Antidepressant drugs
Antidepressant drugs
Antidepressant drugs are used to treat serious, continuing mental depression that interferes with a person’s ability to function. Antidepressants, specifically the group MAOIs (monoamine oxidase inhibitors), were discovered in the early 1950s. The first MAOI found was iproniazid, which was initially used to treat tuberculosis. According to the National Institute of Mental Health, depressive disorders affect about 28 million U.S. citizens (and about 18.8 million adults), as of 2006. The rate of increase of depression is about 23% in children within the United States.
Everyone feels sad, blue, or discouraged occasionally, but usually those feelings do not interfere with everyday life and do not need treatment. However, when the feelings become overwhelming and last for weeks or months, professional treatment can help. Depression is one of the most common and serious mental disorders. However, it is also one of the most treatable. According to the American Psychiatric Association, 80 to 90% of people with depression can be helped. If untreated, depression can lead to social withdrawal, physical complaints, such as fatigue, sleep problems, and aches and pains, and even suicide.
The first step in treating depression is an accurate diagnosis by a physician or mental health professional. The physician or mental health professional will ask questions about the person’s medical and psychiatric history and will try to rule out other causes, such as thyroid problems or side effects of medicines the person is taking. Lab tests may be ordered to help rule out medical problems. Once a person has been diagnosed with depression, treatment will be tailored to the person’s specific problem. The treatment may consist of drugs alone, counseling alone, or drugs in combination with counseling methods such as psychotherapy or cognitive behavioral therapy.
Antidepressant drugs help reduce the extreme sadness, hopelessness, and lack of interest in life that are typical in people with depression. These drugs also may be used to treat other conditions, such as obsessive compulsive disorder, premenstrual syndrome, chronic pain, and eating disorders.
Description
Antidepressant drugs, also called antidepressants, are thought to work by influencing communication between cells in the brain. The drugs affect chemicals called neurotransmitters, which carry signals from one nerve cell to another. These neurotransmitters are involved in the control of mood and in other responses and functions, such as eating, sleep, pain, and thinking.
The main types of antidepressant drugs in use today are:
- Tricyclic antidepressants, such as amitriptyline (Elavil®), imipramine (Tofranil®), and nortriptyline (Pamelor®).
- Selective serotonin reuptake inhibitors (SSRIs or serotonin boosters), such as fluoxetine (Prozac®), paroxetine (Paxil®), and sertraline (Zoloft®).
- Monoamine oxidase inhibitors (MAO inhibitors), such as phenelzine (Nardil®), and tranylcypromine (Parnate®).
- Lithium (used mainly to treat manic depression, but also sometimes prescribed for recurring bouts of depression).
Selective serotonin reuptake inhibitors act only on the neurotransmitter serotonin, while tricyclic antidepressants and MAO inhibitors act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body. Selective serotonin reuptake inhibitors have fewer side effects than tricyclic antidepressants and MAO inhibitors, perhaps because selective serotonin reuptake inhibitors act only on one body chemical, serotonin.
Because the neurotransmitters involved in the control of moods are also involved in other processes, such as sleep, eating, and pain, drugs that affect these neurotransmitters can be used for more than just treating depression. Headache, eating disorders, bed-wetting, and other problems are now being treated with antidepressants.
All antidepressant drugs are effective, but different types work best for certain kinds of depression. For example, people who are depressed and agitated do best when they take an antidepressant drug that also calms them down. People who are depressed and withdrawn may benefit more from an antidepressant drug that has a stimulating effect.
Recommended dosage
Recommended dosage depends on the kind of antidepressant drug, the type and severity of the condition for which it is prescribed, and other factors such as the patient’s age. Check with the physician who prescribed the drug or the pharmacist who filled the prescription for the correct dosage.
KEY TERMS
Cognitive behavioral therapy— A type of psychotherapy in which people learn to recognize and change negative and self-defeating patterns of thinking and behavior.
Depression— A mood disorder where the predominant symptoms are apathy, hopelessness, sleeping too little or too much, loss of pleasure, self-blame, and possibly suicidal thoughts.
Obsessive-compulsive disorder— An anxiety disorder in which people cannot prevent themselves from dwelling on unwanted thoughts, acting on urges, or performing repetitious rituals, such as washing their hands or checking to make sure they turned off the lights.
Premenstrual syndrome (PMS)— A set of symptoms that occur in some women 2 to 14 days before they begin menstruating each month. Symptoms include headache, fatigue, irritability, depression, abdominal bloating, and breast tenderness.
Precautions
While antidepressant drugs help people feel better, they cannot solve problems in people’s lives. Some mental health professionals worry that people who could benefit from psychotherapy rely instead on anti-depressant drugs for a quick fix. Others point out that the drugs work gradually and do not produce instant happiness. The best approach is often a combination of counseling and medicine, but the correct treatment for a specific patient depends on many factors. The decision of how to treat depression or other conditions that may respond to antidepressant drugs should be made carefully and will be different for different people.
Always take antidepressant drugs exactly as directed. Never take larger or more frequent doses, and do not take the drug for longer than directed.
Most antidepressant drugs do not begin working right away. The effects may not be felt for several weeks. Continuing to take the medicine is important, even if it does not seem to be working at first.
Side effects
Side effects depend on the type of antidepressant drug.
Interactions
Antidepressant drugs may interact with a variety of other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Some interactions may be life-threatening. Anyone who takes antidepressant drugs should let the physician know all other medicines he or she is taking.
Resources
BOOKS
Breggin, Peter. The Anti-Depressant Fact Book: What Your Doctor Won’t Tell You About Prozac, Zoloft, Paxil, Celexa, and Luvox. New York: Persus, 2001.
Dworkin, Ronald William. Artificial Happiness: The Dark Side of the New Happy Class. New York: Carroll & Graf, 2006.
Preskorn, Sheldon H. ed. Antidepressants: Past, Present, and Future. Berlin, Germany, and New York: Springer, 2004.
Nancy Ross-Flanigan