Antidepressants are a class of psychiatric medication that aids patients suffering from various mental health conditions. They work by raising levels of specific brain chemicals connected to mood and emotion.
Medications from the class of antidepressants are primarily used to treat depression, as the name suggests. They may, however, be prescribed for other conditions too, including some forms of anxiety. This article includes key information about antidepressant types, uses, and side effects.
What Are Antidepressants?
Antidepressants are one of the most often prescribed classes of drugs. They can assist in treating and managing mental health problems by balancing the chemicals in the brain and improving the circuits that transmit messages through nerve pathways.
Antidepressants are categorized into groups according to how they alter the brain’s chemistry. Although their modes of action and side effects tend to be similar, there are variations in their molecular structures that may affect how well the medication is absorbed, distributed, or tolerated in different individuals.
Although antidepressants are commonly known as drugs for depression, they are also prescribed for other conditions:
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Generalized anxiety disorder (GAD)
- Chronic pain
- Panic disorders
- Bedwetting in children
Antidepressants are frequently prescribed in conjunction with talking therapies like cognitive behavioral therapy (CBT), which increases the effectiveness of psychological treatment. While medications help manage actual symptoms of the disorder, therapy helps a patient to define the root causes and learn healthy coping techniques.
How Do Antidepressants Work?
The precise mechanisms of action of depression medications are still unknown. Yet, research so far shows that antidepressant drugs boost the function of neurotransmitters — chemicals in the brain, — such as serotonin, norepinephrine, and dopamine. These chemicals are typically less available in the brains of depressed individuals. Antidepressants increase the concentration and activity of these neurotransmitters, which appears to reduce the signs and symptoms of anxiety and depression.
Here are some of the functions of the neurotransmitters targeted by antidepressants.
|Serotonin||Regulates social behavior, sexual desire, memory, hunger, sleep, and mood.|
|Dopamine||Plays a crucial part in motivation, arousal, decision-making, and the signaling of pleasure and rewards.|
|Norepinephrine||Helps control blood pressure and heart rate in reaction to stress, attention, and motor skills.|
Types of Antidepressants
Antidepressants are divided into many classes, each containing various distinct drugs. While all antidepressants generally have positive effects, not everyone who takes the same medication will have the same benefits from it. Below mentioned are different types of antidepressants given in the order doctors most frequently recommend them.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are most commonly prescribed because they often have fewer adverse effects than other antidepressants. These are typically the first-choice medications for depression. Other illnesses like bulimia, phobias, and anxiety disorders can occasionally be treated with SSRIs. In rare cases, doctors also prescribe them to manage pain.
SSRIs are believed to raise the brain’s serotonin levels by inhibiting its reuptake. Since serotonin transmits signals between nerve cells in the brain, medications can favorably impact sleep, emotion, and mood.
Examples of SSRIs:
- Celexa (citalopram)
- Lexapro (escitalopram)
- Viibryd (vilazodone)
- Prozac (fluoxetine)
- Zoloft (sertraline)
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs help to relieve depressive symptoms such as sadness and irritability. They are a good choice for depressive symptoms such as nerve pain and muscle aches against which SSRIs are relatively ineffective.
As their class name suggests, SNRIs differ from SSRIs in inhibiting both norepinephrine and serotonin reuptake. Their ability to inhibit serotonin reuptake is nevertheless equivalent to that of SSRIs. Those with psychomotor retardation may benefit most from elevating norepinephrine levels concurrently with serotonin levels (slowing physical movement and thought).
Examples of SNRIs:
- Pristiq (desvenlafaxine)
- Effexor XR (venlafaxine)
- Cymbalta (duloxetine)
- Fetzima (levomilnacipran)
Tricyclic Antidepressants (TCAs)
Tricyclic antidepressants are also known as cyclic antidepressants. They are older medications for depression, initially developed in the 1950s. Because of the possibility of side effects, doctors tend to prescribe them less frequently than other types of antidepressants. However, they are a valuable alternative for patients who don’t respond to SSRIs.
Like previous types of drugs, TCAs also have an impact on the brain’s chemical messengers and prevent serotonin and norepinephrine from being absorbed again. It leads to raising the concentrations of both neurotransmitters in the brain, which helps lift one’s mood. They have been used to treat chronic neuropathic pain.
Examples of TCAs:
- Norpramin (desipramine)
- Tofranil (imipramine)
- Pamelor (nortriptyline)
- Surmontil (trimipramine)
- Vivactil (protriptyline)
Monoamine Oxidase Inhibitors (MAOIs)MAOIs are a class of traditional antidepressants. They block an enzyme called monoamine oxidase, and it prevents a decrease in the levels of the brain’s neurotransmitters. The concentrations of serotonin, dopamine, and norepinephrine rise after using this kind of medication, which is necessary for proper brain function.
However, because of the potentially serious interactions with tyramine-rich meals, such as aged cheese, chicken liver, and smoked fish, MAOIs are less frequently utilized. Tyramine levels can rise due to improper MAOI use, leading to dangerous blood pressure increases. MAOIs and SSRIs should not be co-administered as they may cause serious serotonin syndrome.
Examples of MAOIs:
- Marplan (isocarboxazid)
- Parnate (tranylcypromine)
- Emsam (selegiline)
- Nardil (phenelzine)
Noradrenergic and Specific Serotonergic Antidepressants (NaSSAs)
When traditional antidepressants are unsuccessful or poorly tolerated, many clinicians resort to noradrenergic and specific serotonergic antidepressants (NaSSAs). In individuals who experience recurrent depression while using SSRIs or SNRIs, for instance, or in those who experience sexual dysfunction as a side effect of other medications, a NaSSA antidepressant drug may be helpful. By blocking receptors NASSAs block the inhibitory signals, which increases the availability of noradrenaline and serotonin.
Examples of NaSSas:
- Norval (mianserin)
- Remeron (mirtazapine)
- Tecipul (setiptiline/teciptiline)
Serotonin Antagonists and Reuptake Inhibitors (SARIs)
Antidepressant drugs known as serotonin antagonists and reuptake inhibitors (SARIs) have been licensed to treat the major depressive disorder. They are, however, used off-label to treat anxiety and insomnia.
SARIs function by preventing the brain’s serotonin reuptake. They serve as antagonists to reuptake receptors, increasing the quantity of active serotonin throughout the central nervous system (CNS). These medications may work right away for sleeplessness and anxiety, but for depression, it may take 2-4 weeks.
Examples of SARIs:
- Desyrel (trazodone)
- Psigodal (mepiprazole)
- Axiomin (etoperidone)
- Normarex (lorpiprazole)
Norepinephrine-dopamine Reuptake Inhibitors (NDRIs)
NDRIs prevent norepinephrine and dopamine from returning to the brain cells that released them. In turn, more active neurotransmitters remain available in the brain, which could eventually result in alterations that help lessen the symptoms of depression. NDRIs are frequently used when other antidepressants, such as SSRIs, are ineffective or have unfavorable side effects.
Examples of NDRIs:
- Focalin (dexmethylphenidate)
- Ritalin (methylphenidate hydrochloride)
- Wellbutrin (bupropion)
Side Effects of Antidepressants
Every drug may cause unwanted consequences. Treatment is typically started at a low dose to reduce side effects and is gradually increased until the appropriate dose is established. The best dose is one that offers the most advantages with the fewest negative effects.
If you experience side effects, check the details provided to you by your doctor on the precise effects of any medication you have been prescribed. It is advisable to continue taking your medicine as directed if side effects are minimal and manageable, but you should notify your doctor as soon as possible if they are severe or prolonged.
The side effects of various antidepressants kinds are included in the table below as common or well-known side effects.
|Antidepressant type||Common or widely known side effects|
|Selective Serotonin Reuptake Inhibitors (SSRIs)||Diarrheas |
Feeling or being sick
|Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)||Tiredness|
|Tricyclic Antidepressants (TCAs)||Dry mouth|
|Monoamine Oxidase Inhibitors (MAOIs)||Drowsiness|
|Noradrenergic and Specific Serotonergic Antidepressants (NaSSAs)||Constipation|
|Serotonin Antagonists and Reuptake Inhibitors (SARIs)||Headache|
|Norepinephrine-dopamine Reuptake Inhibitors (NDRIs)||Anxiety|
You might feel inclined to stop taking an antidepressant or lower your dose if adverse effects become intolerable. But note that the full positive effects of antidepressants may not be felt for up to almost eight weeks after taking them as directed.
Never changing your medication’s dosage is crucial without consulting your doctor. This could increase your risk of experiencing a relapse, and abruptly discontinuing your antidepressant may result in withdrawal-like symptoms. Talk with your doctor to help you find the best solutions for your particular circumstances.
An Overview of the Risks and Considerations
Those who use antidepressants for an extended period are more susceptible to their risks. Each neurotransmitter has a unique function. Therefore changing how they are absorbed or released could have unintended consequences. For example, serotonin syndrome can occasionally result from using SSRIs that exert serotonergic activity. This toxic buildup of serotonin can result in a string of potentially harmful physical and mental symptoms.
Other common risks of antidepressants are as follows:
- Weight gain
- Decreased libido
- Increased risk of suicidal thoughts
Always tell your doctor about all medications you are taking, whether they are prescription, over-the-counter, herbal medicines, or nutritional supplements, to avoid drug interactions.
Antidepressant in Forensics
There is no such thing as risk-free drug use. There are many risks linked with certain medicines. Alcohol, heroin, and tranquilizers all have sedative effects that slow down the body’s and the brain’s natural processes. While substances like cannabis don’t cause physical dependence, using sedatives can result in physical dependence and withdrawal symptoms. Large-scale stimulant misuse can result in anxiety or panic attacks. Stimulants are especially dangerous for those with heart and blood pressure issues. Similar to this, hallucinogen usage can occasionally result in extremely unsettling experiences and unpredictable or dangerous behavior on the part of the abuser, particularly if they are already unstable.
Forensic Analysis of Drug
The forensic analysis of such substances moves from screening tests to more focused confirmatory testing in order to satisfy the legal criteria. If a white object labelled “Powdered Sugar” is recovered from the crime scene, identifying it would be the first step.
The majority of confirmatory procedures used to identify drugs take a fair amount of time and need the use of high-end, expensive equipment like a gas chromatograph-mass spectrometer or a Fourier transform infrared spectrophotometer. Rapid and affordable presumptive drug studies should be performed before doing a confirmatory study (which might result in definitive information).
Different types of antidepressants are frequently used to treat depression and other mental health conditions. Sometimes, the first prescribed antidepressant may be successful. Yet a patient might need to try another one if it doesn’t help the symptoms or has unpleasant side effects. There are many different antidepressants on the market, so chances are good that with the help of your doctor, you may discover one that suits your needs.