When we go to the doctor because we’re unable to cope with life, the doctor’s first treatment choice is antidepressants.
Antidepressants are widely used for depression. However, doctors will admit that they although they may not cure depression, they could reduce symptoms like low mood or insomnia.
There is definitely a difference in the way certain antidepressants work and you might find that you have to try one or two before you decide which one works best for your particular symptoms.
The first time you use an antidepressant it may work fine but then again, it may not, in which case its important to go back to your doctor and explain that you're not happy with that particular antidepressant.
If the first antidepressant you try doesn't relieve your symptoms or, it causes unpleasant side effects that bother you, you may need to try another.
It maybe that a combination of medications may be an option if the initial prescription doesn’t work first time. Your doctor will know that it may take several attempts to get the right antidepressant at the correct dose for you so don’t be worried about returning to the doctor for advice and support.
Understanding what antidepressants do and which ones we should take, however, can feel overwhelming.
So here’s my guide to the different medications for depression allowing you to gen up on which one could work for you.
Things Your Doctor May Consider When Choosing An Antidepressant For You
It’s vital your doctor gets the measure of what you are suffering because some antidepressants relieve certain symptoms better than others.
For example, if you have insomnia, a sedating antidepressant may work best for you.
Antidepressants all work in slightly different ways with different side effects. There’s no way of knowing, ahead of time, which one, or combination, will suit you.
Here’s a list of things your doctor may consider when prescribing medication.
Your presenting symptoms.
Symptoms of depression can vary but this is a general list of symptoms your doctor will ask you about:
Inability to focus
Feeling tired and/or run down
Very low mood, sadness
Suicidal thoughts
Feeling empty, lost, alone
Feelings of hopelessness, guilt and low self worth
Sleep problems either insomnia or sleeping too much
Angry for no reason
Food issues either over or under eating
Lack of motivation
No sex drive
Lost interest in hobbies
Anxiety, mild or crippling
Aches, pains, headaches, or cramps that won't go away
Digestive problems that don't get better, even with treatment
Joint pains
Digestive problems
Other family members’ history
It’s now thought that you’re more likely to suffer from depression if other family members also suffer from depression and especially parents. Depression is spreadable and can be transmitted, hopping from one family member to another without being aware of it.
The dominant energy will be contagious so if the parents have a negative view on life, it’s common for the children to pick up that same outlook. Living with or under another person’s ‘black cloud’ can be debilitating for everyone else’s mental health.
So, be sure to inform your doctor of other family members’ history of depression. This gives the doctor the opportunity to ask about what treatment worked for other them because it can indicate how well it might work for you.
The side effects.
Side effects of antidepressants are common and it’s good to understand that before going ahead. Doctors often say that the side effects will diminish after about two weeks.
Side effects may include:
Feeling agitated, shaky or anxious
Feeling and being sick
Indigestion
Stomach aches
Diarrhoea
Constipation
Loss of appetite
Dizziness
Not sleeping well (insomnia), or feeling very sleepy
Headaches
Low sex drive
What other medications you are taking.
Some antidepressants can’t be taken with other medications because of potential reactions and so your doctor will want to know what else you're taking.
Other medical conditions
Other mental or physical conditions will be considered as part of the doctors overall plan to treat you. There maybe some overlap with drugs that help relieve more than one condition. For example, using duloxetine to help with pain symptoms or amitriptyline to prevent migraines.
If you're pregnant or breast-feeding your doctor may wish to discuss the risks and find the best way to manage depression when you're expecting or planning on becoming pregnant.
Different Types of Antidepressants
There are brain chemicals called neurotransmitters that are associated with depression. The main ones are called serotonin, norepinephrine and dopamine. These chemicals affect mood and emotions.
Antidepressants can help rebalance the brain chemicals, which, in turn, improve your mood, help you sleep better, and increase your appetite and concentration, although the medical profession will admit that this process isn't fully understood.
Each type of antidepressant works slightly different ways and the main antidepressant medications are as follows:
Selective serotonin reuptake inhibitors (SSRIs)
Doctors often start by prescribing an SSRI. These medications generally cause fewer problematic side effects and are less likely to cause problems at higher doses than other types of antidepressants.
Examples of SSRIs include:
Fluoxetine (Prozac)
Paroxetine (Paxil, Pexeva)
Sertraline (Zoloft)
Citalopram (Celexa)
Escitalopram (Lexapro)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Examples of SNRI medications include:
Duloxetine (Cymbalta)
Venlafaxine (Effexor XR)
Desvenlafaxine (Pristiq, Khedezla)
Levomilnacipran (Fetzima).
The biggest difference between an SSRI and an SNRI is although SSRI ‘s and SNRI’s both affect absorption of serotonin, SNRI’s also affect norepinephrine levels in the brain.
SNRI's are more recent and may reflect more progressive research into the brain chemistry of depressed individuals.
Atypical antidepressants
These medications don't fit neatly into any of the other antidepressant categories.
They include:
Trazodone
Mirtazapine (Remeron)
Vortioxetine (Trintellix)
Vilazodone (Viibryd)
Bupropion (Wellbutrin, Aplenzin, Forfivo XL)
Bupropion is one of the few antidepressants that sexual side effects.
Tricyclic antidepressants
Tricyclic tend to cause more side effects than newer antidepressants. So tricyclic antidepressants generally aren't prescribed unless you've tried other antidepressants first without improvement.
These include:
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Amitriptyline
Doxepin
Desipramine (Norpramin)
Monoamine oxidase inhibitors
Monoamine oxidase inhibitors (MAOI's) may be prescribed, often when other medications haven't worked, because they can have serious side effects.
These include:
Tranylcypromine (Parnate)
Phenelzine (Nardil)
Isocarboxazid (Marplan)
Using an MAOI requires a strict diet because of dangerous (or fatal) interactions with foods, other medication and certain herbal supplements. These medications cannot be combined with SSRI's.
***A note to those who pay for private healthcare. There are some generic versions of antidepressants that maybe available. I mention this because the branded medication can be costly. Be sure to ask your doctor if there's a generic version available and ask about its effectiveness.***
Antidepressants and risk of suicide
Although most antidepressants are thought to generally be safe, the Food and Drug Administration (FDA) issued a statement in 2007 that proposed that manufacturers of all antidepressant medications 'update the existing black box warning on their products' to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24 during initial treatment (generally the first one-two months).
Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.
Doctor’s also state however that to keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
Making antidepressant treatment work for you
Here are some guidelines for making antidepressants work for you.
Give it time. You may start to see improvement in a few weeks after taking antidepressants, but it may take six or more weeks for it to be fully effective. You may need to gradually increase your dose so talk to your doctor about coping with depression symptoms as you wait for the antidepressant to take effect.
Don’t change your dose until you see your doctor. If your medication doesn't seem to be working or is causing problematic side effects, see your doctor before making any changes.
Monitor the side effects. Many antidepressants cause side effects that improve with time. Initial side effects may include nausea, dry mouth, different bowel movements, headaches and insomnia These may ease as your body adjusts to the medication.
Explore other options. If you have no significant improvement in your symptoms after four weeks, go back to your doctor and discuss changing dosage or switching to a different antidepressant. Your doctor may suggest a combination of antidepressants or other medication.
Avoid alcohol and street drugs. These are short-term solutions but generally worsen symptoms and make depression harder to treat.
Withdrawing from antidepressants
Almost one third of people using antidepressants who try to stop taking them experience withdrawal symptoms, according to a 2014 survey by the Royal College of Psychiatrists.
The survey of more than 800 people found that anxiety, dizziness, a head buzz, stomach upset, flu-like symptoms and depression were among the most common effects of withdrawal.
One quarter of those in the survey were unaware there could be problems linked to stopping antidepressants. Some people have said that after taking an antidepressant for some months, they have had difficulty managing once the drug has been stopped and so feel they are addicted to it. Most doctors would say that it is more likely that the original condition has returned.
The College advises that anyone who wishes to stop taking antidepressant medication should:
Discuss the options with their doctor and be aware of possible withdrawal
Choose a good time to withdraw
Seek support from friends and family and investigate whether you will need time off work
Reduce the dose very slowly
Be prepared to increase the dose again if needed
Keep a diary of your symptoms and drug doses
Keep an eye on your mood, look after yourself and keep active
Practice cognitive behavioral therapy (CBT) and relaxation techniques
Go back to your doctor if you are worried about how you feel