Overview
For many battling depression, the fear of medications can seem insurmountable. Who wants to tolerate uncertain side effects just to feel “normal” again? Yet millions have found relief through strategic use of antidepressants. This article will explore common medication concerns, provide insight into treatment approaches, and offer practical strategies for overcoming fears and taking control of your mental well-being. Most importantly, you are not alone in this struggle. By facing your medication fears and embarking on a treatment journey, you’ll find this to be the best choice you’ve made in your life.
A Brief History of Antidepressants
Changes in the neurotransmitter levels of serotonin, norepinephrine and dopamine in the brain involving imbalances or malfunctions are thought to play a role in depression’s underlying mechanisms. As such, antidepressants are developed to correct such issues and relieve symptoms.
The development of modern antidepressants began in the 1950s with the discovery of tricyclic antidepressants (TCAs) like imipramine. In the late 1950s, additional classes included monoamine oxidase inhibitors (MAOIs) such as iproniazid and phenelzine entered the market.
In the late 1980s, selective serotonin reuptake inhibitors (SSRIs) like fluoxetine emerged and became widely used due to improved tolerability versus prior medications. However, issues with incomplete relief persisted.
A breakthrough occurred in 2000 when ketamine was found to rapidly reduce depression symptoms by targeting glutamate pathways. This discovery fueled new drug development focusing on ketamine’s mechanism of rapid antidepressant action. [1]
Types of Antidepressants
There are several types of antidepressants that can be used to treat depression and they include:
- SSRIs increase the levels of serotonin in the brain by blocking its reabsorption. This can lead to improved mood and reduced symptoms of depression and anxiety.
- Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) increase serotonin and norepinephrine levels in the brain. They are considered to be effective in treating both mood and physical symptoms associated with depression. [2]
- TCAs work by increasing the level of serotonin and norepinephrine in the brain. They were once the first choice for treating depression but were replaced by SSRIs and SNRIs which have fewer side effects.
- MAOIs block the enzyme that breaks down neurotransmitters like serotonin and norepinephrine in the brain. By inhibiting this enzyme, MAOIs increase the levels of these neurotransmitters to help alleviate depression symptoms.
- Noradrenaline and specific serotonergic antidepressants (NASSAs) work by targeting both noradrenaline and serotonin receptors in the brain to treat depression and anxiety. They may be effective for people who can’t take SSRIs. [3]
- Atypical antidepressants (e.g., trazodone) are a class of medications that have unique mechanisms of action compared to other antidepressants, and do not fit into the categories of other standard antidepressants.
- Other antidepressants (e.g., bupropion) are a class of antidepressants that differ from the aforementioned categories for their unique molecular structures and mechanisms of action involving diverse central nervous system receptors. [4]
Effectiveness of Antidepressants
While psychotherapy and lifestyle changes are effective for treating depression, antidepressants are often prescribed as the first line of treatment due to their easier accessibility and affordability. However, the effectiveness of antidepressants varies among individuals as genetic factors impact how the body metabolizes medications, influencing benefits and side effects.
Unsurprisingly, finding the right antidepressant often involves a “trial-and-error” process of adjusting dosage or switching medications. In some cases, multiple antidepressants may need to be tested. Typically, antidepressants take 4 to 6 weeks to reach their full effectiveness, and side effects may occur during the initial 2 weeks. [5]
In addition to genetic factors, the effectiveness of antidepressants is also influenced by an individual’s adherence to the prescription schedule and the severity of their depression symptoms. Antidepressants are generally less effective for mild or moderate depression. Nevertheless, evidence shows that certain antidepressants are more effective than a placebo for mild to moderate depression, particularly if the depression is long-lasting, and they are similarly effective as counseling.
For some individuals, particularly those with severe depression, treatment-resistant depression may occur, where the symptoms do not respond to even two different antidepressants. Major studies have found that combining treatments does not significantly help relieve symptoms. [6]
Types of Antidepressant Side Effects
Antidepressants are commonly prescribed to treat depression. While these medications can be effective in managing symptoms, they can also cause side effects. It’s important to note that not everyone experiences these side effects, and their severity can vary from person to person. Below are the side effects common to all antidepressants:
- Nausea, diarrhea, and stomach upset are common side effects associated with SSRIs, SNRIs, TCAs, and MAOIs.
- Headaches, including tension headaches and migraines, can occur as a common side effect across different types of antidepressants.
- Dry mouth is also a common side effect across different types of SSRIs, SNRIs, TCAs, MAOIs, and atypical antidepressants.
- Dizziness may be a common experience of individuals who take SSRIs, SNRIs, and atypical antidepressants.
- Sleep disturbances, such as excessive sleepiness or insomnia, can be experienced with SSRIs, SNRIs, TCAs, MAOIs, NASSAs, and atypical antidepressants.
- Sexual dysfunction is common with SSRIs, SNRIs, and TCAs with side effects such as reduced libido, difficulty reaching orgasm, or erectile dysfunction.
- Constipation is a common problem for those who take SNRIs, TCAs, and atypical antidepressants.
- Change in appetite that leads to weight gain or loss are observed side effects of SSRIs, SNRIs, TCAs, and atypical antidepressants.
As for the side effects specific to certain antidepressant types, they include:
- SNRIs may cause tiredness in some people.
- TCAs may cause blurred vision, urinary problems, and excessive sweating, in addition to the common side effects.
- MAOIs have distinctive side effects, including involuntary muscle jerks, muscle cramps, tingling sensations in the skin, and low blood pressure. [7]
Prevalence and Impact of Antidepressant Side Effects on Depression Treatment
A study of individuals taking selective SSRIs for depression found 38% experienced side effects. Common issues included low sex drive, drowsiness, and weight gain. Around 25% found the side effects significantly problematic. Surprisingly, only 40% reported negative impacts to their healthcare providers. [8]
Another study found antidepressant side effects peaked at 2 weeks, gradually improving by 6 weeks. Interestingly, the specific drug or other mental health issues did not impact severity. Those severely bothered by side effects had lower treatment success. This suggests troublesome side effects can predict poorer depression treatment outcomes. [9]
Helpful Tips on Overcoming Antidepressant Side Effects
Many people taking antidepressants are worried about potential side effects. Addressing side effects upfront with a healthcare provider is key. With open communication, many side effects can be prevented or reduced in severity. Some tips to consider are:
Communication and Collaboration
- Stay informed about potential side effects and educate yourself on the specific medication you are taking.
- Communicate openly with your healthcare provider about any side effects you experience.
- Discuss your medical history and current medications with your doctor.
- Attend regular follow-up appointments to monitor your progress.
Medication Management
- Understand the importance of medication adherence for optimal treatment outcomes.
- Ask your pharmacist or healthcare provider about alternative medications or dosage adjustments that may minimize side effects.
Adjustment and Patience
- Be patient and give your body time to adjust to the medication.
- Understand that it may take time to find the right antidepressant for you.
- Adjust your dosage or switch medications only under medical guidance.
Self-Care and Lifestyle
- Keep a symptom diary to track any changes or side effects.
- Consider lifestyle modifications such as dietary changes or exercise to alleviate side effects.
Final Thoughts
While medication fears are understandable, don’t let them prevent you from getting the treatment you need. By having open discussions with your doctor and making lifestyle adjustments, many side effects can be diminished or avoided altogether. Finding the right antidepressant may take time, but making your mental health a priority will pay off in the long run. Taking that first step to treat your depression can lead to feeling like yourself again.
Sources:
- Vitor Silva Pereira, & Hiroaki-Sato, V. A. (2018). A brief history of antidepressant drug development: from tricyclics to beyond ketamine. Acta Neuropsychiatrica, 30(6), 307–322. https://doi.org/10.1017/neu.2017.39
- Helpful for chronic pain in addition to depression. (2019). Retrieved May 16, 2024, from Mayo Clinic website: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20044970
- NHS Choices. (2023). Overview – Antidepressants. Retrieved May 16, 2024, from https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/overview/
- Schwasinger-Schmidt, T., & Macaluso, M. (2018). Other Antidepressants. Handbook of Experimental Pharmacology, 325–355. https://doi.org/10.1007/164_2018_167
- Kekic, Adrijana. (2023, February 7). Just how effective are antidepressants, anyway? Why don’t certain ones work for me? – Mayo Clinic Press. Retrieved May 16, 2024, from Mayo Clinic Press website: https://mcpress.mayoclinic.org/women-health/just-how-effective-are-antidepressants-anyway-why-dont-certain-ones-work-for-me/
- Elizabeth Maggie Penn, & Tracy, D. K. (2012). The drugs don’t work? antidepressants and the current and future pharmacological management of depression. Therapeutic Advances in Psychopharmacology, 2(5), 179–188. https://doi.org/10.1177/2045125312445469
- An option if other antidepressants haven’t helped. (2019). Retrieved May 16, 2024, from Mayo Clinic website: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992
- Cascade, E., Kalali, A. H., & Kennedy, S. H. (2009). Real-World Data on SSRI Antidepressant Side Effects. Psychiatry (Edgmont (Pa. : Township)), 6(2), 16–18. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719451/
- Braund, T. A., Tillman, G., Palmer, D. M., Gordon, E., A. John Rush, & Harris, A. (2021). Antidepressant side effects and their impact on treatment outcome in people with major depressive disorder: an iSPOT-D report. Translational Psychiatry, 11(1). https://doi.org/10.1038/s41398-021-01533-1