Antidepressants is the umbrella term for medication that is used to treat mental illnesses not just depression.
With 1 in 8* Australians taking some sort of antidepressant (this is around 15% of the population), they’re becoming more common to take. But how many of us know what antidepressants do or the types of antidepressants available?
Antidepressants work by balancing chemicals in your brain called neurotransmitters, however like many things this isn’t as straightforward as it sounds. As the brain is complex it can often take time to figure out the right medication (or combination of medications) and it can take anywhere from weeks to months to notice a change.
There are five main types of antidepressants:
Selective Serotonin Reuptake Inhibitors (SSRIs) – these are the most common prescribed type of antidepressants, and they work by increasing the serotonin in the brain by blocking the reabsorption of serotonin into neurons. To put it in simple terms they prolong the serotonin lifespan in the brain. Each type of SSRI varies as they differ in their potencies at blocking serotonin reuptake and how quickly the body metabolises the medications. They take around 7 months to feel the full effect, but most people start to notice a change within 4-6 weeks. The side effects tend to be similar regardless of what kind you take however, they should reduce after a few weeks.
Common types of Selective Serotonin Reuptake Inhibitors include Sertraline (Zoloft), Escitalopram (Lexapro) and Fluoxetine (Prozac).
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) – these work the same as SSRIs, but they also block the reabsorption of norepinephrine along with serotonin. They are most often used to treat major depression but can also be used to treat ADHD, chronic pain and chronic nerve pain.
Common types of Serotonin and Norepinephrine Reuptake Inhibitors include Duloxetine (Cymbalta), Venlafaxine (Effexor XR) and Levomilnacipran (Fetzima)
Tricyclic Antidepressants (TCAs) – these were one of the first antidepressants and were introduced in the late 1950’s. They are still considered effective in treating depression and are a good choice for people whose depression may not be responding to other medications. Some people may find their side effects difficult to tolerate though, which is why they are not the first choice of treatment. Tricyclic Antidepressants help keep more serotonin and norepinephrine available to your brain helping elevate your mood. In lower doses they can be used to prevent migraines and chronic pain, along with panic disorder.
Something to be cautious about when taking these types of antidepressants is that people should avoid drinking alcohol while prescribed these, as it can lessen the impact and increases their sedation effects.
Common types of Tricyclic antidepressants include Desipramine (Norpramin), Doxepin, and Amitriptyline.
Monoamine Oxidase Inhibitors (MAOIs) – these were the first antidepressant developed and while they are still considered effective, they have since been replaced by antidepressants that are safer and have fewer side effects. They work due to an enzyme called monoamine oxidase is involved with removing neurotransmitters norepinephrine, serotonin, and dopamine from the brain. This means that more of these brain chemicals are available in the brain which effects changes in both cells and circuits that have been affected by depression.
Monoamine Oxidase Inhibitors can cause high blood pressure when taken with certain foods or other medications. Which is why they are often a last resort when other medications haven’t worked.
Common types of Monoamine Oxidase Inhibitors include Isocarboxazid (Marplan), Phenelzine (Nardil) and Tranylcypromine (Parnate).
Atypical Antidepressants – these are not typical antidepressants and don’t fit any of the above classes of antidepressants and each work in their own unique ways. They work by effecting changes in the brain chemistry and change the levels of one or more neurotransmitters (such as serotonin, dopamine or norepinephrine) however how they do it varies. Most recently approved is Esketamine (Spravato) which is a nasal spray that is intended to be used in conjunction with an oral antidepressant.
Atypical Antidepressants include Vortioxetine (Trintellix), Mirtazapine (Remeron) and Bupropion (Wellbutrin SR, Wellbutrin XL, others).
The following isn’t considered an antidepressant but can be used to treat mental illnesses specifically anxiety and panic disorders:
Benzodiazepines – these are sedatives that can help relax your muscles and calm your mind and work by increasing the effects of neurotransmitters. They tend to only be used for short-term treatment as they can be habit forming and can increase drowsiness, and cause problems with memory and balance.
Common types of Benzodiazepines include Diazepam (Valium), Lorazepam (Ativan) and Alprazolam (Xanax).
Like with any medications there’s going to be side effects and if they don’t reduce (or actually increase) after a few weeks it’s a good idea to check with the medical professional who prescribed them.
Common side effects for antidepressants include:
- Dry mouth
- Increase/decrease of appetite
It’s important to talk to your doctor and tell them as much as you can about what medications you currently take, taken in the past, how you reacted to them and what your lifestyle is like. This is so that your doctor can help you find the best antidepressant for you with minimal side effects or interruptions to your life.
You also shouldn’t stop your antidepressants without medical advice (especially suddenly), as you may experience withdrawal symptoms and always follow the directions given to you by your doctor when it comes to making any changes in your dose.
How long you stay on antidepressants is a personal thing, for some people they will be on them for only a short period but for others it’s long-term. It’s up to you and your doctor (whether that is your GP or psychiatrist), but you shouldn’t feel shamed for taking them. For some people their body doesn’t make enough of serotonin just like some people’s bodies don’t make enough iron, everyone is different.
*According to the latest information I could find. Also, it’s worth noting that antidepressants can be used to treat other conditions not just mental illness.
Feel free to drop by, just say, ‘Hey Erin’ in strict confidence and you can be anonymous if you wish. Or, do not hesitate to leave a question in the comments below any time.
How Antidepressants and Depression Medication Can Affect Your Life Choosing an antidepressant Antidepressants: Selecting one that's right for you Overview - Antidepressants The 5 Major Classes of Antidepressants Antidepressant medicines explained