Antidepressant drugs have been around for a long time, constantly in development. While controversy still exists surrounding the potential side effects for these drugs, they are much safer than they used to be, and while over half a dozen different types exist, most people exclusively rely on one type of antidepressant: selective serotonin reuptake inhibitors (SSRIs). However, antidepressants aren’t something to approach nonchalantly. They’re still a prescription drug with black label warnings and understanding how they work can help you choose the right drug.
SSRIs are safer than most other antidepressants but risks always exist. The side effects a person experiences while using antidepressants largely depends on how their body reacts to the drug, as per a myriad of reasons ranging from genetics to possible coexisting conditions. Side effects include mild temporary effects such as stomach aches and rashes, to highly dangerous side effects, such as rare cases of increased suicidal tendencies. SSRIs also have potential counterindications, such as NSAIDs, in cases where you may be bleeding. This is because they can potentially reduce clotting, an effect that more than doubles when SSRIs are taken with aspirin or ibuprofen. Certain herbal medication (such as St. John’s wort, also used to treat depression) can have adverse effects in combination with SSRIs. Be sure to regularly consult your doctor after being prescribed an antidepressant to watch out for any unusual side effects, and request switching to a different drug to avoid negative side effects should they present themselves.
How Antidepressants Work
Antidepressants all work utilizing the same basic mechanics. Differences between antidepressants of the same type involve how the drug was designed and developed, while differences between types involve how the drug interacts with different neurotransmitters. All antidepressants aim to increase the availability of certain neurotransmitters in the brain, to reduce depressive symptoms. SSRIs, the most common type of antidepressant, get the job done by keeping the brain saturated with serotonin.
Low serotonin is often linked to depression, and antidepressants are quite effective at relieving depressive thoughts – this is because serotonin is generally thought to be a key player in mood balance. I say, “generally thought”, because the effects of serotonin are quite widespread and unspecific. Serotonin plays a role in regulating sleep, appetite, bowel movements, emotions, motor functions (like movement), cognitive functions (like math), and autonomic functions (like breathing).
SSRIs bind to the serotonin reuptake receptors in the brain’s synapses, preventing serotonin from being quickly reabsorbed by the brain’s cells. What this does is keep serotonin around for longer, hanging out in the intracellular fluid of the brain. This increases happiness and helps regulate the mood, undoing depressive symptoms. There are people who are resistant to antidepressants, despite being depressed. Research suggests that genetics play a large role in whether antidepressants work or not. Some people possess genes that make them resistant to antidepressants by having a different kind of serotonin receptor.
A major weakness in current SSRIs is that we haven’t completely identified how they work, or in what cells they work best. Until research allows us to better target any type of brain cell, there will always be the risk that antidepressants won’t work. Additionally, in people without depression, SSRIs may have a different effect. Although existing studies involved primates, they suggest that the use of antidepressants without depression might affect intellectual capacity. 1 Others suggest that misusing SSRIs may trigger bipolar disease, or manic-depressive disorder, in those susceptible to the condition. 2
Other antidepressants have a similar effect, but usually do more than focus on serotonin reuptake. Here’s a quick list of the different kinds of antidepressants still available today:
- Reuptake Inhibitors: Selective serotonin reuptake inhibitors are the most common antidepressants available today, but they’re not the only ones. Norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors – basically, all reuptake inhibitors manipulate the way certain neurotransmitters are reabsorbed by the brain, thus keeping them around for longer. Dopamine, norepinephrine (also known as noradrenaline) and serotonin are all known as monoamine neurotransmitters – these are neurotransmitters specializing in emotion, arousal, and memory, alongside other cognitive processes.
- TCAs: Tricyclic and tetracyclic antidepressants are antiquated drugs that block the reuptake of serotonin and reuptake, but their mechanisms are different from those of modern reuptake inhibitors. Tricyclic and tetracyclic antidepressants are named such depending on the number of rings each medication’s chemical structure possesses. These drugs are potentially prescribed when other antidepressants do not work, but they are rarely considered a first option because they usually exhibit more side-effects than modern antidepressants.
- MAOIs/RIMAs: Remember when I mentioned monoamine neurotransmitters? MAOIs inhibit the enzymes that break these neurotransmitters down, keeping them around for longer this way rather than inhibiting their reuptake. Because it keeps the body from breaking down dopamine, serotonin, and norepinephrine, these are very powerful antidepressants. RIMAs are reversible, selective versions of MAOIs. They’re weaker, but safer, because they don’t permanently stop the breakdown of monoamine neurotransmitters. MAOIs are powerful and effective but are also riskier. They’re usually reserved as a last resort if other antidepressants fail.
- Atypical Antidepressants: These are all antidepressants that don’t fit into the previous categories, or other unused categories. These drugs work separate from one another, but they all ultimately still focus on the saturation of dopamine, serotonin and/or norepinephrine in the brain.
Most therapists and doctors will prescribe SSRIs, unless there is a specific reason not to. Antidepressants are not typically prescribed for mild depression or dysthymia – the medication is usually reserved for severe depressive symptoms, to help patients cope with negative thinking long enough for psychotherapy to take effect. It’s rare to be on antidepressants for years – often, patients with an antidepressant prescription are recommended to take the medication for six to nine months at a time.
Why Antidepressants Have Side Effects
Following suicide rates and studies, antidepressants have saved thousands of lives. These drugs are incredibly powerful in relieving depressive symptoms, including suicidal thoughts. But they’re still not completely understood and involve the (albeit subtle) manipulation of major neurotransmitters that affect the way we think, feel, and move, among other things.
Most of the side effects associated with antidepressant usage are related to the functions of the neurotransmitters they affect. Common side effects of antidepressant use include sexual dysfunction and weight gain, both of which are usually temporary. If sexual dysfunction remains after a month of medication, speak to your doctor about switching antidepressants or getting a prescription for an ED drug like sildenafil (Viagra).
More severe side effects include involuntary movement, dizziness, and nausea, as well as loss of effectiveness. Increased serotonin activity may cause Parkinson’s-esque symptoms – that means you’ll have some shakes, but you’re not actually getting Parkinson’s. Another possible side-effect is serotonin syndrome, where your serotonin levels are high enough to experience dangerous symptoms such as excessively high body temperature, agitated bowel movements, sweating, and increased reflexes.
One of the most dangerous side effects regarding antidepressants is increased suicidal thoughts. Studies show that this side effect has so far only shown up in patients under the age of 25, but it’s important to observe how you think and feel after trying out new medication or switching to a different drug. Changes in cognitive quality – your ability to think, be creative, apply critical thinking and solve problems – as well as negative thinking are very important. Consult your doctor or therapist if you’re experiencing any adverse effects, so you can work on switching to different medication as soon as possible.
Antidepressants and Addiction
Antidepressants are not addictive in the same vein as opiates, stimulants, barbiturates, and such. What these drugs have in common is an increased release of dopamine, as well as an effect on the brain’s reward system. In short, they all feature risks of physical dependence. Antidepressants do not make you feel better in the sense that they boost the production of dopamine or serotonin – rather, they increase the availability of naturally-available neurotransmitters.
That does not mean you can’t get addicted to them. Just as you can get addicted to food, gambling, TV and the Internet, a psychological addiction to antidepressants is very possible. Relying on the medication to make you feel better rather than using it as a tool to improve the quality of other treatments like talk therapy and exercise increases your risk of developing a dependence to the drug.
Antidepressants can still be very dangerous if taken too often, or in a high dose. An overdose on antidepressants causes abnormally fast heart rate, abnormal breathing, seizures, tremors, and twitching, eventually leading to death by cardiac arrest or respiratory distress. They can also cause a coma. Be sure to stick to the prescription, and not use antidepressants more than as per your doctor’s recommendation.
Alongside lower overall side effects, SSRIs are also harder to overdose on if taken alone. Overdose symptoms are still severe, but death is rare. When combined with other medication, however, the risk of death skyrockets.
Safely Changing Antidepressants
It’s not wise to abruptly end treatment with one medication to switch to another. Instead, you often must taper off one drug, introduce a “washout period”, and finally you can introduce another medication.
It’s important to figure out whether antidepressants are working for you or not. Waiting until symptoms of a mismatch get worse will only make the transition to better medication worse – because you must consider the taper period, as well as the washout period. Therefore, consider asking your doctor about switching when you’re feeling your best.
It might take a few tries to get medication that works for you. If you’re resistant to antidepressants in general, there is still hope. Treatment-resistant depression does have one treatment with great promise: transcranial magnetic stimulation. This type of treatment seems particularly effective for people who can’t make much use of other treatment types.