Antidepressants: Medications and Side Effects

Antidepressants are medications used to treat major depression and a number of other disorders (e.g., personality disorders, anxiety disorders). They are not habit-forming and are safe if used as directed by a physician. They are generally taken in pill form, often once or several times daily. However, extended-release and controlled-release versions are available for many antidepressants. These can be taken less frequently.

Nerves send messages to each other by means of neurotransmitters. Large numbers of neurotransmitters are released for each message. Many neurotransmitters adhere to receptors on other nerves. These receptors read the messages. Some neurotransmitters are brought back into the nerve cells without adhering to receptors and being read. This process, which is called reuptake, allows the nerves to reuse neurotransmitters instead of continually making more.

Antidepressants work by increasing the levels of the neurotransmitters serotonin, nor epinephrine and dopamine (collectively called monoamines) in the synapse (the space between the nerves) of the brain. Monoamines are involved in thinking, emotions, memory and regulating certain body functions. When the levels of these chemicals are too low, patients may become depressed.

Levels of monoamines can be increased by blocking the receptors that read the messages (receptor blockers) or blocking the reuptake of the chemicals (reuptake inhibitors). When either the reuptake or the receptors are blocked, the levels of the monoamines in the brain are increased.

The effect of antidepressants on brain chemistry is not immediate. It typically takes several weeks for a patient to begin to respond to the medication. Initially, only side effects (e.g., insomnia, dry mouth, fatigue) occur. In most cases, the side effects improve or go away after about a week or two, and newer antidepressants have fewer side effects than older antidepressants.

It is important for a patient to take an antidepressant for at least six months. This allows the medication to have time to work and reduces the risk of relapse. Antidepressants may be taken for months or years depending on the condition that is being treated.

Antidepressants need to be taken exactly as prescribed in order to provide their desired effect. Skipping a dose may cause these medications to not work properly. It is also important not to stop taking antidepressants without consulting a physician. Many people confronted with initial side effects and no immediate positive effect stop taking antidepressants before they have had a chance to work. When antidepressants are stopped suddenly, they often cause withdrawal symptoms (e.g., nausea, headache, dizziness). Such symptoms can usually be prevented by stopping antidepressant use gradually.

patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

Antidepressant Medications

The kind of depression that will most likely benefit from treatment with medications is more than just "the blues." It's a condition that's prolonged, lasting 2 weeks or more, and interferes with a person's ability to carry on daily tasks and to enjoy activities that previously brought pleasure. The depressed person will seem sad, or "down," or may show a lack of interest in his surroundings. He may have trouble eating and lose weight (although some people eat more and gain weight when depressed). He may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. He may speak of feeling guilty, worthless, or hopeless. He may complain that his thinking is slowed down. He may lack energy, feeling "everything's too much," or he might be agitated and jumpy. A person who is depressed may cry. He may think and talk about killing himself and may even make a suicide attempt.

Side Effects of Antidepressant Medications

Tricyclic Antidepressants

There are a number of possible side effects with tricyclic antidepressants that vary, depending on the medication. For example, amitriptyline (Elavil) may make people feel drowsy, while protriptyline (Vivactil) hardly does this at all and, in some people, may have an opposite effect, producing feelings of anxiety and restlessness. Because of this kind of variation in side effects, one antidepressant might be highly desirable for one person and not recommended for another. Tricyclics on occasion may complicate specific heart problems, and for this reason the physician should be aware of all such difficulties. Other side effects with tricyclics may include blurred vision, dry mouth, constipation, weight gain, dizziness when changing position, increased sweating, difficulty urinating, changes in sexual desire, decrease in sexual ability, muscle twitches, fatigue, and weakness. Not all these medications produce all side effects, and not everybody gets them. Some will disappear quickly, while others may remain for the length of treatment. Some side effects are similar to symptoms of depression (for instance, fatigue and constipation). For this reason, the patient or family should discuss all symptoms with the doctor, who may change the medication or dosage. Tricyclics also may interact with thyroid hormone, antihypertensive medications, oral contraceptives, some blood coagulants, some sleeping medications, antipsychotic medications, diuretics, antihistamines, aspirin, bicarbonate of soda, vitamin C, alcohol, andtobacco. An overdose of antidepressants is serious and potentially lethal. It requires immediate medical attention. Symptoms of an overdose of tricyclic antidepressant medication develop within an hour and may start with rapid heartbeat, dilated pupils, flushed face, and agitation, and progress to confusion, loss of consciousness, seizures, irregular heart beats, cardiorespiratory collapse, and death.

The Newer Antidepressants

The most common side effects of these antidepressants are gastrointestinal problems and headache. Others are insomnia, anxiety, and agitation. Because of potentially serious interaction between these medications and monoamine oxidase inhibitors, it is advisable to stop taking one medication from 2 to 4 or 5 weeks before starting the other, depending on the specific medications involved. In addition, some SSRIs have been found to affect metabolism of certain other medications in the liver, creating possible drug interactions.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs may cause some side effects similar to those of the other antidepressants. Dizziness when changing position and rapid heartbeat are common. MAOIs also react with certain foods and alcoholic beverages (such as aged cheeses, foods containing monosodium glutamate (MSG), Chianti and other red wines), and other medications (such as over-the-counter cold and allergy preparations, local anesthetics, amphetamines, insulin, some narcotics, and antiparkinsonian medications). These reactions often do not appear for several hours. Signs may include severe high blood pressure, headache, nausea, vomiting, rapid heartbeat, possible confusion, psychotic symptoms, seizures, stroke, and coma. For this reason, people taking MAOIs must stay away from restricted foods, drinks, and medications. They should be sure that they are furnished, by their doctor or pharmacist, a list of all foods, beverages, and other medications that should be avoided. Precautions to be observed when taking Antidepressants When taking antidepressants, it is important to tell all doctors (and dentists) being seen not just the one who is treating the depression about all medications being used, including over-the-counter preparations and alcohol. Antidepressants should be taken only in the amount prescribed and should be kept in a secure place away from children. When used with proper care, following doctors' instructions, antidepressants are extremely useful medications that can reverse the misery of a depression and help a person feel like himself again.

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