Regardless of the importance of non-medical treatment options for depression like talk therapy and physical exercise, none of them can be as quick and effective as medication. The primary form of medication for depression is antidepressants which help boost brain activity and alleviate depression symptoms. They are usually prescribed in conjunction with alternative therapies. They correct chemical or hormonal imbalances that produce dysfunctional behavior in the patient. Psychotherapy is often required to look into the causes that lead to depression and arrive at remedial measures.
It may take some time before you start experiencing the benefits of the medication. Some people start reporting changes in their mood and behavior as early as the second to the third week, while in others, it may take a little longer. If you do not notice any changes after taking the medication for at least four to six weeks, you must consult your doctor to have the prescription or dosage changed.
Once the drug starts taking effect, you will notice that you have more energy and will to carry out tasks, and you may start enjoying routine challenges. Standard depression medication is not known to be addictive. However, there are certain categories of drugs used for the treatment of rare forms of depression that may become addictive in the long run.
In case you feel intoxicated or experience short bouts of euphoria after taking the medication, you must consult your doctor immediately. This could possibly be a side effect, or it may be the result of interactions with other drugs.
Most of the commonly prescribed antidepressants have mild side effects that disappear over time. However, if you experience anything unusual, you must discuss it with your doctor before continuing the medication.
How depression medication works
Depression is experienced when there is an imbalance of neurotransmitters in the brain like dopamine, norepinephrine, and serotonin. These chemicals are responsible for regulating emotions, and an imbalance, especially a negative one, can lead to depression. Contrary to popular belief, depression medications do not contain these neurotransmitters; rather, they stimulate the brain to produce either more or less of them.
These neurotransmitters alleviate negative moods of the individual and enable him to handle stressors with equanimity.
Depending on the type of depression, there are different medications that work to treat the problem.
Selective serotonin reuptake inhibitors (SSRIs)
These are very common antidepressants that are used for the treatment of clinical depression and other mood and anxiety disorders. The drugs work on the serotonin transporters by limiting their activity, thereby limiting the reabsorption of serotonin. This allows most of the serotonin to remain in the presynaptic cell, increasing the level of serotonin. SSRIs barely affect norepinephrine and dopamine transporters.
Examples of SSRIs include sertraline (marketed as Zoloft), fluoxetine (Prozac), citalopram (Celexa), and paroxetine (Paxil).
They are common in most countries because their side effects are somewhat mild and tolerable. Some of their side effects include agitation, diarrhea, nausea, tremors, dry mouth, excessive sweating, headaches, insomnia, and reduced sex drive and other sexual problems including difficulty in reaching orgasm and erectile dysfunction. However, most of these symptoms subside with continued use of the drug.
In a few cases, there may be other side effects, mainly due to SSRI's interaction with other drugs. If you experience confusion, difficulty in walking, hallucinations, an inability to pass urine, or if you notice blood in your vomit or stool, you must get in touch with your doctor immediately.
Some elderly patients may suffer hyponatremia or a sudden fall in the sodium levels in the body's cells. This condition can turn dangerous if it remains unchecked. The common symptoms of hyponatremia are muscle pain, confusion, disorientation, headache, and seizures. It is always advisable to consult a doctor immediately if you suspect any of these symptoms in an elderly patient.
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Unlike SSRIs which act on the neurotransmitter serotonin alone, SNRIs have the added advantage of increasing norepinephrine levels in the brain as well. They function in the same way as SSRIs, and some common types include venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).
They don’t have many side effects either, but some of them can be observed as causing nausea, constipation, fatigue, dry mouth, and drowsiness. Some SNRIs are known to cause sexual dysfunction. Other possible side effects are loss of appetite, headache, and anxiety.
Tricyclic antidepressants (TCAs)
These were among the first types of depression medications invented in the 1950s for the treatment of depression. They essentially work in the same way as SNRIs--by blocking serotonin and norepinephrine transporters, raising the concentration of these compounds and increasing neurotransmission across the synapses.
Examples of TCAs include amitriptyline, amoxapine, clomipramine, and doxepin.
It is rare for a patient to be prescribed TCAs because they tend to have numerous negative side effects that may be disabling to the user. Dosage may also determine the nature and intensity of side effects. Some of these side effects include:
They can also have serious side effects like:
- Low blood pressure
- Arrhythmia, i.e., irregular heart rate
Despite these potentially harmful side effects, TCAs are still used in serious cases of depression when other medications fail to work.
Patients who have heart problems, or are under medication for a thyroid condition, or have an enlarged prostate should avoid TCAs. Consumption of alcohol inhibits the effect of this medication and should therefore be avoided.
Monoamine oxidase inhibitors (MAOIs)
These are used to prevent the breakdown of norepinephrine, serotonin, and dopamine. Because they are so strong and tend to interact with other drugs, they aren’t often prescribed. However, just like TCAs, they may be used when other common medications fail.
Examples of MAOIs are isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate).
The following precautions must be kept in mind if you have been prescribed MAOIs.
a. MAOIs react with other medicines that you may be taking. Before you begin using MAOIs, you must inform your doctor about all such medications. During your treatment, always consult the doctor before using another drug. Make a habit of carrying a card stating that you are on MAOIs. This card has details about the food, drinks, and medicines that could be dangerous for you. Before allowing yourself to be subjected to any medical treatment, you must show this card to the concerned healthcare worker.
b. You must avoid all food containing high amounts of tyramine like milk, poultry, cheese, and yeast. Alcoholic beverages also contain a significant percentage of tyramine.
c. Before switching over to any other antidepressant, there must be an intervening period of at least two weeks to eliminate complications.
All antidepressants may at times cause an impulse to commit suicide, especially in children and young adults. If you feel any such urge, consult your doctor immediately. It is always advisable to let people around you know that you are taking antidepressants so that they can reach out during emergencies.