Antidepressant Drugs

Antidepressants are drugs used to relieve the symptoms of depression. They were first developed in the 1950’s and are being extensively used for approximately 50 years.

What types of Antidepressants are there?

Today there are around 30 different kinds of antidepressants. They can be classified in 4 main groups:

1. Tricyclic antidepressants

2. MAO inhibitors

3. SSRI’s

4. Atypical and new generation antidepressants

How do antidepressants act?

It is believed that antidepressants act by increasing the activity of various chemicals in certain areas of the brain. The most important ones of these chemicals are serotonin and noradrenalin. Serotonin and noradrenalin are two of the chemicals responsible for the communication between brain cells.

In which illnesses do we use antidepressants?

• Medium and severe depression

• Anxiety disorders and panic disorders

• Obsessive compulsive disorder

• Chronic pain

• Eating disorders (bulimia nervosa and anorexia nervosa)

• Post-trauma stress disorder

• Other psychiatric disorders

How effective are antidepressants?

Following 3 months of treatment 50-65% of patients suffering from depression recover to a large extent, whereas if a placebo (tablets which do not contain any chemicals) is given to the same patients, only 25-30% of patients recover. These figures show that antidepressants are as effective as many drugs used in other fields of medicine (for example pain killers, epilepsy medication, asthma medication). Any improvement seen with the placebo seems to be related to the natural progress of the illness. Mild depression in particular can improve by itself after a certain while.

Are the new antidepressants more effective than the old ones?

The level of effectiveness of the new antidepressants is very similar to that of the old ones. When compared to old antidepressants like the tricyclic antidepressants, the new antidepressants carry less risk of side effects.

Do antidepressants produce side effects?

As with any kind of medication, antidepressants too can produce side effects. However, if these drugs are used under the regular follow-up of a doctor, it is possible to foresee and eliminate the side effects. Many of the side effects that occur in connection with antidepressants, are mild and generally disappear by themselves when treatment is terminated or the dosage is adjusted. Side effects generally occur during the first few weeks of treatment.

The old antidepressants called tricyclic antidepressants carry the risk of producing a dry mouth, mild tremors, palpitations, constipation and weight gain. Particularly in older patients they can cause confusion, forgetfulness, drowsiness, urinary retention and increase the risk of accidental falls. They should not be used in patients with heart disease. In men they can lead to problems with erection and ejaculation.

The SSRI group of antidepressants belongs to the new generation of drugs which do not often produce serious side effects. These drugs may cause symptoms like dizziness, nausea, indigestion, giddiness, constipation, loose stools or sleepiness, particularly in the early stages of treatment, but symptoms can be eliminated by adjusting the dosage of the medication, or will disappear by themselves in time. Diminished libido, erectile dysfunction, anorgasmia are some of the other complaints that may be experienced during treatment but these disappear after treatment is stopped. It should be remembered that during the first few weeks of antidepressant use, psychiatric symptoms like restlessness, anxiety and irritability that are associated with a psychiatric illness, may temporarily increase.

The SNRI group of drugs and atypical antidepressants have similar side effects as the SSRI group. The risk of side effects related to sexual function is low in atypical antidepressants. Drugs called MAO inhibitors are not available in Turkey.

Should I be driving whilst on antidepressant drugs?

Some antidepressants may cause sleepiness and mental confusion, particularly at the beginning of treatment. However, this risk is lower in the new antidepressant drugs than in the old ones, and it may not be necessary to take any special precautions with regards to the risk of accidents whilst on these drugs. It should also be remembered that an untreated depression will interfere with the person’s attention and ability to concentrate, thereby increasing the risk of accidents and injury.

Do antidepressant drugs produce dependency?

Antidepressant drugs do not produce a dependency of the kind we see with alcohol, tranquillizers or nicotine. In other words, unlike these substances, antidepressants do not produce the need to take more and more of the drug, or have typical withdrawal symptoms. However, after stopping the medication one third of patients may experience a discontinuation syndrome, which is the period in which the body tries to adjust to being without the influence of the drug. Below are some of the mild symptoms which are often seen at this stage:

• A feeling of indigestion

• Flue-like symptoms

• Anxiety

• Dizziness

• Vivid dreams or nightmares

• Numbness in the body

With the help of a program prepared by the doctor for weaning the patient off antidepressants, it is possible to alleviated or completely remove these symptoms.

There is a risk of recurrence of the illness after stopping the antidepressants , therefore the doctor has to carefully assess whether the symptoms are due to the return of the illness or due to the discontinuation of the drug.