They Balance Brain Chemicals
Brain chemicals called neurotransmitters affect mood. People who suffer from depression and other mood disorders may have altered levels of these chemicals. Antidepressants work by helping to normalize the levels of these compounds. This makes the brain chemicals more available to do their job in the brain. All physicians have the ability to prescribe antidepressants. People who have severe or difficult-to-treat mood imbalances are best treated by a doctor who is an expert in sing medications to help balance brain chemistry. These doctors are called psychiatrists. Depression and mental health disorders are serious issues that need to be treated by a medical professional.
Types of Antidepressants
Different classes of drugs work in slightly different ways. Selective serotonin reuptake inhibitors (SSRIs) allow more of the neurotransmitter serotonin to be available in the brain. Sertraline (Zoloft), fluoxetine (Prozac), and proxetine (Paxil) are a few types of SSRIs. Tricyclic antidepressants (TCAs) allow more serotonin and norepinephrine to be available. Protriptyline (Vivactil), trimipramine (Surmontil), and imipramine (Tofranil) are a few kinds of tricyclic antidepressants. Monoamine oxidase inhibitors (MAOIs) slow down the breakdown of serotonin, dopamine, and norepinephrine in the brain. Isocarboxazid (Marplan), phenelzine (Nardil), and rasagiline (Azilect) are a few types of monoamine oxidase inhibitors. Everyone is different, but many depressed patients are first prescribed one of the SSRIs. If that doesn't work, a tricyclic may be the next option. There are more risks and negative effects associated with these drugs.
Antidepressants work best to treat depression when they are paired with psychotherapy, but they do not work right away. Many antidepressants take between 1 to 3 weeks to start working. It can take even longer before they reach maximum efficacy. Most symptoms associated with depression -- lack of interest in things that were once enjoyable and feelings of hopelessness and sadness -- will eventually improve with antidepressant treatment. In rare cases, some individuals may be resistant to certain antidepressants and it may take a trial and error approach with other medicines to find one that works. The effects of a drug may not be known for weeks or months. Each different type and class may be associated with different potential risks.
Increase the Dose or Switch?
In general, it takes approximately 4 to 6 weeks for antidepressants to work. If you are still experiencing symptoms after this amount of time, talk to your doctor. You may need to increase the dose of your current antidepressant drug or switch to another one altogether. Some people experience treatment failure with the first antidepressant they try. In these cases, switching to a medicine in a different class may do the trick. It may take a full 3-month period to experience maximum benefits from an antidepressant. Very rarely, some individuals who have been on an antidepressant for some time may notice that the drug stops working. Always discuss any difficulties you're having with any drug with your health care professional. Untreated depression is a risk to your mental health.
Generic Is the Same, Usually
The US Food and Drug Administration (FDA) says that the safety, strength, and quality of generic drugs are equal to those of brand-name drugs. However, in practical experience, some people notice that they do not experience the same benefits from a generic drug compared to the brand-name version. Results of some studies suggest generic medications may be absorbed and used by the body slightly differently than brand-name drugs. If you notice a generic medicine is not working as well as a brand-name medicine did for you, tell your physician.
Do Not Quit Antidepressant Drugs Prematurely
Antidepressant treatment for depression can last for several months up to a year. It is important not to lower the dose of your medication or stop taking it just because you start to feel better. Depression will likely return if you do so. Stay on the correct dose for as long as your doctor tells you to do so. Take the drug at the same time every day for maximum benefit. You may want to take your pills at breakfast every morning as an easy way to remember to take your medication. People who are depressed may have a hard time complying with treatment. Discuss any issues with your medical professional.
Some individuals may experience side effects from antidepressants. Be sure to discuss them with your doctor. Some common side effects may include increased or decreased appetite, difficulty sleeping or sleeping too much, weight gain or weight loss, or difficulties with sexual response. Some people may experience nausea. Your doctor can help you come up with solutions to handle potential side effects. If the medication makes you nauseous, taking it with food may help. If your antidepressant makes you sleepy, try taking it in the evening before bed. In contrast, certain antidepressants are best taken in the morning. Often, side effects from antidepressants are temporary and may go away after a few weeks of being on them. If side effects are severe, your doctor can prescribe a different medication for you. Never stop taking antidepressant medication abruptly. Doing so may cause serious withdrawal symptoms and depression to return.
Antidepressants that are prescribed today are often far more gentle and have fewer side effects and drug interactions compared to older generation drugs in different classes. However, reactions with other medications, herbs, and supplements you are taking are always possible. Interactions may interfere with the way a drug works or may reduce the effectiveness of a drug. Always make sure your prescribing physician knows about all of the prescription and over-the-counter medications, supplements, and herbs you are taking.
Regular follow up visits with your health care professional are essential. Depression and anxiety are serious illnesses and can be associated with suicidal thoughts and other symptoms. It is imperative to go for follow up appointments as instructed. Treatment with selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), monoanmine oxidase inhibitors (MAOIs), and other antidepressants requires monitoring and fine tuning. The goal is to alleviate depression and anxiety without side effects and symptoms returning. You may also need adjustments to treatment if you undergo a major life change such as being diagnosed with a serious illness or losing a job. Women who are pregnant may also need to adjust the type or dose of medication they are taking. Some medications can have negative effects on a developing fetus.
Many people are afraid to take antidepressant drugs to treat depression and anxiety because they believe the myths perpetuated about treatment. Some worry that antidepressant drugs will make them robotic and emotionless. They can help eliminate feelings of sadness and hopelessness, but they won't make you out of touch with your emotions. Some people also falsely believe they will need to be treated with antidepressants for life. Most people are treated for between 6 to 12 months. Follow your health care professional's guidance about starting, increasing, decreasing, or stopping prescribed drugs. Not following instructions may lead to uncomfortable side effects. Abruptly stopping antidepressants is dangerous and may lead to withdrawal symptoms.
Results of several studies suggest that a combination of antidepressant medication with psychotherapy is the most effective treatment for depression. Mental illness is serious. It is important to take depression medication as directed and to see a therapist regularly. Mental illness is nothing to be ashamed of. Millions of people suffer from depression, anxiety, and other mental health disorders. People should feel comfortable seeking help for mental health disorders just as they would for other organic medical conditions like heart disease or diabetes. Cognitive behavioral therapy (CBT) helps monitor and change unwanted thoughts and behaviors. Interpersonal therapy helps patients have better and more effective relationships with others.
Studies prove that exercise helps alleviate depression as well as medication in cases of mild depression. Some studies suggest exercise can help medicine work better. Get a check-up and your health care professional's permission before embarking on an exercise program for the first time to make sure you're healthy enough for physical activity. Walking is a great activity if you are new to exercise. Working out with a friend or group can help you stay dedicated to your program and provide the added benefit of social support, which is also beneficial for depression. Exercise releases endorphins, chemicals that boost mood and promote well-being.
Weaning off an antidepressant must be done carefully to avoid withdrawal symptoms. Follow your health care professional's instructions for reducing your dose and eventually stopping the medicine. Getting off antidepressants too soon could make depression come back. In general, lowering the dose very gradually is the best plan. Let your doctor know if you experience side effects or symptoms when lowering the dose of your medicine or stopping it altogether.
Getting help for depression is the right thing to do. The risks of untreated depression outweigh the potential side effects of medication. Ongoing clinical trials continue to study new potential therapies for depression and other mood disorders. The US FDA has placed a black box warning on some SSRIs, MAOIs, and TCAs advising of a potential increased risk of suicidal thoughts and behavior in teens and young adults aged 18 to 24 within the first initial 2 months of treatment.
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- National Institute of Mental Health: “Mental Health Medications.”
- UpToDate: “Tricyclic and Tetracyclic Drugs: Pharmacology, Administration, and Side Effects.”