What are antidepressants?
Antidepressants are drugs prescribed by doctors to treat depression, anxiety, post-traumatic stress disorder and/or obsessive compulsive disorder. Antidepressants appear to work by increasing the amounts of certain chemicals (neurotransmitters) such as serotonin and noradrenaline in the brain. These chemicals are thought to be responsible for regulating mood.
The jury is still out on how well antidepressants work. The Royal College of Psychiatrists suggest that around 50-65% of people taking antidepressants see some benefit, compared to 25-30% who took a placebo. They seem to be most effective at helping more severe types of depression.
There are several types:
SSRIs (Serotonin Re-uptake Inhibitors) work by blocking the re-absorption of serotonin in the brain. SSRIs include Sertraline (Lustral) as well as Fluoxetine (Prozac) which is the most widely prescribed antidepressant in the world. These are thought to be the safest type of antidepressant.
SNRIs (Serotonin and Norepinephrine Re-uptake Inhibitors) work by affecting serotonin and norephinephrine levels in the brain. SNRIs include Venlafaxine/Effexor Some people respond better to SNRIs than SSRIs and vice versa.
NASSAs (Noradrenaline and specific serotonergic antidepressants)
NASSAs may be effective for some people who are unable to take SSRIs.
MAOIs (monoamine oxidase inhibitors) act by inhibiting the activity of monoamine oxidase, thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability. This in turn increases the levels of ‘feel-good’ neurotransmitters such as serotonin, norepinephrine and dopamine, by preventing their breakdown in the brain. They are not prescribed very much any more.
Tricyclic antidepressants (TCAs) are an older type of antidepressant. They are no longer usually recommended as a first-line treatment for depression because they can be more dangerous in overdose. TCAs include amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil) and trimipramine (Surmontil)
Most antidepressants take a few weeks to start working.
There has been alarm over the large number of prescriptions being written for antidepressants. Recent prescription figures from the Health and Social Care Information Centre showed that over 57m prescriptions for antidepressants were issued in England in 2014, enough for one for every man, woman and child. This represents a 7.5% increase since 2013, and over 500% since 1992.
Antidepressants are not generally used as street drugs however there has been some evidence of Prozac use in combination with drugs such as an LSD, ecstasy or cannabis.
People do not develop a tolerance to antidepressants in the same way as they do to alcohol or opiates, which require increasing dosages to maintain their effect. However, studies have revealed that people may become psychologically dependent and that about one third of patients experience withdrawal symptoms when they stop taking these drugs.
Withdrawal symptoms include increased anxiety, dizziness, flu like symptoms, stomach aches and nightmares. It is best to talk to your doctor about coming off antidepressants and to do so gradually.
Interactions with other drugs
Antidepressants may interact with street drugs in ways that can cause problems.
Cannabis has been found to interact with certain types of antidepressants, such as tricyclic antidepressants (TCAs), which share similar side effects.
It is best to avoid alcohol while taking antidepressants because alcohol can make depression worse. It can also increase the side effects of some antidepressants, such as drowsiness, dizziness and co-ordination problems.
Always read the information leaflet that comes with your drugs and/or talk to your doctor.
The depressing truth about antidepressants
By Harry Shapiro
The brain has a whole fleet of chemical couriers called neurotransmitters (NTs) which it uses to send messages to different parts of the body. They are released across a synaptic gap to engage with receptors on the other side as a key fits a lock. The brain then reabsorbs the chemical waiting for the next event to occur that will stimulate release. About 100 NTs have so far been identified: one of these is serotonin. It has a number of functions, but one is to regulate mood and increase good feelings.
The theory behind antidepressants is that depression is caused by a lack of serotonin in the brain and the way to deal with that is to prevent the brain from reabsorbing serotonin, leaving it sloshing around to elevate mood. But according to Robert Whitaker, a Pulitzer short-listed science writer speaking at a packed meeting of the All Party Parliamentary Group on Prescribed Drug Dependence on 11th May, this is all wrong. So wrong in fact, that taking these drugs over the long term, makes the depression worse.
This meeting was called to highlight the fact that in several countries across the world with very different health care systems, there is a close correlation between increasing levels of antidepressant prescribing and claims for mental health disability payments. For example, 61m prescriptions for antidepressants were issued in England alone in 2015 – four times as many as in 1995 – while there were over 1.1m disability claims for mental health disorders in the UK in 2014, over double the number 20 years ago.
To get some more insights into his (for me anyway) startling presentation, I spoke to Robert Whitaker after the meeting. Antidepressants such as Prozac are known as Serotonin Specific Reuptake Inhibitors or SSRIs, in other words they block the reabsorption of serotonin into the brain. And in the early stages of drug treatment, they do just that. So it would be wrong to say that these drugs don’t work. But according to Whitaker, after an (undetermined) while, the brain takes what might be called evasive action against the SSRI and reduces the amount of serotonin it releases for the SSRI to then block. So in theory, as the patient takes more and more drug, there is less and less of the happy chemical being released in the first place and so the person feels worse.
Whitaker also offered an explanation as to why people can feel so bad, long after they have stopped taking the drug. When somebody withdraws from heroin, they feel awful for a few weeks while the body’s natural opiates called endorphins fill the gaps left by heroin. But apparently, it takes the brain far longer to readjust levels of serotonin and, according to Whitaker, some research evidence suggests this state might be permanent. Which of course, doesn’t mean that ‘once depressed, always depressed’ – there will be any number of variables that differ from person to person concerning long term prognosis, but it would account for the symptoms people experience after they have stopped treatment which are not (as some doctors would argue) simply a case of the old feelings which caused the depression flooding back.
I assumed that this problem with antidepressants was entirely the product of new research. Not so. According to Robert Whitaker (and reminiscent of tobacco company secret knowledge about the link between smoking and cancer), Big Pharma had some of the key data to hand back in the 1970s.
Credited to: DrugWise