Antidepressants
Antidepressants are a class of medications primarily used to treat clinical depression, a serious condition that significantly impacts a person's ability to function. They are also prescribed for anxiety disorders and other psychological conditions. Antidepressants work by affecting neurotransmitters in the brain, which play a crucial role in regulating mood and emotional responses. There are several classes of antidepressants, including first-generation drugs like monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants, as well as newer selective serotonin reuptake inhibitors (SSRIs). While effective for many, antidepressants can have varying side effects, and the response to treatment can be highly individualized, often requiring some experimentation to find the right medication.
Monitoring is essential, as some patients may experience suicidal thoughts, especially in the early stages of treatment. Over the past few decades, the use of antidepressants has increased significantly, particularly in developed nations, prompting discussions about potential overprescription and the influence of cultural attitudes towards mental health. Despite the availability of these medications, some individuals do not find relief from their symptoms, highlighting the need for ongoing research and alternative treatment options, including therapy.
Antidepressants
DEFINITION: A group of drugs used for the treatment of clinical depression
ANATOMY OR SYSTEM AFFECTED: Brain, nervous system, psychic-emotional system
Indications and Procedures
Antidepressants are prescribed most often to individuals suffering from symptoms of clinical depression, a severe form of depression that interferes with the person’s ability to function (for example, to hold down a job or to handle the responsibilities of being a student). The symptoms of depression must be present for at least two weeks before a diagnosis is made and treatment is recommended. Depression may be treated with antidepressant medications, brief psychotherapy, or a combination of both. Antidepressants are also used in the treatment of anxiety disorders.
Several classes of antidepressants can be considered as treatment options for depression. Each class of drugs acts on the nervous system in its own unique way, and each class produces different kinds of side effects. Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants are regarded as two different classes of first-generation drugs. These two classes and the selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac), all affect the nervous system by increasing the availability of neurotransmitters such as norepinephrine or serotonin. There are also some atypical antidepressants that do not fit clearly in these categories, including bupropion, trazodone, mirtazapine, and others.
Although physicians have several classes of drugs at their disposal to combat the effects of depression, no single drug or class of drugs has been found to be significantly more effective in treating symptoms. In fact, no reliable test exists to discover which antidepressant will be most effective for a particular patient. It is the case, however, that most patients will respond favorably to one class of drugs over the others. The effectiveness of antidepressants can be evaluated on two fronts: the degree to which symptoms of clinical depression are reduced and the pervasiveness of any adverse side effects that may result from a particular medication.
Uses and Complications
Because all antidepressant medications cause some adverse side effects, physicians attempt to determine the minimum clinically effective dose. For some patients, antidepressants may cause suicidal ideation in the first few weeks of their use. Anyone taking antidepressants should be closely monitored by a physician, especially when the medication is first prescribed. Patients should discuss how they are feeling with their doctor after a new antidepressant medication is prescribed so that the physician can evaluate the effectiveness of the antidepressant and identify any adverse side effects. Because there are several different types of antidepressants available, some experimentation may be necessary to determine which medication works best for a given patient.
In terms of specific side effects of drugs, MAOIs may produce a serious adverse side effect known as a hypertensive crisis, which results in a rapid elevation of blood pressure. This condition is caused by an interaction of the drug with foods containing tyramine, such as aged cheeses, aged meats, and red wines; thus, these foods must be avoided while MAOIs are in use. Less serious side effects produced by MAOIs include constipation, diarrhea, and difficulty falling asleep.
Tricyclic antidepressants may produce dry mouth, blurred vision, or weight gain. However, the most serious aspect of tricyclics is the danger if an overdose is taken, as fatal cardiac rhythm disturbances can occur. Given that patients suffering from depression may have thoughts of suicide, the amount of prescription given at one time must be carefully monitored and should be limited.
SSRIs typically have fewer and more easily tolerated side effects than the first-generation antidepressants. However, some patients will experience weight gain and sexual dysfunction resulting in the loss of the sexual drive.
Abruptly stopping an antidepressant prescription will lead to a range of withdrawal symptoms, from feeling more depressed to becoming irritable to developing flu-like symptoms. Although the withdrawal symptoms may not always be dangerous, it is recommended that antidepressants be reduced in dosage over a period of several days.
Perspective and Prospects
Since the late 1980s, individuals suffering from depression have had access to medications that produce fewer adverse side effects than first-generation antidepressants. Investigators are also learning that antidepressants can help patients with other psychological conditions, such as bipolar disorders, anxiety disorders, panic attacks, and obsessive-compulsive disorder.
Despite the successes that have come with the availability of several classes of antidepressants, there still remains a group of patients suffering from depression who do not benefit from them. Investigators are continuing to look for more effective treatments, particularly ones that can alleviate the symptoms of depression more quickly. Group therapy and cognitive behavioral therapy (CBT) are also effective in the treatment of depression and should be used in combination with antidepressants to improve treatment outcome.
Some observers have also expressed concerns over the drastic spike in antidepressant prescriptions in the late twentieth and early twenty-first centuries. This trend was seen in many populations around the world, but especially in developed nations such as the United States and Great Britain. For example, in 2017, the US Centers for Disease Control and Prevention (CDC) noted that between 1999 and 2014, the number of Americans reporting having taken an antidepressant in the past month increased 65 percent to about one in every eight citizens. The study also found that a quarter of those using antidepressants were long-term users of ten years or more, and that women were almost twice as likely as men to take such drugs. Some experts suggested that the rise in antidepressant use was simply due to their approval in treating a growing range of conditions, as well as increasing social acceptance of the drugs. However, others argued that heavy antidepressant prescribing could reflect alarming broad social trends of increased stress, anxiety, and depression, possibly connected to factors such as social media. Additionally, some mental health experts warned that cultural expectations of "wonder drugs" to improve one's feelings—reinforced by pharmaceutical advertisements—contributed to the growth in antidepressant use, possibly to the degree of overprescription. In 2022, the United Kingdom's Pharmaceutical Journal reported a six-year annual increase in antidepressant use, equal to a 34.8 percent increase. In 2024, the American Academy of Pediatrics published a study that found that the monthly rate of antidepressant prescriptions for young adults and teens in the US had increased by more than 66 percent from 2016 to 2022. The researchers also found that after March 2020, when the global COVID-19 pandemic was declared, the monthly rate of prescriptions for female teens and young adults nearly doubled, while the monthly rate for male teens and young adults decreased.
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