Anti-Depressants Background

By: Chris Anderson Psy.D.

Antidepressants have been around since the 1950’s and have a number of applications. Most people assume they are simply used for depression, but many people don’t realize how often they are used to treat anxiety, OCD, PTSD, and social anxiety. They have also been shown to have some success with issues like anorexia and trichotillomania, which is a hair pulling disorder. According to results from the National Center for Health Statistics 12% of the U.S. population used antidepressants in the past month. With the stigma surrounding mental health declining over the past 20 years, more people are seeking help for their issues and this has resulted in a 64% increase in people using antidepressants since 1999. Research says 20% of the population (1 in 5 people) will struggle with some kind of depression or anxiety at some time in their lives. For this reason, it is important to know how these medications work and how effective they are.

What are the different types of anti-depressants?

There are three different types of antidepressants, which all work differently. The Tricyclic antidepressants (TCA’s) are the oldest and first generation of antidepressants. These were commonly prescribed up through the 1980s. Although they help with depression and anxiety, the side effects are difficult for a lot of people to tolerate. The TCA’s often come with side effects that include blurred vision, dry mouth, constipation, low blood pressure when standing, weight gain and sedation. In fact, TCA’s are still often prescribed for their sedating side effect. Trazadone is one of the old TCA’s that is often given for insomnia because of the sedating side effect is caused. For most people, this array of side effects persists as long as you take them, which fueled some of the dislike and non-compliance with this medication and brought about the switch to the other two groups of antidepressants.

In the late 1980’s and early 1990’s two new groups of antidepressants came onto the market; Selective Serotonin Reuptake Inhibitors (SSRI’s) and Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s). The main difference between the two is the neurotransmitters they target with SNRI’s also targeting norepinephrine in addition to serotonin. Common SSRI’s include Prozac, Paxil, and Zoloft and newer ones such as Lexapro and Celexa. Common SNRI’s include Wellbutrin, Cymbalta, and Effexor. Side effects of these antidepressants include nausea, vomiting, headaches, dizziness, and sexual side effects. For most people, these side effects are short-lived until the body adapts to it over a few days. Sexual side effects can persist for a lot of people on SSRI’s, however, SNRI’s seem to be a better alternative if these side effects are persisting.

Antidepressants in the Body

Many people wonder how antidepressants work, so we will give you a quick overview of the mechanism of action. Neurons communicate chemically between each other with microscopic chemicals called neurotransmitters, such as serotonin and norepinephrine to name the two relevant ones. One neuron releases these chemicals in the little space between it and the next neuron in order to communicate to the next neuron. The body is designed for efficiency and recycles these neurotransmitters by sucking them back up into the neuron to be used again. The process of sucking them back into the neuron is called a reuptake mechanism. Antidepressants inhibit the reuptake mechanism, which leaves more serotonin and norepinephrine floating around in a person’s system. We know that people with depression and anxiety have less of these chemicals in their system than they should, so the medications are essentially providing more of the chemicals in the system by disrupting the recycling process. We also know that increased serotonin and norepinephrine impacts mood positively and tend to reduce depressive feelings and anxiety. In short, you are not taking a pill full of serotonin, but actually allowing more of your own serotonin to be accessible and used in your body.

Antidepressant Effectiveness

Now that you know more about how antidepressants work, let’s talk about how effective they really are. Most of the research studies look at trials of depressed or anxious clients who are on the real antidepressant compared to depressed or anxious clients on a placebo (a harmless pill with no real action). The results of these studies show that the antidepressants do work better than a placebo. Studies show that out of 100% of people who used antidepressants, about 60% saw improvement in their symptoms while on medication. This means roughly 40% did not improve on antidepressants. Of those 60% that it helped, most noticed improvement within 6-8 weeks and they reported a 50% reduction in their depressive symptoms. Another study showed that the more severe the depression, the greater the impact the antidepressant had. This suggests that mild depression may not see as a marked improvement as more severely depressed people. Additionally, many people report greater improvement on the physical symptoms of depression and anxiety (sleep, appetite, energy, concentration, muscle tension, moods) relative to the psychological symptoms (feel sad, feeling worthless, loss of pleasure in activities, feeling helpless, etc.). In most courses of treatment with antidepressants, it is suggested people stay on the medication for 1-2 years to prevent relapse. This can be good advice for people who have chronic depression or a history of depressive episode relapses. Some of the most effective brands of antidepressants include Effexor, Cymbalta, Prozac, Zoloft, and Celexa. Around 60-65% of people taking these anti-depressants reported improvement and felt the medication was worth it.

Discontinuing Treatment

Deciding when to discontinue antidepressants can also be a tricky decision and one you should consult your physician or psychiatrist about. Generally speaking, it is never recommended to stop antidepressants abruptly. Some people can develop unpleasant side effects or reactions depending on the medication and many people who stop abruptly are at increased risk for relapse or a rebound episode of depression or anxiety. Most doctors are able to tell you how to wean down over a period of time. It is best to do when you have been symptom-free for a period of 3-6 months and there are no major stressors in the foreseeable future because stress can put people at risk for another episode of depression or anxiety.

*Warning: This information is not intended to be construed as medical advice. You should always consult a physician or psychiatrist about the best treatment for you.

If you are interested in talking with one of our psychiatrists to see if an antidepressant is right for you, please call us now at 763-416-4167, or request an appointment on our website: WWW.IPC-MN.COM so we can sit down with you and complete thorough assessment and help you develop a plan of action that will work for you. Life is too short to be unhappy. Find the peace of mind you deserve.

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