Antidepressants are pharmacological agents that exert significant influence on the central nervous system. Their primary function is to modulate the neurotransmitter levels in the brain, which are pivotal in regulating mood and overall emotional equilibrium. Depletion of crucial neurotransmitters, notably serotonin, is implicated in the onset of depressive conditions.
Specialists categorized antidepressants as psychotropic medications – they are instrumental in the management of diverse mental health conditions, including but not restricted to depression and affective disorders. They are also indicated for the treatment of conditions such as obsessive-compulsive disorder, social phobias, panic disorders, anxiety-related depressive disorders, and post-traumatic stress disorder. Furthermore, individuals contending with neurasthenia and chronic neuropathic pain may also benefit from antidepressant therapy.
Due to their chemical structure, we can divide antidepressants
into two major groups:
Below, we will take a closer look at some of them.
Tricyclic antidepressants (TCAs) were first introduced in the 1950s and are primarily employed to treat endogenous depression. Additionally, they may be prescribed to alleviate symptoms of panic disorders, obsessive-compulsive disorders, and psychogenic pain. However, it is noteworthy that TCAs are known to cause various side effects.
Although severe complications are rare, non-compliance with contraindications and instructions may lead to severe anxiety, anxiety, psychomotor agitation, exacerbation of psychotic symptoms in the course of schizophrenia, mania, seizures, and muscle tremors.
Tricyclic drugs can also significantly impact the circulatory system, causing a drop in blood pressure, increased heart rate, and, less frequently, cardiac arrhythmias and decreased myocardial contractility. Therefore, it is advisable to avoid prescribing antidepressants of this type to patients with circulatory system dysfunction, particularly those with cardiac arrhythmias.
Selective serotonin reuptake inhibitors (SSRIs) are a type of second-generation antidepressant that are widely used today. Research and clinical observations have shown that SSRIs are generally better tolerated, safer, and have a narrower range of contraindications than classic tricyclic antidepressants (TCAs).
SSRIs are effective for treating various depressive disorders, especially recurrent disorders, depression accompanying bipolar disorder, and depression at any age. They are also commonly used to treat obsessive-compulsive disorders and emotional disorders such as social phobia, panic disorder, post-traumatic stress, and bulimia.
While the effectiveness of SSRIs is similar to that of TCA, the prevailing opinion among some psychiatrists is that SSRIs are better for mild and moderate depression. In the case of severe depression of the melancholic type combined with additional psychotic symptoms, TCA treatment is indicated. If TCA treatment is ineffective, SSRIs may be used as an alternative.
There are only a few contraindications to SSRI treatment, including breastfeeding, Parkinson's disease, epilepsy, and liver and kidney failure. Caution should be taken with individuals who have diabetes, circulatory system dysfunction, glaucoma, or prostatic hypertrophy.
Depression can be explained simply as a chemical imbalance or a serotonin deficiency. Unfortunately, it is more complicated because researchers still haven't discovered what causes this condition or how antidepressants enhance the signs.
With that stated, many specialists think that the advantages of antidepressants arise from how they influence specific brain circuits and neurotransmitters. Those are chemicals that transport signals from one nerve cell to another. For example, we distinguished serotonin, and norepinephrine. In different forms, various antidepressants impact how these neurotransmitters act.
Let's look at one of the antidepressant types, reuptake inhibitors. Reuptake is a procedure in which neurotransmitters are reabsorbed back into nerve cells in the brain after they are released to transmit messages between nerve cells. A reuptake inhibitor stops this process. Rather than being reabsorbed, the chemicals stay in the synapse (it is a gap between the nerves). Keeping levels of the neurotransmitters more elevated can enhance transmission between the nerve cells and support circuits in the brain that help to regulate mood.
However, there is a possibility that antidepressants have other unidentified results and that their advantages don't concern neurotransmitter levels.
When taking an antidepressant, be patient. Some individuals begin therapy and anticipate that it will work right away. But that's not how they work – they can take weeks or months to gain their complete effect.
It is commonly believed that antidepressants can be mentally and physically addictive. As psychiatrists emphasize, this is not true. Patients often confuse addiction with withdrawal symptoms (withdrawal syndrome). These symptoms appear when the patient suddenly stops taking the drug or significantly reduces its dose without consulting a doctor.
A side effect of this is a sudden imbalance in the level of neurotransmitters in the brain, which translates into severe mood swings. The patient experiences the following symptoms:
Gradually reducing doses under medical supervision reduces the risk of withdrawal symptoms.
In rare cases, withdrawal syndrome may result in a recurrence of depression, requiring resumption of therapy.
The use of antidepressants is often the subject of concern among patients. Every person responds to medications differently, but some side effects are standard. These are:
The patient can have many, a few, or none of these. Moreover, those manifestations of using antidepressants may go away a few weeks after the beginning of the treatment.
Side effects may occur when the drug has been incorrectly selected or dosed.
Some other side effects from antidepressants aren’t debated as frequently. However, they’re still significant to look out for. They can be:
Observe if there is a manifestation of hyponatremia when you’re adapting to a new medicament. These include:
Consult specialists if you detect these signs.
The withdrawal symptoms that occur following their sudden discontinuation are a result of the drugs' effect on various types of neurotransmitter pathways in the brain. Deprived of the previously supplied substance, these pathways must adapt to this state again. However, they are not accompanied by a craving for the substance and an irresistible, difficult-to-control desire to take it again, which are characteristic of the withdrawal syndrome that occurs after stopping stimulants.
It is worth noting that while it takes at least 2-3 weeks to improve mood after taking antidepressants, an anxiety reduction is observed at the beginning of treatment. This is particularly important in patients who are experiencing suicidal thoughts, as it may result in a greater propensity to act on them. During this time, loved ones should remain vigilant, and in cases of high suicide risk, it is recommended to initiate treatment under the supervision of specialists in a hospital setting.
One of the most critical aspects of depression treatment is establishing good cooperation with the specialist. Patients should not make independent decisions regarding treatment modifications but should inform their doctor of all symptoms and concerns, enabling the physician to choose the optimal treatment.
When selecting medications for patients, psychiatrists follow several fundamental principles, including using the lowest effective dose of the drug. This is because the chance of side effects increases with higher doses, and therapy costs also increase.
Assessing the effectiveness of treatment is not recommended until at least 1-2 weeks after initiation because antidepressants affect complex cellular processes that cannot be modified immediately. If the patient does not experience improvement after 6-8 weeks of using the maximum dose of a given drug, specialists typically recommend changing the drug to another from the same group. If this does not work, they may prescribe a drug from another group.
After the first episode of depression, patients are encouraged to take medications for at least six months following symptom resolution. In the event of a subsequent episode of depression, treatment should continue for a more extended period, up to 2 years after symptom disappearance. If a third episode occurs, the specialist may consider permanent use of the drug.
Determining the most suitable antidepressant for a patient necessitates a comprehensive interview conducted by a physician. The physician selects the most appropriate medication for the patient based on the depressive symptoms they are experiencing.
There are many kinds of medicament available that work in narrowly various ways and have diverse side effects. When choosing an appropriate antidepressant the specialist will consider:
Table of Contents
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