Antidepressants are some of the most common prescriptions around. According to the Centre for Disease Control (CDC), between 2015 and 2018, 13.2% of all adults had used an antidepressant in the past 30 days…and the numbers continue to rise. Most people know the basics–SSRIs, SNRIs, serotonin, dopamine, and some of the common brand names: Zoloft, Celexa, Lexapro, etc.. But how and why do they work? Why are more than 1 in 10 Americans taking them? And What are the differences?
Lifestyle and Antidepressants
Before we jump into the world of antidepressants, it is important to note that the standard treatment for depression is not a packet of pills alone. The research shows a much better outlook when medical treatment is combined with therapy and exercise. Alongside exercise and therapy, talking to a professional like a psychiatrist is the best way to decide if antidepressants are right for you; combine this with someone who has been to online pharmacy school and can give you advice on specific and often complex medications.
Serotonin and SSRIs
The most prescribed forms of antidepressants are Selective Serotonin Uptake Inhibitors or SSRIs, which, as the name suggests, work on the serotonin circuits. Serotonin is often referred to as the “feel good” chemical. In reality, serotonin is a neurotransmitter that carries messages between different parts of your brain; these messages help regulate mood, digestion, sleep, nausea, and many other bodily functions.
The working theory behind SSRIs is that there simply isn’t enough serotonin available for your brain to use, which starts causing problems like low mood. This is where the uptake inhibition comes in. SSRIs don’t actually produce serotonin or a precursor–they essentially hold down the “recycle” switch so your body can keep reusing serotonin instead of dissipating it. The only problem is the ‘serotonin theory’ of depression was never exactly proven, and to this date, many studies have questioned the efficacy of SSRIs.
Norepinephrine and SNRIs
Serotonin aside, there are a few options that can be used by themselves or occasionally together. Norepinephrine (also known as noradrenaline) is another neurotransmitter that plays a critical role in regulating attention, stress response, and alertness. Low levels are linked to symptoms like low energy and poor focus in depression and anxiety–they are also used as an alternative to stimulants like Ritalin in treating Attention Deficit Hyperactivity disorder (ADHD).
SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) target both serotonin and norepinephrine, preventing their reabsorption and keeping them active in the brain longer. This helps improve energy, motivation, and mood. However, the “norepinephrine theory” of depression, like the serotonin theory, remains debated, with questions about how directly it affects mood improvement.
MAOIs, Monoamine, and Managing Medication
MAOIs or Monoamine oxidase inhibitors are an older class of antidepressants developed in 1950 to treat Major Depressive Disorder. Unlike the previous reuptake inhibitors that are known as tricyclics, MAOIs inhibit the enzyme monoamine oxidase, which is responsible for removing norepinephrine, serotonin, and dopamine from the brain.
MAOIs are seldom prescribed today because, while they effectively prevent the breakdown of neurotransmitters like serotonin, norepinephrine, and dopamine, they also interfere with the metabolism of tyramine, a compound found in various foods. When MAOIs inhibit the enzyme that breaks down tyramine, it can build up to dangerous levels, potentially leading to severe spikes in blood pressure. As a result, patients taking MAOIs must follow strict dietary restrictions, avoiding foods like aged cheeses, cured meats, and fermented products to prevent adverse reactions. Coupled with a high side effect profile, including dizziness and insomnia, MAOIs have gone out of fashion and become a last resort option for treatment-resistant depression.
Approaching Cyclics and Their Side Effects
SSRIs like Zoloft (Setraline), Prozac (Fluoxetine), Celexa (Citalopram), and others are commonplace in pill cabinets across the country. The side effect profile is pretty small; they aren’t addictive, and your primary care doctor can prescribe them. Of course, many people will experience side effects. Some of the most reported are feeling agitated, shaky, or anxious, indigestion and stomach aches, dizziness, loss of libido (reduced sex drive), not sleeping well (insomnia), or feeling very sleepy.
SNRIs also cause various side effects along the same lines as SSRIs, including nausea, dry mouth, dizziness, and increased sweating. People using them might also experience insomnia, fatigue due to the stimulatory effect, or weight changes. While these side effects can vary from person to person, they are generally manageable and often diminish over time.
Weighing up the Options
Like any medical decision, it is important to weigh up the risks and benefits of starting any medication. Luckily, it’s not a decision you have to make alone. If you have access to one, a psychiatrist is a highly specialized doctor who can provide expert guidance on the most appropriate antidepressant for your specific needs, considering both potential benefits and side effects. Even if you do not have access to a specialist, your family doctor can often help with a treatment plan to suit your needs and monitor your progress to ensure the best possible outcome.
***Please note, this article is not medical advice; if you or someone you care for are suffering, please contact your Doctor or one of the many helplines for advice.
