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ANTIDEPRESSANTS

Antidepressants are psychoactive drugs intended to be prescribed for people suffering from serious depression. They act on brain chemicals called neurotransmitters that some scientists—but not all—believe play a role in depression.

Yet antidepressants are among the most commonly prescribed drugs in America—hundreds of millions of prescriptions are written every year. No one believes there are that many people suffering crushing depression.

Along with their questionable effectiveness and many adverse side effects—and the fact that no one knows what, if anything, antidepressants do for depression—they have become the subject of much debate.

MOST-COMMON ANTIDEPRESSANTS

NEUROTRANSMITTERS

Antidepressants create specific effects on various neurotransmitters, which are special chemicals in your brain that relay, amplify and modulate signals between a neuron—a special nerve cell—and another cell. In other words, neurotransmitters help nerve cells communicate.

Antidepressants are thought to increase the amount of time that one or more of the neurotransmitters called serotonin, norepinephrine, or dopamine remain active in your brain.

Neurotransmitters are thought, by some researchers, to play a role in depression. Other scientists point to the fact that there is no medical test to determine if increasing the amount of time that neurotransmitters remain active in the brain is needed or even occurs and question if these drugs  play any role at all in addressing depression.

Antidepressants  can cause significant changes in brain chemistry but many researchers believe that any apparent relief of depression is due to other factors and not to the affect of antidepressants on the neurotransmitters.

Some studies have shown that placebo pills, which have no effect on neurotransmitters or anything else in the brain or body, are just as effective at relieving depression, and in some cases, even better at it. The same is often true for exercise, changes in diet, various vitamins, minerals and herbs, and other holistic approaches.

In other words, there is no exact science proving that neurotransmitters  or any type of chemical imbalance have anything to do with the depression that someone is experiencing, or that antidepressants themselves are measurably doing anything to relieve depression that other therapies couldn’t accomplish without the antidepressant's side effects.

TYPES OF ANTIDEPRESSANTS

There are seven major kinds of antidepressants, each type based on the neurotransmitter it targets, and the action it takes:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Noradrenergic and specific serotonergic antidepressants (NASSAs)
  • Norepinephrine (noradrenaline) reuptake inhibitors (NRIs)
  • Norepinephrine-dopamine reuptake inhibitors
  • Monoamine oxidase inhibitor (MAOIs)
  • Tricyclic antidepressants (TCAs)

There are several other antidepressant types which don’t fall into the above classes.

OTHER TYPES OF ANTIDEPRESSANTS

Other drugs not generally called antidepressants are also sometimes used to treat depression. These are most often antipsychotics and benzodiazepines, two classes of drugs which  cause powerful and poorly understood effects on brain chemistry.

In most people, these two classes of drugs are more powerfully psychoactive than antidepressants, and can cause more serious side effects.

SIDE EFFECTS OF ANTIDEPRESSANTS

Antidepressants can make some people feel immediately worse—more depressed than before. Or they can suffer from sudden anxiety, aggressiveness, or become suicidal. In some cases antidepressants can induce a complete swing from depression to wild mania.

Antidepressant drugs are, in their own way, as dangerous as cocaine, heroin and other street drugs:

  • Antidepressants can lead to dependence
  • Antidepressants can be difficult and even dangerous to stop taking
  • Antidepressants can cause side effects that ruin lives, or even kill you
  • Antidepressants can lead to suicide, especially in the young
  • Antidepressants have been linked to extreme mania, including violent acts against others.

SOME OF THE COMMON SIDE EFFECTS of ANTIDEPRESSANTS:

  • Agitation
  • Akathisia (severe restlessness)
  • Anxiety
  • Indigestion
  • Excessive urination
  • Headache/migraine
  • Hypomania (pervasive elevated or irritable mood)
  • Nausea
  • Vomiting
  • Confusion
  • Decreased Libido
  • Dependence
  • Irritability
  • Insomnia
  • Impulsivity
  • Low blood pressure
  • Rash
  • Weight gain

  • Diarrhea
  • Dizziness
  • Dry mouth
  • Muscle pain
  • Mania (extremely elevated mood, unusual thought patterns and psychosis)
  • Panic attacks
  • Suicidal thoughts
  • Tremor
  • Weight loss

Mania SIDE EFFECTS OF Antidepressants

Several well-documented manias are associated with SSRIs:

  • Pyromania: A compulsion to start fires
  • Kleptomania: A compulsion to embezzle, shoplift, commit robberies
  • Dipsomania: An uncontrollable urge to drink alcohol
  • Nymphomania and erotomania: Sexual compulsions—a pathologic preoccupation with sexual fantasies or activities.

The serotonin-type antidepressants (SSRIs and SNRIs) seek to affect the levels of serotonin in the brain. Serotonin syndrome, also called serotonin toxicity or serotonin toxidrome, is a potentially life-threatening adverse drug reaction that can occur after taking antidepressants as directed, but more usually is associated with an overdose or drug interactivity.

The sexual side effects of SSRI/SNRIs, including loss of libido and problems with normal function, can be so pronounced that many people stop taking them. But some of  these side effects have been known to last for months or even years after stopping the drugs.

MAOI antidepressants can produce a potentially lethal reaction if taken with foods that contain high levels of tyramine, a component of dozens of kinds of food such as cheese, cured meats, soy sauce, sour cream -- the list is long.

Serious, and occasionally lethal, reactions of antidepressants to prescription and over-the-counter medications have also occurred. Spikes in blood pressure, liver inflammation, heart attacks, strokes and seizures have all been recorded.

Common TCA antidepressant side effects include dry mouth, blurred vision, drowsiness, dizziness, tremors, sexual problems, skin rash, and weight gain or loss.

Anyone under the age of 24 who suffers from depression is warned by the FDA that the use of antidepressants can increase their risk of suicidal thoughts and actual suicides.

DEPENDENCE, ADDICTION AND WITHDRAWAL

PHYSICAL DEPENDENCE

Some antidepressant medications create physical and psychological withdrawal symptoms when discontinued -- this is called dependence.

The common practice is to ‘wean’ patients off antidepressants by slowly decreasing their dosage over a period of many weeks. Sometimes other drugs are used to counteract the withdrawal, trading one drug dependence for another. Medical drug detox, called medically assisted withdrawal, offers many advantages.

ADDICTION

A person is addicted who continues drug use to ‘get high’ or experience some other drug effect, who do things they would not normally do, and will go to almost any lengths to get more drugs. Addiction is not commonly associated with antidepressants, but is not unknown.

MEDICALLY ASSISTED WITHDRAWAL

Medical detox facilities use proper nutrition, hydration and other means to help the withdrawal from antidepressants to be safer, more comfortable, and much faster than other means.

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