For the 52.9 million Americans who have been diagnosed with depressionpersistent feelings of sadness, trouble sleeping, changes in appetite, trouble concentrating, and loss of interest in activities can difficult to operate.
The COVID-19 pandemic has led to a estimated 25% increase in the incidence of depression and anxiety worldwide and leads to a large increase in the number of antidepressants prescription refills with over 23% of adults taking a prescription drug for mental health.
Antidepressants are among the most common methods of treating depression.
Although there is some debate about the effectiveness of antidepressants in treating depression, there is studies showing that prescription drugs play an important role in treating depression, but getting relief can take time.
“Unfortunately, we do not have the ability to know which patients will respond best to which [antidepressant] treatment,” says Dr. Zachary Cordner, MD, Ph.D., assistant professor of psychiatry and behavioral sciences at Johns Hopkins Medicine. “With persistence and sometimes trial and error, depression is almost always treatable.”
There are several different classes of antidepressants used to treat depression.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are considered the “first-line” treatment for depression, according to Dr. Lokesh Shahani MD, Ph.D., associate professor of psychiatry at UTHealth Houston.
The drugs prevent neurons from absorbing serotonin, one of the neurotransmitters thought to be deficient in people with depression; Increasing serotonin levels are thought to alleviate depression.
“Most vendors would start someone who is [newly diagnosed with depression] on an SSRI,” adds Shahani. “It could be effective for about 40% of patients.”
SSRIs, which include fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and sertraline (Zoloft), target serotonin receptors only, not other transmitters or transmitters. bodily systems, which means there are fewer side effects compared to other antidepressants.
Serotonin-norepinephrine reuptake inhibitors
Like SSRIs, SNRIs target serotonin receptors, but these drugs also target norepinephrine, another neurotransmitter thought to be deficient in people with depression.
Cordner notes that SNRIs are often prescribed when someone has tried an SSRI but did not get enough benefit from the drug. Switching to an antidepressant like duloxetine (Cymbalta), venlafaxine (Effexor), or desvenlafaxine (Pristiq) that targets an additional neurotransmitter can have a much broader effect.
The drug, better known as Wellbutrin, is in a class of its own. Compared to SSRIs and SNRIs, which act on serotonin and norepinephrine, Wellbutrin increases dopamine, a different neurotransmitter.
“It has a different mechanism of action,” says Shahani.
Bupropion is often used in combination with other antidepressants, including SSRIs.
Although these are older antidepressants and no longer considered first-line treatments, Cordner believes TCAs are still effective in treating depression in some groups, but there are caveats. guard.
“TCAs impact a much larger number of neurotransmitters in the brain [and] their effects are broader than current first-line treatments and, perhaps because of this broader mechanism of action, they also come with a greater risk of side effects,” he says.
TCAs like desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Pamelor) have been linked to side effects like drowsiness, constipation, blurred vision, and dry mouth.
Shahani notes that some of the side effects, including confusion and urinary obstruction, tend to have a greater impact in older people and TCAs also tend to have a greater number of interactions with other medications. . Therefore, these antidepressants tend to be prescribed to younger populations.
Monoamine oxidase inhibitors (MAOIs)
MAOIs were among the first antidepressants. The drugs act on an enzyme, monoamine oxidase, which increases levels of serotonin, norepinephrine and dopamine in the brain, easing symptoms of depression.
MAOIs approved to treat depression include socarboxazid (Marplan), phenelzine (Nardil), and selegiline (Emsam) are linked to high blood pressure, drug interactions, food and drink interactions, and others serious side effects.
Although these “old” antidepressants are not as popular (or as safe) as newer drugs like SSRIs, there are still times when an MAOI may be prescribed.
“We tend to reserve these medications for treatment-resistant depression for patients who have failed the first two standard lines of antidepressant treatments,” Shahani says. “We strongly recommend that you consult a psychiatrist [if you plan to take an MAOI] to ensure there is no drug interaction.
Other treatments for depression
Antidepressants are just one of the treatments available for depression. Medication is often used in conjunction with counseling or “alternative” therapies such as acupuncture and massage.
New research into depression treatments has also led to new drugs and therapies like esketamine, an FDA-approved drug based on ketamine, or transcranial magnetic stimulation, a form of magnetic brain stimulation.
“There is still a lot of stigma around depression and sometimes the stigma is a barrier for patients accepting antidepressant treatment,” Shahani says. “What psychiatrists try to do is provide antidepressants so that you can recover from depression and live a meaningful life.”