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Controlled substances policyAbout Antidepressants
Antidepressants are prescribed to patients having mental health issues like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and chronic pain due to underlying health conditions. These medications are used to treat clinical depression. However, they are not recommended for mild anxiety or depression, where therapy can help.
What conditions do antidepressants treat?
Antidepressants can be prescribed depending on the patient’s medical history and the severity of the condition he is currently suffering from. For example, your doctor may prescribe you antidepressants if you are suffering from any of the following conditions:
- Long-term pain
- Clinical depression
- Generalized anxiety disorder
- Obsessive-compulsive disorder
How do antidepressants work?
The precise mechanism of action for antidepressants is not clear. However, they are believed to function by elevating neurotransmitters and chemicals in the brain associated with mood and emotions, i.e., serotonin and noradrenaline.
These neurotransmitters may also impact the transmission of pain signals through nerves, providing a potential explanation for the alleviation of chronic pain observed in some cases with the use of antidepressants.
While antidepressants effectively address depression symptoms, they may not directly target the root causes of depression. Consequently, they are often employed in conjunction with therapy, particularly in the treatment of more severe depression or other mental health conditions.
Types of antidepressants
Different classes of antidepressants serve different modes of action and purposes as follows:
1. Tricyclic antidepressants (TCAs)
One of the oldest known antidepressant classes is tricyclic antidepressants, used to treat health conditions like OCD, bipolar disorder, or, in some cases, chronic nerve pain. However, doctors no longer recommend them due to more side effects than the new alternatives like SNRIs and SSRIs. Here are some of examples of drugs that belong to this class:
- Amitriptyline
- Clomipramine
- Dosulepin
- Imipramine
- Lofepramine
- Nortriptyline
2. Monoamine oxidase inhibitors (MAOIs)
This is another older class of antidepressants which is not recommended usually due to many serious side effects of the drug unless deemed fit by your doctor. Here are some of the examples:
- Tranylcypromine
- Phenelzine
- Isocarboxazid
3. Selective serotonin reuptake inhibitors (SSRIs)
This class of antidepressants is widely prescribed and is preferred over traditional classes due to fewer side effects. Even their overdose is less serious than others. One of the frequently prescribed SSRIs is fluoxetine, sold under the brand name Prozac. Others include the following:
- Citalopram (Cipramil)
- Escitalopram (Cipralex)
- Paroxetine (Seroxat)
- Sertraline (Lustral)
4. Serotonin-noradrenaline reuptake inhibitors (SNRIs)
Another class of antidepressants similar to SSRIs is serotonin-noradrenaline reuptake inhibitors (SNRIs), designed to treat depression effectively. For example:
- Duloxetine (Cymbalta and Yentreve)
- Venlafaxine (Effexor)
5. Serotonin antagonists and reuptake inhibitors (SARIs)
This class of antidepressants is only recommended when other options don’t work and aren’t considered the first choice of drugs for the treatment of mental health disorders due to its serious side effects, for example, trazodone (Molipaxin).
6. Noradrenaline and specific serotonergic antidepressants (NASSAs)
This class is recommended for those who are unable to take SSRIs. Although its side effects are similar to SSRIs, they don’t cause as many sexual problems as SSRIs do. They may have a sedative effect, i.e., mirtazapine (Zispin).
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Side effects of antidepressants
Different classes of antidepressants can have different side effects. However, depression or the underlying health condition can worsen if left untreated than the side effects of treatment itself. Here are some of the general side effects antidepressants can impose:
- Nausea
- Diabetes
- Headaches
- Suicidal feelings
- Sexual problems
- Decreased alertness
- Serotonin syndrome
- Hypomania or mania
- Gastrointestinal bleeding
- Neuroleptic malignant syndrome
- Tooth decay and oral health issues
Who should not take Antidepressants?
Underlying health conditions in some people may make certain antidepressants unsuitable for use. In the case of Tricyclic Antidepressants (TCAs):
- People with epilepsy
- People with liver disease
- Individuals with a history of heart disease
- Those who have recently experienced a heart attack
- Those diagnosed with an inherited blood disorder known as porphyria
- Men with an enlarged prostate gland (benign prostate enlargement)
- Individuals with bipolar disorder or schizophrenia
- Individuals diagnosed with glaucoma, characterized by increased eye pressure
- People with a growth on the adrenal glands causing high blood pressure (pheochromocytoma)
Similarly, for Selective Serotonin Reuptake Inhibitors (SSRIs):
- Those with a bleeding disorder
- Individuals with kidney disease
- Individuals with type 1 or type 2 diabetes
- Individuals with bipolar disorder during a manic phase (although they may be beneficial for depressive phases)
- People with epilepsy (only recommended if the condition is well-controlled, with discontinuation if epilepsy worsens)
Consultation with a healthcare professional is crucial to determine the most suitable antidepressant based on individual health factors.
FAQs about antidepressants
Can I get antidepressants without seeing a doctor?
To obtain prescription medication for depression, it is necessary to consult with a doctor or mental health professional. Following their assessment, if deemed beneficial, they may prescribe an antidepressant, such as a selective serotonin reuptake inhibitor (SSRI).
Who can prescribe antidepressants?
Healthcare professionals authorized to prescribe antidepressants include your general practitioner (GP), a psychiatrist, a specialist nurse prescriber, and a pharmacist.
Can you buy antidepressants over the counter?
Antidepressants cannot be purchased over the counter as they require a prescription from a certified doctor. However, telemedicine allows you to consult with a healthcare professional remotely and get prescriptions delivered to your pharmacy in less than an hour.
Are there any psychiatric conditions you can’t help with?
Some psychiatric conditions are difficult to treat, like borderline personality.
How do doctors decide which antidepressant to prescribe?
Doctors consider the patient’s symptoms, family history, health conditions, and other relevant aspects when determining which antidepressant to prescribe.
Can primary care physicians prescribe antidepressants?
Yes, primary care providers (PCPs) are qualified to prescribe antidepressants commonly used for treating mental health conditions like depression, anxiety, and post-traumatic stress disorder.
When are antidepressants prescribed?
Antidepressants are primarily prescribed for treating clinical depression in adults and are also employed for other mental health conditions and the management of long-term pain. In most cases, adults with moderate to severe depression receive antidepressants as the first line of treatment.
What antidepressants can a primary care physician prescribe?
Primary care providers (PCPs) can and do prescribe antidepressants, which are frequently utilized for various mental health conditions such as depression, anxiety, and post-traumatic stress disorder. These include antidepressants like Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline, Vortioxetine, and Trazodone.
How long does it take for antidepressants to start working?
Antidepressants typically require 1 or 2 weeks of consistent intake before their benefits become noticeable. It is essential not to discontinue usage due to mild early side effects, as these effects usually subside quickly.
Can antidepressants be used during pregnancy?
While the risk of birth defects from exposure to antidepressants is generally low, some antidepressants may pose a higher risk of complications for the baby during pregnancy. Consultation with a healthcare provider is, therefore, mandatory.
Can I stop taking antidepressants on my own?
Antidepressant use should be stopped gradually, with smaller dose reductions over an extended period. Abrupt discontinuation is only recommended in case of rare serious side effects that necessitate urgent medical attention.
How long should I continue taking antidepressants?
A recommended course of antidepressants typically extends for at least six months after symptom improvement to prevent recurrence. Some individuals with recurrent illness may be advised to continue medication indefinitely.
How do doctors diagnose depression?
Diagnosing depression involves a doctor’s consultation for symptom inquiry and, if needed, blood tests to rule out other conditions. A psychological evaluation assesses feelings and symptoms, including sadness, loss of enjoyment, and changes in weight or appetite.
Can online doctors prescribe anxiety medication?
Yes, online doctors can diagnose and treat anxiety via prescription medications during video or audio consultations, where discussions cover symptoms, medical history, and current medications.
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