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Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)
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Antidepressants

What are antidepressants?

Antidepressants are a group of medications which are used to treat depression. They have been available in the market for many decades and new research has lead to more molecules coming to the market for treatment.

How do antidepressants work?

Antidepressants work on certain chemicals in the brain called neurotransmitters thereby helping people suffering from depression.

What are the types of antidepressants?

There are many anti depressants available in the market and they can broadly be divided into the following groups depending upon the chemical it works in the brain

  1. Serotonin specific reuptake inhibitors (SSRI) : fluoxetine, sertraline, citalopram, escitalopram, fluvoxamine and paroxetine
  2. Serotonin and nor adrenaline reuptake inhibitors ( SNRI ) : venlafaxin, des –venlafaxin, duloxetine, milnacipran
  3. Tricyclic antidepressants (TCA): Imipramine, amitryptlyine, doxepin
  4. Monoamine inhibitors:   used very infrequently
  5. Nor adrenalin and serotonin specific re uptake inhibitors  ( NASSA) : mirtazapine

What are the side effects of antidepressants?

The side effects of anti depressants depend upon the group of medication used.

Some of the common side effects are as follows

1. SSRI:  SSRI can cause nausea, vomiting, gastritis, diarrhea, increased sweating, headache, sleep disturbances and at times anxiety.  These side effects normally occur during the initial stages of treatment and most of them subside after a few days. Other side effects like sexual dysfunction and low sodium level can also occur. Contact your doctor if the side effects occur.

For a complete list of side effects consult your doctor, pharmacology books or the literature given along with the medication.

2. SNRI:  It can cause nausea, sleep disturbances, increased sweating, headache, sexual dysfunction and constipation.  Blood pressure can be elevated at higher doses and hence blood pressure must be checked regularly ( venlafaxin)

For a complete list of side effects consult your doctor, pharmacology books or the literature given along with the medication.

3. Tricyclic antidepressants:  Some of the side effects caused by tricyclic anti depressants  are sedation, dry mouth, constipation, blurred vision and a drop in blood pressure .( postural hypotension ) .  

For a complete list of side effects consult your doctor, pharmacology books or the literature given along with the medication.

4. NASSA:  some of the side effects caused by mirtazapine are sedation, increased appetite, weight gain, and headache. 

For a complete list of side effects consult your doctor, pharmacology books or the literature given along with the medication.

POINT TO NOTE:  All medications given in allopathy have side effects it does not mean you will certainly get the side effects. Always the side effect profile should be weighed with the therapeutic benefit.  Most side effects can be treated and are not long lasting.  

How long does the antidepressant take to start working?

Earlier it was commonly believed that antidepressant starts to work after about 2 weeks. However new research shows that the antidepressant effect can start much earlier and even within one week.

How long should a person take antidepressants?

An untreated episode of depression normally lasts for 8-12 months. Hence antidepressants are normally continued for 6 months after you feel better and then gradually stopped.

Are antidepressants addictive?

Anti depressant drugs do not cause addictions like how nicotine, sleeping tablets and alcohol cause. You will not have to go on increasing the dosage to get the desired effect and once the medication has been stopped you will not having craving for the medications.

Some of the antidepressants can cause withdrawal symptoms if stopped abruptly and hence it must be gradually reduced and stopped.

How should I take antidepressants?

Anti depressants is usually started on a low dosage and gradually increased to the optimum dosage depending upon the response the patient has. It is usually increased once in two weeks and hence you should see the psychiatrist once in two weeks for an assessment until you stabilize. DO NOT INCREASE THE DOSAGE BY YOURSELF WITHOUT THE CONSULTATION OF THE DOCTOR.

If you get any side effects it will wear off after a few days, persist with the medication and consult your psychiatrist about the side effects.

Antidepressant should be taken everyday otherwise it will not work.

It is advisable not to drink alcohol along with the antidepressant.

When you are unwell it is advisable for some responsible person to administer the medication. Once you have shown significant improvement you can take over the responsibility of taking your medications. 

Keep them out of reach from children.

Overdose of anti depressant can be dangerous consult your doctor immediately.

Can I drive when on anti depressants?

Some of the anti depressants can be sedative and make you drowsy and hence it is advisable not to drive when you are drowsy. 

Will my depression come back?

For some people depression can come back and hence will have to take medications for a longer period of time.  Such people who get multiple episodes suffer from recurrent depressive disorder and other medication like lithium will be added to their antidepressant.  In addition to medications talk therapy like cognitive behaviour therapy will help patients.