are drugs called antidepressants that have been designed to alleviate symptoms of depression by changing the chemical levels within the human body. It is important to note however that antidepressant drugs are not the first choice when treating teens for depression. Heightened symptoms of depression may occur in teens from use of these drugs which could further lead to suicidal actions. People especially teens should be under direct supervision by a physician when being treated with antidepressants and be aware of the reverse effects antidepressants may provoke. As in most cases, there are side effects that will be either raised or lowered with extended use of these drugs. Everyone has a different chemical makeup so finding the right drug for your particular body is of the utmost importance. It’s like trying on shoes in a department store. One wouldn’t buy a shoe just because it’s their size; rather, they would try it on to make sure it fit every contour of their foot. Such is the case when deciding on the right anti-depressant drug for depression. There are many factors needed to be addressed and evaluated before the prescription of drugs can begin.
Function of antidepressants
It’s important to know how these particular drugs work and to what is going on inside the body during stages of depression. Serotonin is a chemical in the body that helps in translating information between neurotransmitters in the brain. One of the functions of serotonin is defining ones mood and emotions. When levels of serotonin are deficient, depressed symptoms may occur. Antidepressants help by blocking the re-absorption of serotonin where it derived from causing higher levels and ensuring balance between the neurons in the brain with reduced characteristics of depression. Currently, the most standard kind of antidepressants is Selective Serotonin Re-uptake inhibitors or SSRIs.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are recommended over other antidepressants due to the mildness and fewer side effects. Some of the more familiar SSRIs being used are as follows:
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Excitalopram (Lexapro, Esipram)
- Citalopram (Celexa)
- Sertraline (Zoloft)
- Fluvoxamine (Luvox)
Just like a new pair of shoes, these drugs take time to adjust and form to the complexities of the brain. In most cases, antidepressants take 2-6 weeks to become fully effective with beginning side effects magnified. Such side effects include nervousness, dry mouth, drowsiness, decreased appetite, insomnia, anxiety, and sexual function ability decreased. Over time, these side effects may lessen as the body adjusts to the new drug. Currently, Fluoxetine (Prozac) is the only recommended antidepressant for people under the age of 18. Again, it is of highly importance that teens are closely monitored by a trained physician when taking antidepressants. In cases where SSRIs are not effective, other types of anti-depressants are available such as Serotonin norepinephrine re-uptake inhibitors (SNRIs), monoamine oxidase inhibitor or MAOIs, tricyclic antidepressants, Noradrenergic and specific serotonergic antidepressants (NaSSAs), norepiniephrine re-uptake inhibitors (NRIs), and norepinephrine-dopamine re-uptake inhibitors (NDRIs).
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs are similar to SSRIs other than they can affect the neurotransmitter and hormone norepinephrine which is secreted by the adrenal gland. It coincides with the hormone epinephrine which releases bursts of energy in times of stress. SNRIs can inhibit the re-uptake of norepinephrine allowing balance when treating patients with depression. SNRIs include:
- Desvenlafaxine (Pristiq)
- Duloxetine (Cymbalta)
- Milnacipram (Ixel)
- Venlafaxine (Effexor)
The downfall of SNRIs is they have a higher withdrawal level when use of these drugs stop. Dosage tapering is recommended when stopping the treatment to limit side effects of withdrawal. Side effects of these drugs are similar to that of the SSRIs.
Monoamine oxidase inhibitor (MAOIs)
MAOIs may be used if other antidepressants are not effective. However, there is fatal potential when using these drugs mixed with foods that contain Tyramine, red wine, and certain drugs. Because of this possible danger, MAOIs are hardly prescribed. MAOIs may be effective by hindering the enzyme monoamine oxidase which breaks down the neurotransmitters serotonin, norepinephrine, and dopamine. As previously discussed when there are low levels of these neurotransmitters, symptoms of depression may set in. Because of the dangerous side effects of MAOIs, a current group of MAOIs have been produced with fewer dangers but still with side effects such as rapid and extreme weight gain but does not require the patient to watch his or her diet when mixed with the drugs as was the case with earlier MAOIs. Current MAOIs:
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Selegiline (Eldepryl, Emsam)
- Moclobemide (Aurorix, Manerix)
Tricyclic antidepressants (TCAs)
TCAs have been used since the 1950’s and are classified as the oldest group of antidepressants and are still very effective. Since newer antidepressants such as SSRIs have been discovered, TCAs have seen a decline in use mostly because of more safe and selected drugs available. Side effects of TCAs include increased heart rate, drowsiness, blurred vision, dizziness, dry mouth, sexual dysfunction, and confusion. Because of the affect these drugs have on the heart, overdoses of these drugs can be deadly causing a fatal arrhythmia but are still prescribed because of their success in treating depression especially severe cases of major depression. TCAs include:
Tertiary Amine Tricyclic antidepressants:
- Trimipramine (Surmontil)
- Amitriptyline (Elavil, Endep)
- Doxepin (Adapin, Sinequan)
- Clomipramine (Anafranil)
- Imipramine (Tofranil)
Secondary Amine Tricyclic antidepressants:
- Desipramine (Norpramine)
- Protriptyline (Vivactil)
- Nortriptyline (Pamelor, Aventyl)
Noradrenergic and specific serotonergic antidepressants (NaSSAs)
NaSSAs main objective is to increase levels of neurotransmitters such as serotonin and norepinephrine by blocking other receptors that cause lower levels of these hormones causing depressed symptoms. NaSSAs are a newer type of antidepressant but still carry side effects such as weight gain, drowsiness, and increased appetite. Such drugs are:
- Mirtazapine (Remeron, Avanza, Zispin)
- Mianserin (Tolvon)
Norepinephrine reuptake inhibitors (NRIs)
NRIs accomplish the same results as other antidepressants by affecting the increase of norepinephrine but also help with better concentration and motivation. Examples of these drugs are listed:
- Maxindol (Mazanor, Sanorex)
- Atomexetine (Strattera)
- Viloxazine (Vivalen)
- Reboxetine (Edronax)
Norepinephrine-dopamine reuptake inhibitors (NDRIs)
NDRIs use the same process as other NRIs by blocking norepinephrine inhibitors but also block the re-uptake of dopamine which is another hormone that aids in communicating between neurotransmitters related to depression. One known NDRIs is:
- Burpropion (Wellbutrin, Zyban)
Burpropion unlike other antidepressants does not cause weight gain or sexual dysfunction. It is effective on its own or can be combined with other antidepressants for an even more positive result. It’s also been known to help people who are trying to quit smoking.
It is important to note any changes or discomforts associated when taking antidepressants. Just as the new shoe is broke in with continued wear, the right antidepressant should feel comfortable with long time use. Everyone has shoes in their closet that some time or other begins to be painful to wear for long periods of time. Such is the perfect fit for a prescribed antidepressant. Over time, there may be a need for a change in prescription for antidepressants. Seek help with a trained and licensed physician, monitor changes closely, and understand the importance of comfort when walking the paths of depression.