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One of the most significant medical developments in the past thirty years has been the emergence of antidepressant drug therapy. Antidepressants were the breakthrough intervention for the treatment of depression since the 1980s, and have been found to be efficacious for many other mental health disorders as well. Antidepressants are a cornerstone treatment element for depressive disorders, prescribed alongside psychotherapy and other interventions for best results.
Antidepressant drug therapy mitigates symptoms associated with depression, anxiety, bipolar disorder and other mood disorders, and personality disorders. These drugs help alleviate distress by balancing chemicals in the brain called the neurotransmitters. Nearly 13% of Americans aged 12 and older are on antidepressants, based on data provided by the Centers for Disease Control.
Among those prescribed antidepressants, the highest prevalence was among adults aged 65 and older. Regarding possible over-prescribing of antidepressants for older adults, Dr. Donovan Mause, M.D., M.S. who specializes in geriatrics at the University of Michigan states, “Many patients are given antidepressants for non-depression diagnoses, such as anxiety, sleep, and neuropathic pain.”
When a doctor decides to prescribe an antidepressant, he or she will take into consideration the benefit versus risk ratio. This simply means that the overall benefit to the wellbeing of the patient is balanced against potential side effects. For many individuals diagnosed with depression, anxiety, or a mood disorder, an antidepressant regimen offers significant benefits that offset the possible adverse effects. For those who find side effects intolerable, alternative treatments for treatment are then explored.
There are five categories of antidepressants. These include:
- Selective serotonin reuptake inhibitors (SSRIs). SSRIs are designed to modulate how serotonin is processed. These drugs increase the level of serotonin in the brain and block the reabsorption, or reuptake, of serotonin, making more serotonin available for transmitting messages between the neurons. Drugs in this class include Prozac, Lustral, Cipramil, Faverin, and Seroxat.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs). A newer type of antidepressant, the SNRIs work by blocking both the norepinephrine and serotonin neurotransmitters. These drugs include Cymbalta, Effexor, Fetzima, and Pristiq.
- Norepinephrine and dopamine reuptake inhibitors (NDRIs). Only one drug is represented in this class, which blocks reuptake of both dopamine and norepinephrine, Wellbutrin.
- Tetracyclics. These are drugs that work by preventing neurotransmitters from binding with specific receptors on the nerves. These drugs include Ludiomil, Remeron, and Asendin.
- Tricyclic antidepressants. Tricyclics block the reabsorption of serotonin and epinephrine into nerve cells after being released into a synapse. Tricyclics include Elavil, Tofranil, Pamelor, and Norpramin.
- Monoamine oxidase inhibitors (MAOIs). MAOIs work by blocking the effects of an enzyme called monamine oxidase, which breaks down serotonin, dopamine, and epinephrine. Drugs include Nardil, Marplan, Emsam, and Parnate.
While the positive effects of antidepressants are well established, the list of adverse side effects somewhat taints the reputation of these medications. Fortunately, with about thirty different antidepressants on the market a doctor can trial a patient on a few before finding the best therapeutic fit with the least amount of side effects. Each trial may last 4-6 weeks, after which the psychiatrist can adjust dosages or switch the patient to a different antidepressant if the trial is unsuccessful.
What Are the Positive Effects of Antidepressants?
When antidepressants are combined with psychotherapy and holistic treatment approaches they can help the individual struggling with a mental health disorder achieve a better quality of life. Being considered one prong of a three-pronged wellness approach, antidepressants play a big role in managing difficult symptoms which otherwise cause impairment in daily functioning.
While antidepressants can take several weeks before noticing a meaningful difference in symptoms, the accompanying interventions—therapy and holistic activities—can provide some relief in the meantime. When the antidepressant does become effective, the individual will experience a leveling out of the distressing symptoms to varying degrees, including some that achieve full remission.
Once the mental health disorder symptoms are under control, the individual will be able to be more productive and present in their jobs and their relationships. This in turn leads to improvements across the range of daily life, including career, family, physical health, and relationships.
These Mental Health Disorders May Benefit from the Positive Effects of Antidepressants
While commonly associated with an essential treatment method for depression, it is true that antidepressants are also efficacious in the treatment of a range of mental health conditions. Such disorders may call for a combination drug therapy that includes both antidepressants and another psychotropic drug, such as antipsychotics, anti-anxiety medications, or mood stabilizers. Antidepressants have been shown to be helpful for the following conditions:
Depression is a common mental health disorder that impacts over 17 million Americans annually. There are several sub-types of depression, including seasonal affective disorder, dysthymia, postpartum depression, and bipolar depression. Major depressive disorder is diagnosed when at least five of the following symptoms persist for more than two weeks.
Symptoms of depression include:
- Low mood, persistent sadness, feelings of despair and hopelessness
- Change in eating habits
- Sleep disorders
- Loss of interest in daily life
- Sluggish cognitive functioning or movements
- Inappropriate feelings of guilt or shame
- Thoughts of suicide
Anxiety disorders are the most prevalent mental health disorders in the US, with approximately 40 million adults struggling with anxiety. There are several different types of anxiety disorders, including generalized anxiety disorder, social anxiety, phobia, panic and disorder.
Symptoms of anxiety include:
- Irrational worry and fear, feelings of dread
- Shortness of breath
- Heart palpitations
Bipolar disorder is classified as a mood disorder, and has four types, including bipolar I, bipolar II, cyclothymic, and non-specified bipolar.
Symptoms of bipolar disorder include:
- Intense mood swings between mania and depression
- Impulsive behaviors
- Engaging in high-risk behaviors
- Substance abuse
- Intense irritability
- Hyper sexuality
- Rapid speech
- Increased energy
- Suicidal ideation
There are several different personality disorders, including antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, borderline personality disorder, avoidant personality disorder, paranoid personality disorder, and dependent personality disorder, not all of these will benefit from antidepressants although some definitely do.
There are several personality disorders, each with unique features and symptoms. Generally, someone with a personality disorder might experience:
- Distorted sense of self
- Antisocial behavior
- Emotional instability
- Impaired relationships
- Feelings of emptiness
- Delusional thinking
Binge Eating Disorder
Among the eating disorders, only binge eating disorder appears to benefit from the use of antidepressants. Possibly that is due to the relationship between the disorder and coexisting depressive disorder. Other eating disorders, such as anorexia and bulimia, do not seem to benefit from antidepressants.
Symptoms of binge eating disorder include:
- Continual eating even when full
- Stockpiling food, hiding food
- Inability to stop eating
- Gorging in isolation
- Feelings of numbness while bingeing
- Never feel sated, or satisfied after eating
- Low self-esteem
What are the Negative Effects of Antidepressants?
Now that we have covered the positive effects of antidepressants, it is helpful to also mention the limitations or negative effects of antidepressants. This is important, as antidepressants are usually effective in 50%-70% of individuals who are prescribed them for managing a mental health disorder. The balance are individuals who are diagnosed as treatment-resistant, either due to a lack of successful mitigation of symptoms or side effects that caused the individual to suspend treatment.
Antidepressant side effects might include:
- Weight gain
- Sexual dysfunction
- Blurred vision
- Dry mouth
Treatment for Depression and Anxiety is a 3-Pronged Approach
- Medication. There is a wide selection of antidepressants on the market for treating depression and also for treating anxiety. Each type of antidepressant varies slightly in how they function in the brain, making certain types best for treating depression and others better for anxiety or other mental health conditions.
- Psychotherapy. Cognitive behavioral therapy (CBT) is a behavioral approach that is very effective for treating depression or anxiety. CBT helps the patient identify irrational thoughts that leads to depressive symptoms or anxiety responses. The CBT therapist will guide patients toward developing more rational thought patterns. There are also exposure therapies for helping those with depression or anxiety that is related to a trauma.
- Holistic activities. Acknowledging the powerful mind-body connection, establishing healthy habits that promote physical wellness and help to regulate stress is essential. Incorporating regular exercise, a nutritious diet, and stress-reduction activities helps round out the treatment approach. Some activities that help reduce stress and promote calm include yoga, deep breathing techniques, practicing mindfulness, guided meditation, acupuncture, massage, and aromatherapy.
For patients with depression who do not respond to antidepressant drug therapy, there are some alternative approaches that may be helpful. These include brain stimulation techniques such as TMS therapy, vagus nerve stimulation, and deep brain stimulation.
Antidepressants remain the centerpiece of depression treatment protocols. While these medications do not work for everybody, the positive effect of antidepressants experienced by the majority of depression patients reinforces them for essential treatment of depressive disorders. Depression is a serious mental health disorder that should be diagnosed and treated to limit impairment. Giving antidepressants a trial run is a prudent step in stemming the impact of the symptoms on one’s life.
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