Antidepressants: A Complete Review of Proven Medication

These are drugs that provide symptom relief for persons suffering from depression spectrum disorders. These medications are many and varied, with their benefits linked to specific conditions regarding mental health. Caution is advised when dealing with antidepressants, many of them having a series of severe side-effects.

This comprehensive report shall provide an overview of antidepressant medications. First by detailing the complicated world of mental illness, with respect to treatment options. After a short definition of depression meds, we will move on to why and how they work. Mental health drugs battle against multiple conditions, it’s central to know which.

It is furthermore important that the current state of antidepressants be considered. Thus, we’ve gathered statistics and research data to help. The latter part of the article will then underline the pros and cons of using antidepressants. Referencing side effects of specific drugs is principal for a complete review, so there will be a part on that too.

Before we begin our review, know depression is a severe issue. Mental health is a sensitive topic, so all steps must be tread with utmost respect for the suffering.

Contents

Living with Clinical Depression

General Depression Treatment Options

Achieving Relief through Antidepressants

What Are Antidepressants?

How Do Antidepressants Work?

Types of Antidepressants

Table of Active Substances in Antidepressants

List of Antidepressants Available over the Counter

A Word of Caution on Antidepressants

Antidepressant Statistics, Usage, and Research

Popular Antidepressant Usage Statistics

New Antidepressants and their Effectiveness

Advantages and Disadvantages of Antidepressant Medication

General Benefits of Antidepressants

Side Effects of Antidepressants

Conclusion

Living with Clinical Depression

Depression is not a singular issue. The depression spectrum disorders include:

• Major depression. Lack of motivation/interest is the main symptom. It is generally accompanied by weight loss, trouble sleeping and concentrating. One devalues him or herself to the point of feeling worthless. Excessive guilt also comes into play, in some cases leading to thoughts of suicide. Most other types of depression show these symptoms, yet have a clear distinctive feature.
• Persistent depression. Depression lasting two years or more.
• Postpartum depression. Occurring in mothers over the months after childbirth.
• Psychotic depression. Characterized by hallucinations, delusions, and paranoia.
• Situational depression. Depression occurs in an on-and-off state.
• Atypical depression. Lacking one or more of the typical symptoms. Inability to accept criticism.

These are the most common conditions for treatment via antidepressants. The complete list of depressive disorders is longer and far-reaching, covering bipolar disorder, addiction, anxiety, and many others.

General Depression Treatment Options

Depressive disorders and mental health issues, in general, do not possess a definitive cure. Unlike traditional diseases, these deal with the human psyche. The psyche is a fragile biological machine we have only just begun to understand.

The typical depression treatment options are:

• Lifestyle changes. Health care specialists recommend patients with depression undergo habitual changes. Exercise is recommended, as well as changing one’s diet. Addictive activities need to be stopped. Lastly, the patient must implement regular sleeping patterns.
• Therapy. Counseling is not only recommended, it should be required. In the UK, it’s mandatory for people under 18. Typical therapy includes cognitive behavioral, interpersonal, and family therapy. Some may employ psychoanalytical methods for more severe cases.
• Antidepressants. Studies show conflicting results when it comes to depression medication healing the disorder. Therefore, as mentioned above, antidepressant medication should only be utilized for symptom relief.
• Other methods. These include but are not limited to: electroconvulsive therapy, transcranial magnetic stimulation, and light therapy.

Achieving Relief through Antidepressants

Antidepressants typically combine psychological effects with pharmacological ones. Subjects that undergo treatment with this type of medication must show patience. The relief generally coming with depression meds shows only after a period of two weeks.

Furthermore, remission sets in after at least six weeks. After this period, medication is still necessary for at least 16 weeks to maintain remission. Medication for adolescents and young adults is furthermore restricted as studies have shown a higher risk of suicide through overdose in these age groups.

What Are Antidepressants?

Treating depression spectrum disorders is not as easy as taking antidepressants. Still, while therapy and other methods help resolve the root cause, these medicines aid a great deal in improving social behavior. Antidepressant meds work mainly towards healing depression, but also help fight anxiety. They improve appetite and some act as painkillers as well.

Most depression drugs are only purchasable with a written prescription from your health care provider. Antidepressants over the counter include several dietary supplements that significantly improve response. As we’re dealing with a case by case basis, there is no best antidepressant. Each doctor may choose the one(s) he or she thinks best fits each case.

How Do Antidepressants Work?

Nearly all antidepressants regulate the brain’s serotonin levels for a specific outcome. Because of this, there are many good antidepressants for anxiety as well. This outcome differs depending on the types of drugs. We’ve outlined the most important ones below.

Types of Antidepressants

There are eight main types of antidepressants:

• Selective serotonin reuptake inhibitors (SSRIs). SSRIs increase serotonin levels in the synaptic cleft. Research has contested their effectiveness on mild to moderate depression spectrum disorders.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs inhibit the norepinephrine and serotonin reuptake, this severely altering a patient’s mood. Recently, MAOIs have begun to replace inhibitors because they cover a wider range of symptoms.
• Serotonin modulators and stimulators (SMSs). SMSs act both as serotonin reuptake inhibitors and modulators of serotonin receptors.
• Serotonin antagonists and reuptake inhibitors (SARIs). As the name suggests, SARIs antagonize the serotonin receptors, thus inhibiting norepinephrine, serotonin, and sometimes dopamine reuptake.
• Norepinephrine reuptake inhibitors (NRIs). NRIs only inhibit norepinephrine through by blocking its transporter.
• Tricyclic antidepressants (TCAs). TCAs are basically SNRIs. They block the transporters of serotonin and norepinephrine. The advantage of TCAs is that they do not act as dopamine inhibitors.
• Tetracyclic antidepressants (TeCAs). TeCAs contain four rings of atoms in their chemical composition (as opposed to TCAs which have only three).
• Monoamine oxidase inhibitors (MAOIs). MAOIs inhibit the whole family of the monoamine oxidase enzyme. Because of this, they are especially effective in combating a wide range of mental health disorders. The downside of MAOIs is that they impose strict dieting and restrictions from other drugs on the part of the patient.

Table of Active Substances in Antidepressants

	Effective against	Active substances
SSRIs	moderate depression	citalopram, escitalopram, paroxetine, fluoxetine, fluvoxamine, sertraline
SNRIs	moderate depression, anxiety, OCD, ADHD	desvenlafaxine, duloxetine, levomilnacipran, milnacipran, tofenacin, venlafaxin
SMSs	depression spectrum disorders	vilazodone, vortioxetine
SARIs	depression spectrum disorders, anxiety	etoperidone, nefazodone, trazodone
NRIs	major depression, ADHD, narcolepsy, obesity, anxiety, panic disorder	reboxetine, viloxazine
TCAs	depression spectrum disorders, anxiety, other mental disorders	amitriptyline, amitriptylinoxide, clomipramine, desipramine, dibenzepin, dimetacrine, dosulepin, doxepin, imipramine, lofepramine, melitracen, nitroxazepine, nortriptyline, noxiptiline, pipofezine, protriptyline, trimipramine
TeCAs	depression spectrum disorders	amoxapine, maprotiline, mianserin, mirtazapine, setiptiline
MAOIs	atypical depression, Parkinson’s disease, panic disorder, agoraphobia, social phobia, bulimia, PTSD, BPD, bipolar depression, OCD, avoidant personality disorder	Irreversible, non-selective: isocarboxazid, phenelzine, tranylcypromine; selective: selegiline; Reversible, selective:  metralindole, moclobemide, pirlindole, toloxatone;

Other antidepressant medications include: atypical antipsychotics, marketed meds (but not proven), and over-the-counter meds. Apart from that, adjunctive treatments, combination products, and investigational agents exist and have been used to combat depression. However, most of the latter are still under research.

 

List of Antidepressants Available over the Counter

The following antidepressants can be obtained without a prescription:

• Ademetionine. Found in: Samyl, Heptral, Transmetil;
• Hypericum perforatum. Found in: Kira, Jarsin, Movina;
• Oxitriptan. Found in: Levothym, Triptum, Cincofarm;
• Tryptophan. Found in: Optimax, Aminomine, Tryptan.

A Word of Caution on Antidepressants

When dealing with mental disorders, self-diagnosis should be out of the question. If you or a relative need help, contact your health care provider immediately. Even though over the counter meds could provide the relief one is looking for, they are far from ideal.

Furthermore, once treatment has begun, one needs to schedule routine doctor’s appointments. Due to the sensitive nature of mental health problems, special care should be taken of patients that follow antidepressant medication treatments. Drugs such as MAOIs (but others too) can be lethal if one takes them irresponsibly. Even simpler symptom relief pills can be dangerous (especially non-prescription sleeping pills). If you know someone who uses any of these, make certain they receive the medical attention they need.

Antidepressant Statistics, Usage, and Research

By and large, antidepressant user numbers in the US are the highest in the world (per the US Centers for Disease Control and Prevention, cited in Business Insider, see chart below). Harvard Health cites the NHANES in observing a general rising tendency for antidepressant use. Some results show 23% of women aged over 40 and 50 regularly consume depression medication. The survey also saw women likelier to resort to these drugs. This was the case for white people in general as well.

Popular Antidepressant Usage Statistics

There are two conclusions that can be drawn:

• Positive: it’s good that more Americans are seeking help while acknowledging they have a problem.
• Negative: antidepressant benefits are still vastly overstated. Furthermore, the number of mental health patients is clearly on the rise.

The same survey shows that under one-third of the people taking mental health medication have had an appointment with a mental health expert over the past year.

While this is alarming, it also points to another clear flaw in the US healthcare system. Although the clear majority of antidepressants cannot be obtained over the counter, there are a lot of people that do basically that. These people enlist the help of a professional only for prescriptions, without exploring other treatment option.

One other conclusion is long-time mental health patients stop seeking help. These patients choose to rely solely on the meds indefinitely.

The NHANES researchers conclude that between 1988, 1994, 2005, and 2008 the rate of antidepressant use rose by %400.

New Antidepressants and their Effectiveness

A 2009 study led by Dr. Andrea Cipriani, Ph.D., looked over 12 new antidepressants. The team compared multiple treatments through meta-analysis. Here are some of their conclusions:

• Reboxetine (NRI found in commercial drugs as Edronax) was the least effective of all 117 trials.
• Escitalopram (SSRI known as Cipralex) and sertraline (SSRI, known under the same name) were the most acceptable forms of treatment.

Of the two above, the team recommends sertraline for adults that are just starting their treatment. The researchers also put affordability into the study, among other factors.

Advantages and Disadvantages of Antidepressant Medication

Antidepressant medication has, like all other treatments, its pros and cons. We’ve seen antidepressants work against major depressive disorder, anxiety disorders, eating disorders, severe pain, and other mental health conditions. The main adverse effects circle around pregnancy, mania, sexuality, weight changes, and withdrawal.

General Benefits of Antidepressants

• Getting sufficient sleep. Persons suffering from mental health issues usually have problems with their sleeping patterns. Both insomnia and narcolepsy are extremely unpleasant. Most health care providers can prescribe drugs which help with getting better sleep.
• Improving relationships. People taking antidepressant medication not only improve their love life, but their social being overall.
• Increasing work productivity. Relief from depression shows in many ways, one of which is increased productivity at work. Concentration increases, as does mental acuity.
• Reducing the risk of relapse. Once on depression drugs, the likelihood of future mental health problems decreases towards zero.
• Motivating one to seek help. When antidepressants work, the patient motivates his/herself to find help themselves.

Side Effects of Antidepressants

Antidepressants side effects are many and complicated. The spectrum changes per the class of the meds used (see the types of antidepressants above). However, there are some general side-effects that tend to show up whatever the drug one uses. Many of these side effects are adverse ones (negative).

Other antidepressant side effects not highlighted above include:

• Increased appetite. This leads to weight gain. Some depression cases come with bulimia or anorexia as a side effect. Others bring about binge-eating and obesity. Depending on this, a health care provider may prescribe different antidepressant meds.
• Decreased appetite. Adversely, some antidepressants that cause weight loss have been linked to appetite loss.
• Constant nausea. Because of their meddling with the gastrointestinal system, some antidepressant meds cause constant or episodic nausea.
• Blurred vision. Eyesight problems come only with more powerful antidepressants.
• Headaches. Some patients complain of headaches and nervousness, going into hallucinations for some. However, studies have shown that hallucinations only occur if the patient overdoses.
• The possibility of suicide. Surviving antidepressants is a serious matter, especially since less than a third of people using them also seek help from a doctor. Unfortunately, many antidepressants can be taken in large amounts as a method of suicide.

Conclusion

The antidepressants list is a large and complicated one. People suffering from mental health disorders should obligatorily seek help from mental health professionals. Antidepressants should never be self-prescribed as the side effects are too wild and uncontrollable to afford any misdiagnosis.

If you or a loved one suffer from mental health problems, contact a health care provider as soon as possible. Do not use this guide to antidepressants as a sole source of information. Any extra bit of information relating to your case can be left in the comment section below.

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