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Antidepressants Depression medications Types Side Effects & More

December 29, 2021

Antidepressants are a group of medications designed to relieve symptoms of depressive disorders, general anxiety disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, and seasonal affective disorder.

Certain chemicals are present in the brain which are responsible for behavior and mood. The imbalance of these chemicals or neurotransmitters causes the development of depression and anxiety. These antidepressant drugs maintain the balance of these chemicals.

Brain chemicals or neurotransmitters are released by the nerve endings of neurons and make a connection between the brain and spinal cord. These are released by one nerve and taken up by another following nerve.

Normally they are stored in nerve-ending vesicles and are released when the brain sends messages. These neurotransmitters are not only taken up by the following nerve but are also taken up by the nerve that releases them. This phenomenon is known as the reuptake of neurotransmitters. 

The main neurotransmitters that are responsible for mood and behavior are dopamine, serotonin, and norepinephrine (Adrenaline). Their balance is necessary for normal mood and behavior.

Antidepressants were first created in the decade of 1950. Their use has become more pronounced nowadays. They are also used for the management of chronic pain.

Depression is a common condition that can affect anyone around you. It often affects people in their adulthood and is more prevalent in women than men.

How do they work?

It is still not known that how exactly antidepressants work.

It is postulated that these drugs work by preventing the reuptake of specific brain neurotransmitters. They increased the brain levels of these neurotransmitters, such as norepinephrine, dopamine, and serotonin.

These three neurotransmitters also work by inhibiting pain signals. This is why some of these antidepressants are used in the management of chronic pain.

Antidepressants can treat these depressive disorders, but they cannot treat the underlying cause of depression. This is why doctors prescribe these drugs in combination to treat depressive disorders.

For example, selective serotonin reuptake inhibitors (SSRIs) prevent the reuptake of serotonin in the brain. They increase the brain level of serotonin to elevate mood.

Antidepressants Depression medications Types Side Effects

Effectiveness of depression medications

Researchers say that antidepressants are useful in almost all cases of moderate to severe depressive disorders. They are better than the placebo drugs (Placebo is a dummy medication that does not have the active principle).

They are not as effective for mild depression as for severe depression. Doctors usually use other techniques for mild cases of anxiety and depression. If these techniques are not effective, they can prescribe these antidepressants at the end.

Research studies suggest that almost 50-60 percent of people get help after using antidepressants when compared with the placebo.

Depression drugs are different depending upon the type of target neurotransmitter. They also differ in their side effects and dosage. Doctors cannot say that one drug is better than the other. Patients may respond better to one drug than to the other.

Uses of antidepressants

These depression drugs are used to manage and treat several disorders. They are not only selective for general depressive disorders but are also used for the following diseases,

  • Generalized anxiety disorders and anxiety attacks
  • Obsessive-compulsive disorder (OCD)
  • Neuropathic pain
  • Peripheral neuropathy
  • Post-traumatic stress disorder (PTSD)
  • Social anxiety disorders
  • Schizophrenic states
  • Major depressive diseases
  • Bedwetting conditions
  • Manic depressive diseases or states

Some other uses of antidepressants include,

  • Binge eating conditions
  • Pruritis (itchy situations)
  • Urticaria ( hives in the skin)
  • Drug-induced hyperhidrosis
  • Fibromyalgia
  • Hot flushes on the skin
  • Tourette disease (a type of psychotic illness)
  • Bulimia nervosa
  • During symptoms before the menstrual cycle

Types of antidepressants

There are many types of depression drugs based on altered mental states. They are classified based on neurotransmitters on which they act. We are listing these drugs here.

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Noradrenaline serotonergic antidepressants (NASSAs)
  • Tetracyclic antidepressants
  • Norepinephrine dopamine reuptake inhibitors (NDRIs)

Selective serotonin reuptake inhibitors (SSRIs)

This is the class of antidepressants that are most commonly prescribed by doctors. They are preferred over the other depression medications because they are more efficient and have fewer side effects.

Selective serotonin reuptake inhibitors block the reuptake of serotonin in the brain. The brain level of that neurotransmitter is increased, which results in stabilizing the mood.

They are known as selective as they maintain only one neurotransmitter, called serotonin.

These drugs include,

  • Fluoxetine (Prozac)
  • Citalopram (Celexa)
  • Sertraline (Zoloft)
  • Paroxetine (Pexeva)
  • Escitalopram (Lexapro)
  • Fluvoxamine (Luvox)

These drugs cause fewer side effects than the other drugs. Their overdose may cause the following side effects,

  • Nausea
  • Low blood glucose level (hypoglycemia)
  • Rashes
  • Hyponatremia
  • Diarrhea or constipation
  • Sedation
  • Weight loss and weakness
  • Tremor
  • Agitation and general anxiety
  • Sexual impairment
  • Sleep problems (insomnia)
  • Dizziness
  • Thought problems

It is postulated that people who are under 18 may suffer from suicidal thoughts on using these drugs.

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

These drugs block the reuptake of both serotonin and norepinephrine in the brain. They are made for better effects than SSRIs, but their effectiveness is uncertain yet.

They may lessen the symptoms of depressive disorders. Many people respond better to SNRIs and many respond better to SSRIs.

Some of these drugs are listed below,

  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor XR)
  • Desvenlafaxine (Khedezla and Pristiq)
  • Levomilnacipram  (Fetzima)

Duloxetine can also be used to treat chronic pain as well as depression. It is thought that chronic pain can also lead to the development of depression. A drug like this can be very helpful for people who also suffer from pain.

Their common side effects involve,

  • Constipation
  • Nausea
  • Xerostomia (dry mouth)
  • Agitation
  • Fatigue
  • Drowsiness

Tricyclic antidepressants (TCAs)

These depression drugs are older than all other drugs. They are not used as first-line treatment of depressive disorders and anxiety states, because they have more side effects.

They are prescribed when other antidepressants are found to be less effective. They are named because they have three cyclic rings in their chemical structure.

They block the reuptake of almost all of these neurotransmitters and they are believed to be the most potent and effective than other depression drugs. They are chemically and structurally related to antipsychotic drugs (drugs that are used in psychosis).

These include,

  • Amitriptyline (Tryptizole)
  • Clomipramine (Anafranil)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Protriptyline (Vivactil)
  • Desipramine (Norpramine)
  • Doxepin (Sinequan)

An antidepressant, such as Amitriptyline can also be used to treat chronic pain.

Since they cause many side effects, their common side effects include

  • Sedation
  • Insomnia
  • Sexual dysfunction
  • Agitation and anxiety
  • Xerostomia (dry mouth)
  • Constipation
  • Skin rashes
  • Seizures
  • Urinary problems
  • Weakness with weight loss
  • Arrhythmia and hypertensive conditions
  • Low blood pressure
  • Liver failure
  • 3 Cs (Coma, Convulsions, and Cardiotoxicity)

Antidepressants also impose addective sedating effects when taken with other drugs, such as benzodiazepines, barbiturates, and opioids. They are well absorbed orally and undergo first-pass metabolism. Their excretion depends on their inactivation by liver metabolism.

They are administered once daily because of their half-life of 8-36 hours.

Tetracyclic drugs

They are also somehow similar to tricyclic antidepressants. They are used to treat anxiety and depression. They also act by maintaining the balance of certain neurotransmitters.

Examples are

  • Maprotiline (Ludiomil)
  • Mirtazapine (Remeron)

Their general side effects are

  • Headache
  • Lethargy
  • Blurred vision
  • Xerostomia (dry mouth)
  • Weakness
  • sedation

Monoamine oxidase inhibitors (MAO inhibitors)

These depression drugs inhibit an enzyme called monoamine oxidase, which breaks down serotonin. These drugs are structurally related to amphetamines. They are orally active and are metabolized by the liver enzymes.

These drugs are prescribed at first then the other SSRIs and SNRIs.

There are two different5 kinds of monoamine oxidase inhibitors,

  • MAO-A: These drugs break down serotonin, dopamine, and norepinephrine. They are used in depressive disorders and anxiety attacks.
  • Phenelzine (Nardil)
  • Isocarboxazid (Marplan)
  • MAO-B: These drugs break down dopamine in the brain and are used in Parkinson’s disease.
  • Selegiline (I-deprenyl)
  • Rasagiline

These are largely replaced by newer antidepressants nowadays. They increase the serotonin level of the brain. They are used when other medications, such as SSRIs and SNRIs do not work well. They interact with other depression and antipsychotics to produce additive effects.

Their common side effects are,

  • Headache
  • Nausea
  • Constipation
  • Xerostomia (dry mouth)
  • Sleeplessness
  • Increase in weight
  • Muscle tremors
  • Sexual impairment
  • Profuse sweating
  • Urinary problems

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

These drugs block the reuptake of dopamine and norepinephrine both. They are used to treat depressive disorders and some seasonal affective disorders. Doctors often prescribe them before SSRIs.

Its only known member is Bupropion (Wellbutrin)

Their side effects include,

  • Constipation
  • Dizziness
  • Little sedation
  • Sleeplessness
  • Headache
  • Lethargy
  • Profused sweating
  • Tremors of the hand

Norepinephrine and specific serotonergic antidepressants (NASSAs)

They are prescribed for people who are unable to tolerate SSRIs. They are used to manage some anxiety disorders and depressive disorders. Side effects of these drugs are almost the same as SSRIs, but they are less likely to cause sexual dysfunction.

Their common side effects include,

  • Blurriness of vision
  • Dry mouth
  • Decreased peristalsis
  • Weight gain

Some more life-threatening side effects are,

  • Seizures
  • Severe allergic reactions
  • Deficiency of leukocytes
  • Fainting

Atypical drugs

These medications do not categorize into typical antidepressants. They are used to treat bipolar affective disorders and general anxiety disorders. They are known as atypical antidepressants

Based on your mental state, your physician may ask you to take these drugs.

Olanzapine, nefazodone, and trazodone are atypical drugs. They are generally used to treat manic depressive disorders, bipolar disorders, and major depressive disorders.

Consult your doctor if feel well after taking these drugs. He will check and then prescribe you these medications.

Consult your doctor

These drugs may not work well for you if they work for other people. They can take time if you take them on your own.

They take almost 6 weeks to show their full beneficial effects. You need to consult your doctor to find a better treatment plan for you. He will make an accurate diagnosis and then tell you the best treatment plan based on your mental health.

Are these drugs addictive?

These antidepressant drugs do not cause addiction. Although they produce additive effects when used with other same drugs, they are not addictive.

They do not produce a craving effect. They do not make you happy, that’s why they are not addictive.

Dosage of antidepressants

You should take these drugs for almost 7-8 weeks. You should also visit your doctor if you get any side effects during their use. Your doctor will prescribe alternative medications that will be better for you.

If you feel no effectiveness or improvement in your mood and behavior, you should consult your doctor. He will do trial and error to find the best medications for you.

To produce beneficial effects, your doctor will prescribe these medications for almost 7-12 months. During your treatment, he will monitor you and will see the effects of drugs. In the end, your psychiatrist tapper off the drug to prevent withdrawal effects.

Natural remedies for depression

Some people are interested in treating their depression naturally by herbs or some other mental techniques instead of taking drugs. People are also interested in using natural remedies along with antidepressants.

There are natural herbs available to treat depressive disorders. St. John`s wort is a herb used to manage symptoms of depression. In past, people used this herb to stable their mood in depressive disorders.

This herb is not that effective though. It can have some positive and beneficial effects and it also has several drug interactions. These symptoms can be life-threatening. Some of these interactions are listed here,

  • Interaction with anti-seizure drugs, such as valproic acid or lamotrigine
  • Interaction with progesterone pills: They cause birth effects here
  • Interaction with warfarin drug (Coumarin derivative)
  • Prescribed antidepressants

Some people show less effectiveness of their antidepressants if they also take that herb with them.

Another natural treatment option is SAMe, which some people have used to manage their symptoms of depression. It also has drug interactions with other prescribed antidepressants. It can also be used to treat joint pain and has less effective in treating depression.

Regular exercise and a good diet

Research studies say that you should do regular exercise to control your depression. Well-balanced nutrition can also be valuable in treating and preventing depression.

Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist


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