Antidepressants are drugs used to treat moderate and severe cases of MDD (major depressive disorder), as well as depressive symptoms in other disorders. These drugs are available only on a prescription basis and are usually coupled with other forms of non-medical treatment, especially talk therapy like CBT (cognitive behavioral therapy).
Antidepressants produce at least 50% remission of depressive symptoms in about half of the people who take them. However, note that they often don’t work for people who have mild depressive symptoms – these are cases where depression is caused predominantly by outside factors and can’t be helped with a treatment that targets the neurobiology of depression.
Medication for depression takes a while to actually get working, usually a few days to about two weeks. Just as not all people are affected by antidepressants, not all antidepressants are useful to people who do respond to them – it may take a couple tries before your therapist or doctor finds the right drug for you. Usually they narrow it down based on a number of important factors, which include your age, sex, environmental factors, and severity of your condition.
Aside from different brands of antidepressants, there are also different kinds or groups of antidepressants. This means there are hundreds of different antidepressant medications on the market and navigating them all can be very daunting. Online resources such as specialized search websites can help you significantly narrow down the number of possible medications that might work for you, or you can just ask your doctor directly.
There are cases where patients have severe depression but don’t respond well to any antidepressants or to therapy. That’s where alternative treatments come into play. Regardless of how severe your depression is or what other factors are involved in it – such as physical and mental health, other disorders and illnesses, and more – there is bound to be a treatment protocol out there that can provide you with relief from your symptoms. Relief does not mean cure – there is no definitive cure for depression, but it is a condition that can often be managed into total remission through the right treatment process.
This blog exists to help you figure out what might work for you by opening your eyes to the many ways in which depression is treated and dealt with, both medically and therapeutically, as well as through family support and other environmental elements. I’ve taken the time to pick out a slew of basic information to help you get started on understanding how antidepressants work, as part of a comprehensive strategy against depressive symptoms – in other words, I’m here to tell you how these pills work and how they might play a role in helping you feel happier.
How Antidepressants Work
Antidepressants generally work by entering the bloodstream and interacting with your brain’s cells. These cells send signals between one another through electromagnetic pulses, as well as chemicals called neurotransmitters. Think of neurotransmitters as uniquely-shaped puzzle blocks floating through the brain’s blood supply – as they pass brain cells, they’re sucked into the cells uniquely-shaped receptors, and activate a signal.
Most neurotransmitters are multi-purpose, working to do many different things depending on the context of their deployment. Serotonin, for example, is often associated with love and happiness, but it’s also partially responsible for things like mood and sleep. As is dopamine and norepinephrine.
In about half of all depression cases, manipulating the way these neurotransmitters work has a significant positive effect on the person’s mood and thoughts. Antidepressants generally increase the volume of certain neurotransmitters currently active in the brain, essentially inducing feelings of positivity and happiness, or just normal emotion, by compensating for depression with increased neurotransmitter activity.
However, remember how I mentioned that neurotransmitters are also responsible for other things than just making you feel better and generally putting you in a good mood, or at least a neutral one? Well, yeah. Antidepressants are not an exact science, because we haven’t fully cracked the code on depression. It’s such a complicated disease with a very wide list of possible factors and reasons, and self-reporting is a big part of diagnosing depression, meaning ultimately that treatment has to account for a little trial and error. This also involves side effects.
Antidepressants can have a variety of side effects, including minor ones like nausea or small headaches, or reduced appetites. However, antidepressants also come with one of the most severe of all side-effects – an increased risk of suicide. This risk is minimal and is only present early on during the first transition of the drug, but it’s nevertheless a present risk so it’s important to be around family and friends when you switch to an antidepressant or use one for the first time.
The fact that not all brands are alike in formulation and type means that it can take a while to find the right antidepressant for your needs – or you could get lucky and find useful medication right away. Whatever you do, be sure to follow your therapist or doctor’s advice regarding dosage – don’t take more than necessary, and don’t take less than prescribed. Quitting cold turkey can be detrimental, because of how antidepressants affect the brain’s neurotransmitters. Ask your doctor how to switch medication – some meds require you to taper off. Don’t be quiet about any negative changes – report them as soon as possible and try to get different meds or consider alternative treatment.
The Different Types of Antidepressants
SSRIs are the most common type of antidepressant, and they work by inhibiting the reuptake of serotonin, thus allowing for higher concentrations of serotonin between the brain’s cells. This generally seems to be the most effective and least risky type of antidepressant, but alternatives exist.
SNRIs are serotonin and norepinephrine reuptake inhibitors, affecting not only the reuptake of serotonin but norepinephrine/noradrenaline as well. This has more of a stimulating effect, but studies show a negligible difference in patients using drugs with norepinephrine reuptake inhibitors. That being said, they may still work for you, and are still in common use.
TCAs are among the earliest developed antidepressants, and thus also have the most side effects.
MAOIs are powerful antidepressants that inhibit monoamine oxidases, a family of enzymes responsible for the oxidation of dopamine, serotonin, and epinephrine/adrenaline. They’re often used for treatment-resistant depression, as well as other disorders such as Parkinson’s disease and panic disorder.
RIMAs are a class of antidepressants that function very much like MAOIs, but instead of simply inhibiting monoamine oxidases, they specifically reversibly inhibit monoamine oxidase A. MAOIs cannot be reversed, which make them more potentially dangerous. RIMAs, on the other hand, can be effective and are safer in that regard, but their reduced potency makes them less effective in cases of severe or treatment-resistant depression.
NRIs are noradrenaline/norepinephrine reuptake inhibitors – these antidepressants are also known as NERIs, or ARIs (adrenergic reuptake inhibitor). Like SSRIs and SNRIs, these drugs basically inhibit the immediate reuptake of norepinephrine, letting it linger longer in the brain and keeping your norepinephrine levels a bit higher. Because norepinephrine is a neurotransmitter especially linked to arousal and stimulation, the effect from this medication is different from the others. NRIs are also used to treat narcolepsy and ADHD, both of which can also be treated with prescription stimulants like amphetamine, although NRIs don’t exhibit the same abuse potential (meaning they’re not nearly as addictive as Adderall, for example).
There are other types of antidepressants, such as tetracyclic antidepressants and melatonergic antidepressants, but it’s worth mentioning that SSRIs are most commonly prescribed first because they usually present the lowest risk for side effects and are usually very effective. Other antidepressants are generally considered outdated, although they’re still in use because some respond better to them than to the usually prescribed drugs.
Be sure to contact a professional and see what antidepressants they commonly prescribe, and why. It’ll depend on who you’re contacting and where, as well as where you live.
Every Case is Unique
The basic premise behind antidepressants is that there are cases of depression where a chemical imbalance is responsible for a negative shift in mood and thoughts. But there are many cases of depression where the brain is functionally normal, yet a person’s mood and thoughts have darkened to the point where they have trouble going to work and being productive.
A major concern with antidepressants is that they’re overprescribed, and this is a valid concern because they often don’t have an effect on patients with mild depressive symptoms. Other treatments exist to help a person with a mild depression. However, not everyone who doesn’t respond to antidepressants suffers from a mild depression – treatment-resistant depression can also be severe, with risk of self-harm and suicide.
The multitude of antidepressants on the market, coupled with the fact that there are many types of cases where depressive symptoms are present and serious, without responding to medication, means that ultimately there are a lot of ways a depression can go. Every case needs to be addressed individually, from the eyes of a professional. Don’t go online to get a diagnosis and seek out antidepressants – visit a doctor or therapist, and find out what might be causing your symptoms, as well as what the best course of treatment is. Often, that treatment might have nothing to do with medication.