Antidepressants and their side effects

Globally, more than 264 million people of all ages suffer from depression. The burden of depression and other mental health conditions is on the rise globally.

76% and 85% of people in low- and middle-income countries receive no treatment for their disorder (WHO). Those who receive the treatment are not fully aware of the medications given to them..

One of the common types of treatments given is antidepressants. Although antidepressants were first developed in the 1950s, their use has been progressed in the last 20 years. According to the Centers for Disease Control and Prevention (CDC), the percentage of people aged 12 years and over using the antidepressant United States are  12.7 (2011-2014).

Antidepressants are medications given to reduce the symptoms of major depressive disorder, anxiety, obsessive-compulsive disorder, post traumatic stress disorder, seasonal affective disorder, and many other mental disorders. Apart from the treatment of mental disorders, they are also used in the cure of other problems such as fibromyalgia, chronic urticaria (hives), hot flashes, hyperhidrosis (drug-induced), pruritus (itching), premenstrual symptoms, bulimia nervosa, Tourette syndrome, binge eating disorder, etc. As the medications given for the treatment have many serious side effects, it is necessary for the patients as well as the general public to understand how these meds work.

Antidepressants aim to reduce the symptoms of the mental disorders that are caused by a chemical imbalance of neurotransmitters in the brain that are believed to be responsible for changes in behavior and mood.

Some of the commonly prescribed Antidepressants:

SSRIs and SNRIs

Selective Serotonin reuptake inhibitor

Serotonin and norepinephrine inhibitor

Serotonin is a neurotransmitter that contributes to a good mood, social behavior, appetite, sleep cycle, and body’s internal clock whereas norepinephrine is a neurotransmitter that is responsible for processing emotions, thought processes, increasing alertness, retrieving memory, and bringing the brain in action. When the quantity of these neurotransmitters decreases in the brain, it gives rise to several disorders. These antidepressants (SSRIs and SNRIs) increase the level of serotonin and norepinephrine in the brain by blocking or delaying their reuptake by nerves. This makes it easier for brain cells to send and receive messages which result in stable moods.

These antidepressants are used to treat major depressive disorder, anxiety disorders less commonly but also used for treating menopausal symptoms, chronic neuropathic pain, obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and many more.

Names of the commonly prescribed SSRIs and SNRIs:

Citalopram (Celexa)

Escitalopram (Lexapro)

Fluoxetine (Prozac, Sarafem

Fluvoxamine (Luvox)

Paroxetine (Paxil)

desvenlafaxine (Pristiq, Khedezla)

duloxetine (Cymbalta)

levomilnacipran (Fetzima)

venlafaxine (Effexor XR)

Sertraline (Zoloft).

Side effects of SSRIs and SNRIs include low blood sugar, weight loss, tremor, sexual dysfunction, insomnia, headaches, abnormal thinking, anxiety, agitation, and dizziness.

 

Tricyclic Antidepressants ( TCAs)

Tricyclic antidepressants work on five different neurotransmitter pathways. They block the reuptake of norepinephrine and serotonin, increasing their levels in the brain. They are used to treat depression, fibromyalgia, some types of anxiety, and they can help control chronic pain.

Names of the commonly prescribed Tricyclic Antidepressants:

Amitriptyline (Elavil)

Amoxapine- clomipramine (Anafranil)

Desipramine (Norpramin)

Doxepin (Sinequan)

Imipramine (Tofranil)

Nortriptyline (Pamelor)

Side effects of these antidepressants include dry mouth, blurred vision, constipation, urinary retention, nausea, vomiting, abdominal cramps, hypertension, anxiety, and seizures.

Monoamine oxidase inhibitors (MAOIs)

MAOIs inhibit the action of the brain enzyme monoamine oxidase. This enzyme helps in breaking down neurotransmitters such as serotonin. When less serotonin is broken down, there is more circulation of serotonin in the brain. This leads to stabilized moods and fewer anxieties. As MAOIs interfere with several other medications and food, these antidepressants are saved for the cases where other antidepressants do not work

Names of the commonly prescribed MAOIs:

Phenelzine (Nardil)

Tranylcypromine (Parnate)

Isocarboxazid (Marplan)

Selegiline (EMSAM, Eldepryl)

Side effects of these antidepressants include seizures, rashes, insomnia, edema, weight gain/loss, and anxiety.

All antidepressants carry a black-box warning to this effect, as required by the Food and Drug Administration (FDA)

Dopamine reuptake inhibitor

These antidepressants are mild dopamine and norepinephrine reuptake inhibitor and help in the treatment of depression, seasonal affective disorder, and smoking cessation.

Bupropion (Wellbutrin, Forfivo, Aplenzin) is a commonly prescribed antidepressant.

Side effects of dopamine reuptake inhibitors include nausea, vomiting, dizziness, and blurry vision.

 

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Antidepressants do not work immediately and require time for showing their effectiveness. Therefore, patients require to have patience while taking antidepressants.

The Side effects of antidepressants occur usually during the first two weeks of treatment and eventually, they wear off. Sometimes it also includes suicidal thoughts which should be informed to the doctor immediately.

Antidepressants are not addictive, unlike other drugs. This means one doesn’t experience withdrawal symptoms such as those in case of smoking. However, some antidepressants such as SNRIs and SSRIs show withdrawal symptoms in 1 out of 3 patients. It is indeed very necessary for the individual to take the medications as per the prescribed time to avoid the impact of side effects.

Side effects of Antidepressants during pregnancy:

SSRIs: leads to a higher risk of pregnancy loss, congenital birth defects, low birth weight, preterm birth, and excessive bleeding during delivery.

SNRIs or TCAs: increase the risk of pregnancy-induced hypertension or high blood pressure, known as pre-eclampsia.

1 in 3 infants whose mothers take antidepressants suffer from neonatal abstinence syndrome.

Some alternatives to antidepressants:

• St John’s Wort for depression
• Lightbox for the seasonal affective disorder (SAD)
• Proper diet and exercise.

References:

https://www.medicalnewstoday.com/articles/248320#alternative-remedies

https://www.healthline.com/health/depression/medication-list#takeaway