These medications are typically used to help relieve the negative symptoms associated with conditions like depression or anxiety. Other conditions that they help with are bulimia and chronic pain.
Antidepressants help many people. However, they don’t work for everyone. Although they may be effective, there is only so much that they can do. Medications typically work best when combined with other forms of treatment, such as talk therapy, support from family and friends, and self-care (e.g., regular exercise, a nutritious diet, and getting enough sleep).
It may take several weeks for antidepressants to be fully effective. If the medication is working, you will sleep better, have a better appetite, and have more energy. Improvement in mood usually comes later.
Do I Need This Treatment?
If you cannot shake the feeling of sadness, despair, and hopelessness for more than two weeks, or if you are excessively worrying to the point that it becomes difficult to control, see a doctor discuss your symptoms and treatment options. Early treatment can help to ensure treatment success.
Make sure to tell your doctor if you have experienced periods where you felt like you needed less sleep than usual while also having more energy than normal or if your mood has changed from feeling depressed to feeling unusually happy or irritable. You may need a mood stabilizer medication instead of, or in addition to, an antidepressant. Some people who take antidepressants can become manic.
Medications are not the only way to treat depression and anxiety. Interpersonal psychotherapy and cognitive-behavioral therapy are just as effective as talk therapies. Other forms of support that can help manage depression or anxiety include peer support, school counseling, and housing and employment assistance.
What do Antidepressant Medications do?
The activity of chemicals called neurotransmitters in the brain is increased by antidepressant medications. The symptoms of depression and anxiety can be reduced by increasing the activity of neurotransmitters such as serotonin, norepinephrine, and dopamine. Although the brain is a complex organ, the reasons why these drugs work is not yet fully understood.
We know that these drugs help to relieve symptoms of depression and anxiety in up to 70 percent of people who try them. The success rate for people taking antidepressants is even higher when those who don’t experience relief from one type try a second type.
Do antidepressants increase the risk of suicide?
Starting medication treatment for depression may increase the risk of suicide. The majority of cases where suicide risk is increased are seen in adolescents and young people. The treatment might be working if the person experiences more energy, even if their mood doesn’t improve yet. This means that antidepressants could give people the resources they need to act on their suicidal thoughts.
Some antidepressants may also lead to feelings of restlessness, agitation, and detachment. Thes emotions may be similar to those of anxiety and could worsen feelings of hopelessness and despair instead of providing relief. Some people may become suicidal or violent. This reaction is thought to occur in about four percent of people taking antidepressants. The risk is highest in the first few weeks of treatment.
Before you begin your treatment, be aware that you may feel worse before you start feeling better. Find out what resources are available to you and who you can speak to for help.
Keep track of your thoughts and moods when you start treatment and tell your doctor, a crisis line, or the emergency department if you have thoughts of hurting yourself or other people.
If you begin to experience an increase in thoughts of suicide or anxiety, speak with your doctor to see if continuing the medication is the best option or if it may just take some time for the medication to become effective.
Types of Antidepressant Medications
There are multiple classes of antidepressants, each with plenty of individual medications within. No antidepressant drug works the same for every person who takes it. Some may work better for one person than another. You may be advised to try more than one type of antidepressant or to use a combination of antidepressants to seek relief from your distress.
The antidepressants that are most commonly prescribed are listed in order. Medications can be referred to in two ways: by their generic name or by their brand or trade names. Brand names available in Canada appear in brackets.
SSRIs
These drugs, which include fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Cipralex), and sertraline (Zoloft), are often the first drugs prescribed for treatment of depression and anxiety disorders. Some antidepressants have more severe side effects than others. These medications are known to have milder side effects. Buspirone has been found to help with anxiety but not depression. This drug is similar to SSRIs.
Some common side effects of this medication include nausea, vomiting, diarrhea, weight gain, dry mouth, headaches, anxiety, sedation, and decreased sexual desire and response. You may feel jittery or restless and have trouble sleeping when you take this type of medication. You may have difficulty falling asleep, wake up in the night, or have vivid dreams or nightmares.
SNRIs
This group of drugs contains venlafaxine (Effexor), duloxetine (Cymbalta), levomilnacipran (Fetzima), and desvenlafaxine (Pristiq.) Anti-depressants, anxiolytics, and painkillers are commonly used to treat depression, anxiety, and chronic pain, respectively.
Common side effects of the medication include feeling nauseous, drowsy, dizzy, anxious or nervous, tired, having a decreased appetite, and experiencing sexual difficulties. In higher dosages, these medications may increase blood pressure.
NDRIs
The medication in this class is bupropion (Wellbutrin, Zyban). This medication is sometimes prescribed to treat depression by providing an energy boost in addition to other antidepressants. Varenicline is used to help people stop smoking by reducing cravings and withdrawal symptoms.
Common side effects are jitteriness and insomnia.
NaSSAs
Mirtazapine is a sedating antidepressant that is a good choice for people with insomnia or anxiety. This medication also helps to stimulate appetite.
Common side effects are drowsiness and weight gain.
S-Adenosylmethionine (SAMe)
A Methyl Donor
SAMe provides methyl groups to other molecules to start biochemical reactions that change these molecules into active substances. An example of something that can happen when methyl groups are transferred from SAMe to certain phospholipids is the production of phosphatidylcholine. This important lipid is found in all cell membranes. The presence or absence of this substance affects how cells react to stimuli from the outside environment because it controls the accessibility of the cell membrane to signals from the outside.
Here’s how it works: Phosphatidylcholine makes cell membranes pliant. The other lipid in cell membrane-cholesterol-makes them stiff. Pliant membranes are better at transmitting signals than stiff membranes because more receptors are exposed. The receptors of cells that are too viscous may be distorted. The receptors and molecules can be thought of as pieces of a jigsaw puzzle. A malformation can cause a poor fit when trying to insert a piece into its designated spot. The signal between the two pieces will be weaker. Cells that have an overabundance of cholesterol do not receive the message correctly.
Aging causes the “hardening” of cell membranes. The ratio of phosphatidylcholine to cholesterol decreases as one ages, and cholesterol becomes the predominant compound. The decrease in methylation that comes with age is involved in this change in lipids. The increased methylation that SAMe causes protects and enhances cell integrity.
Methylation is a process that helps regulate gene expression. SAMe also helps regulate gene expression through methylation of DNA. The methylation of DNA is a process that can either turn genes on or off. Activated genes transcribe proteins. If proteins are not transcribed properly, cells cannot grow or function as well as they could. Activating or inactivating genes can stop tumor growth.
Other important processes that involve methylation are the following: the suppression of viruses, the activation of heat shock proteins, and the synthesis and signaling of cytokines.
Transsulphuration
SAMe is necessary for the production of the sulfur amino acids cysteine and taurine, as well as the tripeptide glutathione. SAMe is first converted into S-adenosylhomocysteine, which is then used to create cysteine and taurine. Sulfur compounds are found in all proteins and many other biomolecules. Sulfur compounds are incredibly important, to the point where it’s been said that “without sulfur, there is no life.” Every cell in the body contains sulfur compounds, which are found in all proteins and many other biomolecules.
The end products of the transsulfuration pathway are important for scavenging free radicals. Glutathione is the most important substance in the liver. The liver’s primary function is to break down harmful substances that the body comes into contact with. These may be drugs or the body’s own products. A liver that isn’t functioning properly will always have low levels of glutathione. If the level of glutathione decreases, the liver will not be able to function properly. Glutathione is also found in other organs. It protects against the harmful effects of inflammation throughout the body. It is a very strong free radical eliminator in the eye, which protects against cataracts that are caused by UV sunlight. SAMe provides the components needed to make glutathione, which helps to keep the body’s natural defenses strong.
Polyamines
These biochemical bombshells bind DNA and regulate gene expression. The molecules make cell membranes more fluid and act to repair DNA. We will be discussing the importance of polyamines in greater detail in future issues.
Natural Antidepressant
The benefits of SAMe in depression have been supported by over a hundred published studies. SAMe is the most well-documented non-drug antidepressant available today.
The CDC’s National Center for Health Statistics has released new data which shows that suicide is now the 9th leading cause of death in America. This puts it just behind AIDS, which is currently the 8th leading cause of death. Suicide is the 5th leading cause of death for people aged 25-44 and the 3rd leading cause of death for those aged 15-24, following accidents and homicides. In 1995, more people committed suicide in the U.S. than were murdered. Clearly, suicide is a major health problem.
This estimate suggests that successful suicides and suicide attempts cost around $16 billion in 1994 in earnings that were lost, and in hospitalizations. Thousands of Americans will suffer from depression this year, which is the number one cause of suicide. Depression is something that reportedly affects every American at some point in their life. People who are seriously ill often suffer from depression, and this occurs more frequently in both elderly and young adults. What can be done?
Some physicians believe that antidepressant drugs, which are part of a billion-dollar psychopharmacology industry, are dangerous and addictive. While antidepressants work in most patients, there are drawbacks. 53% of emergency room admissions that are related to drugs are from overdoses. People often take too much of their tricyclic antidepressant drug before it has time to start working. Almost all emergency room visits related to tricyclic antidepressants in 1994 were due to overdose (either intentional or accidental).
Clinical Studies Support Efficacy, Safety, and Quick Action
The University of Alabama, the University of Trieste, and BioResearch S.A. sponsored a symposium on SAMe in 1987. The meeting was to figure out how effective SAMe is in treating neuropsychiatric disorders. A study done on 18 patients at the University of California at Irvine showed that hospitalization can improve depression. In this study, SAMe given intravenously was compared to imipramine given orally. The majority of patients taking SAMe saw a 50% improvement in their condition within two weeks, compared to only 22% of those taking imipramine.
A study conducted by DeVanna and Rigamonti confirmed these results in a placebo-controlled, double-blind study using oral SAMe. This study was larger in scope and provided stronger evidence for the efficacy of SAMe in treating depression. In this study, 1,600mg of Same per day was given to patients who had major depression. Before starting the real trial, DeVanna and Rigamonti gave the patients a placebo for a week in order to reduce the “placebo effect”. Patients who felt no difference or worse after taking the sugar pill were included in the study.
The researchers found that SAMe was more effective than imipramine in decreasing depression, as measured by four different depression scales. On day 20, SAMe and imipramine had similar effects on depression, although SAMe had a clear advantage when it came to anxiety. On day 42, imipramine surpassed SAMe. A greater number of patients discontinued the study due to side effects from imipramine than those taking SAMe.
SAMe has been compared to three other drugs in placebo-controlled, double-blind studies. In one study that looked at the effects of SAMe and tricyclics, it was found that 92% of patients responded to SAMe, while only 85% responded to the tricyclics. SAMe has also been compared to other drugs such as amoxapine, maprotiline, and Trazadone.
