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What kind of drugs are antidepressants?

Antidepressants are the group of medicines capable to relieve (and sometimes remove) such symptoms of depression as anxiety, constant fatigue, low self-esteem, despair and even suicidal thoughts. Help and support from a psychotherapist, relatives and friends are very valuable and highly recommended in such a state, however, some drugs are also necessary. You will hardly be able to get out of depression without taking pills. This article provides an overview of what antidepressants are, how they work and when they were discovered. Having read this paper, you will be able to understand why your physician has prescribed you this or that drug with a complicated name.

Some history

Antidepressants were discovered not long ago: in the early 50's of the last century. Before then, doctors prescribed, in order to improve the mood, rather exotic substances such as opium and its derivatives, caffeine or ginseng. They caused feelings close to euphoria, however, they were not able to combat a real depression.

In the first half of the 20th century doctors and biochemists spent decades of concerted efforts to synthesize a remedy against “black melancholy” but to no avail. Antidepressants were “discovered” quite accidentally. Nathan Klein from Rockland State Hospital was trying to find the location of human "ego" with the help of drugs. Klein noticed that some of the patients to whom he had given Iproniazid suddenly stopped being worried about their problems. Around the same time in Germany, Ronald Kuhn discovered psychotropic properties of Imipramine, also by accident.

In a few decades antidepressants replaced all other types of drugs used with depression, and they are now considered to be one of the greatest discoveries of the twentieth century.

How do antidepressants work?

There’s no point in going into details on how information is passed from one neuron to another in our brain. It is enough to say that this is done by special hormones called neurotransmitters or mediators, the most important of which are serotonin, norepinephrine and acetylcholine. Serotonin is especially significant for feeling the joy of life. Depression decreases the concentration of these hormones, and antidepressants contribute to bringing it back to norm. Various groups of antidepressants do it in different ways.

Rumors and prejudices

There are so many prejudices against antidepressants. One can hear that “antidepressants can drive you crazy,” or that “you will be hooked on the pills for life,” or that “these drugs are for the weak only” and what not. We have neither time, nor desire to prove the absurdity of such rumors. Just take it for granted that depression is a hard disease which requires serious treatment including pharmacologically assisted methods. Antidepressants can help reduce pain, like aspirin with a cold. Only not physical pain but spiritual in this case. And one more thing: modern antidepressants do not cause addiction regardless of the duration of treatment. By the way, about 65 percent of the US population are taking antidepressants and tranquilizers these days. That’s it.

Which antidepressant is the right one for you?

No pundit can predict it. It's a matter of trial and error until the right drug or combination of drugs is found for you. The search can take a long and sometimes painful way. This is a sad fact, but it cannot be bypassed. Less than half of the patients get better on the first try. You can also be not lucky. Please understand that this is not because of a low qualification of your doctor. Help him or her find your drug. Try to be patient!

How long will it take me to get rid of depression with antidepressants?

One or two pills will have no effect on the concentration of serotonin in your brain and, correspondingly, on the symptoms of depression. Not less than 2-3 weeks usually pass until you feel some positive effect. Keep in mind that the treatment time can vary individually to a large extent. In some cases a stable result can come only in a few months.

Groups of antidepressants

Modern antidepressants can be split up into three groups according to the effect they have on the biochemical processes in our brain. There are also antidepressants that do not belong to any of these groups. Most commonly used antidepressants are classified as follows:

  • Tricyclic antidepressants (TCAs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Selective serotonin noradrenaline reuptake inhibitors (SSNRIs)

  • TCAs are considered to be the first generation antidepressants.
    SSRIs and SSNRIs are the second generation antidepressants.

    I. Tricyclic antidepressants (TCAs)

    General information

    Synthesized in the 50s of the last century, they have been used for a long time, and their effects is studied better compared with the drugs of other groups. Their structure is based on a triple carbon ring; hence is the name "tricyclic". This group of drugs includes Imipramine, Amitriptyline and Nortriptyline.

    Tricyclic antidepressants increase the concentration of serotonin and noripinephrine in our brain due to a decrease in their absorption by neurons. The effects of drugs in this group are different; for example, amitriptyline has a calming effect, and imipramine, on the contrary, is stimulating. TCAs act faster than drugs belonging to other groups; in some cases, positive mood changes can be observed a few days after the start of taking.

    Side effects

    Since the drugs of this group block other mediators (each in varying degrees), they cause a number of undesirable side effects. The most common are lethargy, drowsiness, dry mouth, constipation. There is also increased sweating, dizziness, increased heart rate, decreased potency, weakness, nausea, difficult urinating. There may be a feeling of anxiety. The overdose of TCAs can lead to severe consequences including death.

    II. Selective serotonin reuptake inhibitors (SSRIs)

    General information

    SSRIs prevent the destruction of such mediators as serotonin and noripinephrine which affect our mood. SSRIs examples are phenyuzine, tranylcypromine and isocarboxazide. The most common drug of this group is moclobemide (aurorix).

    SSRIs are usually prescribed to those who have not had an improvement after taking tricyclic antidepressants. Besides, since SSRIs have rather a stimulating than a calming effect, they are preferable to TCAs for the treatment of dysthymia, a small depression.

    Side effects

    The most common side effects are dizziness, pressure fluctuation, weight gain, sleep disorder, decreased potency, increased heart rate, swelling of the fingers. The difference between SSRIs and other drugs is that when they are taken, the patient should not eat certain foods. This is rather an unusual list: aged cheeses, sour cream, smoked meat, marinades, fish and soy products, red wine, beer, beans, sauerkraut and pickled cabbage, ripe figs. Some medications are not compatible with SSRIs. That is why the antidepressants of this class should be administered with caution.

    III. Selective serotonin noradrenaline reuptake inhibitors (SSNRIs)

    General information

    SSNRIs are the most recent class of antidepressants, and they have fewer side effects compared to the drugs in the two previous groups. The effect of these drugs is based on increasing the supply of serotonin, which affects our mood. This group includes fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox), and sertraline (Zoloft).

    Fluoxetine (Prozac) was the first drug that won universal recognition: since 1980 it has become the most popular antidepressant in the world. It is easy to use (usually one tablet a day is enough) and it does not lead to overdose.

    SSNRIs are good not only at combating depression; they also help to cope with some other unpleasant manifestations, ranging from overeating and ending with obsessive conditions.

    Side effects

    Although this group of drugs has fewer side effects and they are not that pronounced, nevertheless, they exist. The most common are anxiety, excitement, insomnia, headaches, nausea and diarrhea. Unlike the other groups of antidepressants that can cause weight gain, with SSNRIs a person usually loses in weight a little. SSNRIs are not recommended for people with liver problems.

    IV. Other modern antidepressants

    There are antidepressants that do not belong to any of the three described groups, because they differ from them both in chemical composition and in the mechanism of action. These are, in particular,

  • Bupropion (Wellbutrin); it has a large number of side effects, and also has a sedative effect as TCAs. It is well tolerated by people suffering from recurring depressions with hypomania (mild mania depression).
  • Trazodone (Desirel); it has a good sedative effect. Its main disadvantage is that it causes so called priapism or a painful prolonged erection that often requires surgical intervention.
  • There are more recent drugs such as

  • Venlafaxine hydrochloride (Effor); possible side effects are headaches, drowsiness, dizziness.
  • Nefazodone hydrochloride (Sezeron); increases the concentration of serotonin and norepinephrine. Possible side effects are lethargy, low blood pressure, and disorder of accommodation.
  • Mitrazin (Remeron); went on sale in 1996. It stimulates the release of serotonin and norepinephrine and simultaneously blocks serotonin receptors. Possible side effects are as follows: drowsiness, increased appetite, weight gain and dizziness.