Ssris: The Most Frequently Prescribed Antidepressants
Selective serotonin reuptake inhibitors, or SSRIs, are the most commonly prescribed antidepressant class.
Although it is not clear how these drugs treat depression, these drugs are known to prevent the uptake of serotonin into cells.
These are the SSRIs currently approved by the FDA to treat depression:
Although MAOIs can sometimes help people who do not respond to other antidepressants, they are not widely used today because of their potential side effects and interactions with certain foods and beverages as well as other drugs.
For example, for people taking MAOIs, ingesting large amounts of the compound tyramine could cause dangerously high blood pressure.
You may also experience serious reactions if you take an MAOI with various medications, including:
- Other prescription antidepressants
- Cold and allergy drugs
- Herbal supplements
On rare occasions, MAOIs and other serotonin-containing drugs can cause a potentially life-threatening condition called serotonin syndrome. You may be at risk if you take too much of a serotonin-containing antidepressant, or if you combine an MAOI with another prescription antidepressant, certain pain or headache medications, or St. Johns wort .
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How Antidepressants Are Thought To Work
Chemicals like serotonin, norepinephrine and dopamine are naturally present in our bodies. They are needed for normal brain function. In people with depression, it is thought that there may be an imbalance of these chemicals in the brain. Antidepressants are believed to work by bringing one or more of these chemicals back into balance.
There are many types of antidepressants on the market. Talk to your health care provider to see if taking antidepressants is the best choice for you, and if so, which one you should take.
Many people see an improvement with the first antidepressant they use. But you may need to try another type, a higher dose or a combination of drugs to find what works best for you. Also, it may take up to a month to notice the full benefit of the drug.
Even once you start to feel better, keep taking the antidepressant as directed by your health care provider. Most people take antidepressants for at least 6 to 12 months, and some for longer. Make sure you talk to your health care provider before you stop using yours.
Are There Differences Among Antidepressants
Antidepressants differ in their effects on neurotransmitters, established uses, adverse effects and drug interactions. All antidepressants that are used for depression are effective there is no evidence that one antidepressant is more effective than another. However, patients may respond to or tolerate one antidepressant, and not respond to or tolerate another antidepressant.
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Why Is This Medication Prescribed
Escitalopram is used to treat depression in adults and children and teenagers 12 years of ago or older. Escitalopram is also used to treat generalized anxiety disorder in adults. Escitalopram is in a class of antidepressants called selective serotonin reuptake inhibitors . It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
Depression: How Effective Are Antidepressants
Like psychotherapy, antidepressants are a key part of treating . They aim to relieve symptoms and prevent depression from coming back.
Opinions vary on how effective antidepressants are in relieving the symptoms of . Some people doubt that they work well, while others consider them to be essential. But, like with many other treatments, these medications may help in some situations and not in others. They are effective in moderate, severe and chronic depression, but probably not in mild cases. They can also have side effects. It is important to discuss the pros and cons of antidepressants with your doctor.
The main aim of treatment with antidepressants is to relieve the symptoms of severe , such as feeling very down and exhausted, and prevent them from coming back. They are meant to make you feel emotionally stable again and help you to follow a normal daily routine. They are also taken to relieve symptoms such as restlessness, anxiety and sleep problems, and to prevent suicidal thoughts.
This information is about using medication to treat the most common form of , known as unipolar depression. The treatment options for manic depression aren’t discussed here.
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If You Feel Better Can You Stop Taking Antidepressants
Once you and your provider have determined it is safe for you to stop taking your medicine altogether, you should continue to be monitored during periodic follow-up appointments to detect any signs of depression returning.
Long-term treatment with antidepressant medicine may be recommended to prevent further episodes of depression in people who have already had two or more episodes of major depression. A history of depression in ones family is another factor that supports long-term treatment.
Last reviewed by a Cleveland Clinic medical professional on 05/24/2019.
References
Other Antidepressants: Tetracyclics And Saris
- Tetracyclics are another class of antidepressant with drugs such as amoxapine , maprotiline , and mirtazapine . Although it affects neurotransmitters, Remeron doesn’t prevent reuptake in the same way. Instead, it seems to stop neurotransmitters from binding with specific receptors on the nerves. Because the norepinephrine and serotonin don’t bind to the receptors, they seem to build up in the areas between the nerve cells. As a result, the neurotransmitter levels rise.
- Serotonin antagonist and reuptake inhibitor appear to act in two ways. They prevent the reuptake of serotonin. But they also prevent serotonin particles that are released in a synapse from binding at certain undesired receptors and redirect them instead to other receptors that can help nerve cells within mood circuits function better. Examples include nefazodone and trazodone.
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Selective Serotonin Reuptake Inhibitors
SSRIs are the most widely prescribed type of antidepressants. They’re usually preferred over other antidepressants, as they cause fewer side effects. An overdose is also less likely to be serious.
Fluoxetine is probably the best known SSRI . Other SSRIs include citalopram , paroxetine and sertraline .
Side Effects Of Ssris And Snris
Since the neurotransmitter serotonin also plays a role in digestion, pain, sleep, and mental clarity, SSRIs and SNRIs can cause a wide range of side effects, including:
- Nausea
- Constipation
- Headaches
Some SNRIs may also raise blood pressure or exacerbate liver problems. SSRIs and SNRIs can also cause serious withdrawal symptoms, especially if you stop taking them abruptly.
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Prevalence Of Emotional Blunting
Studies from Oxford University have shown that between 46% and 71% of antidepressant users have experienced emotional blunting during treatment. According to the research, the antidepressants most commonly associated with emotional blunting fall into one of three classes:
- Selective norepinephrine reuptake inhibitors such as Cymbalta , Pristiq , and Effexor XR
- Tricyclic and tetracyclic antidepressants like Elavil and Remeron
Though the percentage of people who experienced emotional blunting was similar between the three drug classes, there were variations. On the one end, only 33% experienced emotional blunting while on Wellbutrin while, on the other end, 75% experienced the same effect on Cymbalta.
This is an interesting fact given that Wellbutrin is a different class of drug known as a dopamine and norepinephrine reuptake inhibitor. Unlike the others, Wellbutrin does not target a chemical transmitter in the brainknown as serotoninthat all of the other drugs so. What this suggests is the inhibition of serotonin may be one of the prime causes of emotional blunting.
Can Antidepressants Give You Suicidal Thoughts
In 2004, the FDA issued a black box label warning for suicidal ideation among 18- to 24-year-olds for common antidepressant drugs. This warning is the FDAs strictest warning for labeling prescription drugs.
The effect of suicidal thoughts is most common with SSRIs, occurring in about 4% of people who take them. However, untreated depression is considered to be much more of a suicide risk than taking antidepressants.
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Make Adjustments If Necessary
Increase the Dose or Switch?
In general, it takes approximately 4 to 6 weeks for antidepressants to work. If you are still experiencing symptoms after this amount of time, talk to your doctor. You may need to increase the dose of your current antidepressant drug or switch to another one altogether. Some people experience treatment failure with the first antidepressant they try. In these cases, switching to a medicine in a different class may do the trick. It may take a full 3-month period to experience maximum benefits from an antidepressant. Very rarely, some individuals who have been on an antidepressant for some time may notice that the drug stops working. Always discuss any difficulties you’re having with any drug with your health care professional. Untreated depression is a risk to your mental health.
What Do Anti Depression Meds Do
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You Dont Necessarily Have To Stop Taking Your Antidepressant If Youre Pregnant Or Breastfeeding
Some antidepressants, particularly SSRIs, are considered safe to take while pregnant and breastfeeding.
Women and their doctors must make a risk-benefit calculation, Dr. Cox says. While its best to be on the fewest medications possible during pregnancy, the risk of untreated symptoms of depression and anxiety may be greater than any risk from medication.
When moderate to severe, untreated symptoms can pose risk of serious harm to the mother and baby, Dr. Cox says. These symptoms deserve to be treated just like any other health condition that arises during a pregnancy.
What Are Antidepressants Used For
Antidepressants help to relieve the symptoms of depression such as low mood, irritability, feelings of worthlessness, restlessness, anxiety, and difficulty in sleeping.
In addition to depression, certain antidepressants may also be used to treat a range of other conditions, for example:
It is important to note that not all antidepressants are used to treat the conditions mentioned above.
Antidepressants generally provide some relief of symptoms within one to two weeks however, it may take six to eight weeks of treatment before the full effects are seen.
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If You Experience Anxiety
If you have a form of anxiety or phobia, an antidepressant could help you feel calmer and more able to deal with other problems. It could also help you feel more able to benefit from other anxiety treatments, such as cognitive behavioural therapy .
“Once I started taking , I started to feel better. I was then able to start to see a psychologist and work on the deeper rooted issues.”
What Does The Treatment Involve
Antidepressants are usually taken daily. The goal in the first few weeks and months is to relieve the symptoms and, where possible, make the go away. Once that has been achieved, the treatment is continued for at least four to nine months. This continuation therapy is necessary to stop the symptoms from coming back. The medication is sometimes taken for longer to prevent relapses. The duration of treatment also depends on how the symptoms continue to develop over time and whether the depression is likely to return. Some people take antidepressants over many years.
It’s important to have regular appointments with your doctor when taking antidepressants. There you can talk about whether the symptoms have improved and whether there are any side effects. The dose will be adjusted if necessary. By no means should you reduce the dose or stop taking the medication on your own. That can make the tablets less effective, or they may cause more side effects.
Towards the end of the treatment, the dose is gradually reduced over the course of several weeks. You may experience temporary sleep problems, nausea or restlessness when coming off antidepressants. These symptoms are especially likely if you suddenly stop taking antidepressants. Sometimes people stop taking their medication as soon as they start feeling better, but that increases the risk of the coming back. Unlike many sleeping pills and sedatives, antidepressants don’t cause physical dependence or addiction.
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Antidepressants Should Make You Morenot Lesslike Yourself
People are often concerned that taking a psychotropic drug will change who they are, Dr. Cox says.
Medication should not change your personality. That is never the goal, she says. The goal is to feel like yourself but rid of the problematic symptomsto not feel totally overwhelmed with depression or anxiety.
How Antidepressants Work
It’s not known exactly how antidepressants work.
It’s thought they work by increasing levels of chemicals in the brain called neurotransmitters. Certain neurotransmitters, such as serotonin and noradrenaline, are linked to mood and emotion.
Neurotransmitters may also affect pain signals sent by nerves, which may explain why some antidepressants can help relieve long-term pain.
While antidepressants can treat the symptoms of depression, they do not always address its causes. This is why they’re usually used in combination with therapy to treat more severe depression or other mental health conditions.
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Key Points To Remember
- Taking medicine for your depression can help you get your life back to normal, especially if you also get counseling. But if your symptoms are mild, lifestyle changes and counseling may be all you need.
- You don’t need to be ashamed about taking antidepressants. Depression is a health problem, not a character flaw or weakness. The medicines won’t change your personality.
- Antidepressants don’t work right away. And you may need to try a few before you find one that works.
- Side effects are one reason that people stop taking antidepressants. But talk to your doctor. There are many ways to manage side effects. And lowering the dose or changing medicines may also help.
- The thought of needing to take medicine for a long time can be scary. But many people are able to slowly stop taking antidepressants after a while.
The symptoms of depression include a loss of interest in daily activities or feeling sad or hopeless and having at least four of the following symptoms:
- A change in eating patterns that causes either weight gain or weight loss
- Sleeping too much or not enough
- Feeling restless and unable to sit still, or feeling that moving takes a great effort
- Feeling tired all the time
- Feeling unworthy or guilty without an obvious reason
- Having problems concentrating, remembering, or making decisions
- Thinking often about death or suicide
What If An Antidepressant Doesnt Work
If you donât notice any change in your mood after a few weeks, talk with your doctor. If the first antidepressant you take doesnât work, itâs likely that another one will. About 60% of people who take antidepressants feel better with the first medicine they take, but others need to try more than one before noticing a change.
A study funded by the National Institute of Mental Health in 2008 found that about 50% of patients who did not feel better after using one medication noticed an improvement when they took a new one or added a second medication to the first treatment. You and your doctor can work together to find the medication thatâs right for you.
âI had to try a couple of different kinds of medications to find the right one for me,â Brennan tells WebMD. âOne medication worked for a little while, and then I started to feel depressed again. So my doctor switched me to another medication, and that one is working great. Itâs just a matter of sticking with it and letting your doctor know how youâre feeling.â
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Doctors Can Help With Antidepressant Side Effects
Most antidepressants are well tolerated, but side effects are a possibility. When first starting antidepressants, some people have mild stomach upset, headache or fatigue, but these side effects often diminish in the first few weeks as the body adjusts. Some people gain weight, though many stay weight neutral, and some even lose weight, Dr. Cox says.
Problems with sexual desire or function are fairly common, but this isnt inevitable or irreparable, she says.
A lot of patients feel nervous talking about that with their provider, but I want people to feel free to talk to me about that, she says. There are things we can do to help, such as adding a low dose of another medication.
How Should This Medicine Be Used
Escitalopram comes as a tablet and a solution to take by mouth. It is usually taken once a day with or without food. To help you remember to take escitalopram, take it at around the same time every day, in the morning or in the evening. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take escitalopram exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor may start you on a low dose of escitalopram and increase your dose after 1 week.
It may take 1 to 4 weeks or longer before you feel the full benefit of escitalopram. Continue to take escitalopram even if you feel well. Do not stop taking escitalopram without talking to your doctor. If you suddenly stop taking escitalopram, you may experience withdrawal symptoms such as mood changes, irritability, agitation, nausea, dizziness, burning, numbness, or tingling in the hands or feet, anxiety, confusion, headache, sweating, tiredness, and difficulty falling asleep or staying asleep. Your doctor will probably decrease your dose gradually.
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