In the 1st of 4 parts reviewing Antidepressants we look at different types and how they work

Antidepressants Part 1

I focus on pharmacological treatment options for depression. I will not outline the causes, symptoms etc of depression. Talking therapies such as CBT should be the first line as a treatment option for depression; medication should always be used in tandem with talking therapies for mental health disorders like depression and anxiety.

Antidepressants

The first antidepressants were developed in the 1950s. There are now about thirty different kinds of antidepressants available and there are six main types:

• Tricyclics
• MAOIs (Monoamine oxidase inhibitors)
• SSRIs (Selective Serotonin Reuptake Inhibitors)
• SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors)
• NASSAs (Noradrenaline and Specific Serotonergic Antidepressants)
• Melatonergic agonists
• Serotonin Modulator

How antidepressants work in brief

Antidepressants increase the activity of neurotransmitters neurotransmitters serotonin and noradrenaline in the brain. Melatonergic agonists increase the release of melatonin in the brain which has a positive effect on mood and sleep. Agomelatine (Valdoxan^®) is the only drug in this class so far.

What are they used for?

Antidepressants should never be used for mild depression; they should only be used for moderate to severe depression. Antidepressants are also used for the following conditions:

• Severe anxiety and panic attacks
• Obsessive compulsive disorders
• Chronic pain
• Eating disorders
• Post-traumatic stress disorder.

How well do they work?

After 3 months of treatment, it is estimated that 50% to 65% of patients with depression show improvement when treated with anti-depressants. This compares with 25 to 30% of patients who are treated with a placebo. 

Are newer antidepressants better?

Older tablets such as tricyclic antidepressants are just as effective as the newer ones (SSRIs), but the newer ones generally have less side-effects. Newer antidepressants are less dangerous on overdose. However, older antidepressants still have some benefits. For example, because tricyclic antidepressants cause more drowsiness, they are sometimes prescribed to be taken at night in patients suffering from severe insomnia due to depression.

Are antidepressants addictive?

Antidepressant drugs do not have addictive properties like tranquillisers, alcohol, or nicotine. Therefore, the patient will not need to keep increasing the dose to get the same effect or they will not find themselves craving them when they stop taking them.

However, up to a third of people who stop SSRIs and SNRIs have withdrawal symptoms which can last between 2 weeks and 2 months.

Withdrawal effects include gastrointestinal disturbance, headache, dizziness, sleep disturbance, fatigue, sweating and sensations in the body like electric shocks. In most people these withdrawal effects are mild, but for a small number of people they can be quite severe. They seem to be most likely to happen with Paroxetine and Venlafaxine. Withdrawal effects can be minimised by reducing them slowly when going off them. 

Some people have reported that, after taking an SSRI for several months, they have had difficulty managing once the drug has been stopped and so feel they are addicted to it. However, most experts agree this is due to the depression returning due to discontinuation of the drug.

Covid-19 booster and flu vaccine clinics at Whelehans

Whelehans Pearse St offer a weekly walk in Covid-19 booster clinic. You can get your Flu vaccine and Covid Booster on the same day at Whelehans Pharmacy. Whelehans Pharmacy Clonmore offer the Flu vaccine too. You can book conveniently on the Whelehans website (€5 off flu if booked online but many groups are free of charge). Kids flu vaccines (2 to 12 years) are available too.

To be continued next week

For comprehensive and free health advice and information call in to Whelehans Pharmacies, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).