Finding The Best Antidepressant

Finding The Best Antidepressant – Cutting Through the Confusion

What is the best antidepressant? Short answer – it depends. That’s because everyone is different. Antidepressants affect individuals differently. But don’t worry, I’m going to walk you through them in detail.

First, I’ll explain how your doctor or psychiatrist decides on the best antidepressant for you. Then, I’m going to cover the important things you need to know before starting antidepressants for the first time.

Finally, I’m going to talk about the different types of antidepressant. I’ll cover how they work and what side effects you can expect.

Let’s get going . . .

Choosing the Best Antidepressant

There are several different types of antidepressant available. Each one works in a slightly different way, as well as having different side effects.

Before they prescribe an antidepressant, your doctor or psychiatrist should consider the following:

Your specific symptoms: Depression symptoms will vary between individuals. One antidepressant might treat some symptoms better than others.

Possible side effects: Side effects vary, depending on the antidepressant. They also vary between individuals. And they can make it hard to stay on a particular antidepressant.

Side effects are covered in more detail in the section “Types of Antidepressants”.

Interaction with other medications: Some antidepressants can’t be taken with certain other prescription medications. That’s because they can have dangerous interactions with them.

Existing health conditions: Some antidepressants can lead to complications with certain existing health conditions. Such conditions include heart disease and high blood pressure.

Pregnancy and breastfeeding: Antidepressants can be used during pregnancy or breastfeeding. However, it’s important to weigh up  the risks and benefits.

Taking antidepressants during pregnancy or breastfeeding is usually safe for the baby. Birth defects and other health problems are very rare.

Your doctor or psychiatrist should discuss the risks and benefits with you.

Starting on Antidepressants

Choosing an antidepressant is only the first step. Once an antidepressant has been prescribed, be prepared for a bumpy ride.

When you start taking an antidepressant, bear the following in mind:

Be Patient

Once you’ve started taking an antidepressant you may have to wait six weeks or more before you know if it’s working. If the one you try doesn’t relieve your symptoms, you will have to try another. You may have to try a number of different antidepressants before you find one that works.

If you’re unlucky, it could take months before you find the right one. This is very frustrating, especially when you have to endure side effects with nothing to show for it.

Once you have found the right one, it takes yet more time (a few months) to get the full benefit. And you may need the dose increasing, which can result in side effects all over again. In some cases, a combination of two or medications will be needed.

If the first antidepressant doesn’t work, it’s important not to give up. There are plenty of antidepressants available, and it’s likely that you’ll eventually find one that works for you.

Take Your Antidepressant Consistently and Use the Prescribed Dose:

If it isn’t working, or if it’s causing unbearable side effects, talk to your doctor or psychiatrist. Don’t make any changes before you do so. Many antidepressants have initial side effects, but these usually disappear as your body adapts.

again, side effects are covered in more detail in the section “Types of Antidepressants”.

Explore Other Options if it Doesn’t Work:

If your symptoms don’t improve after six weeks or so, talk to your doctor or psychiatrist. They may advise you change the dose, or try a different antidepressant.

They may even suggest adding another antidepressant. A combination of antidepressants might work better for you than a single one.

Consider Psychotherapy:

Antidepressants are often combined with psychotherapy. This can work more effectively than taking antidepressants on their own. Following recovery, psychotherapy can help prevent depression recurring in the future.

Don’t Stop Taking an Antidepressant Before Talking to Your Doctor:

Some antidepressants can have significant withdrawal symptoms. That’s why it’s important to taper off slowly. Also, going cold turkey can make your depression worse. Your doctor or psychiatrist will advise you how best to stop taking an antidepressant.

Avoid Alcohol or Recreational Drugs:

In the short term alcohol and drugs can alleviate depression. But long term they can make it worse.

Antidepressants and Suicide Risk

Antidepressants have been linked to an increase in suicidal thoughts or behaviour. Children, teenagers and young adults under 25  are considered to be the most vulnerable. The risk is greatest in the first few weeks after starting, or when the dose is changed.

Anyone taking antidepressants should be closely monitored. Worsening depression or unusual behaviour should be watched for.

If they have suicidal thoughts, get help immediately. Contact a doctor or psychiatrist, or get them to a hospital.

However, it’s important to keep things in perspective. Only a small percentage of people taking antidepressants are at risk. In the long run, antidepressants are much more likely to reduce the risk of suicide.

Types of Antidepressant

Brain chemicals known as neurotransmitters are linked to depression. Neurotransmitters are chemical “messengers” that carry signals between nerve cells in the brain. These neurotransmitters are serotonin, norepinephrine and dopamine.

Most antidepressants relieve depression by working on these neurotransmitters. Each type affects these neurotransmitters in slightly different ways.

There are several types of antidepressant available for treating depression, including:

Selective Serotonin Reuptake Inhibitors (SSRIs)

Doctors usually begin by prescribing an SSRI. They generally have fewer side effects than other types of antidepressants. They are also less likely to cause problems at higher doses.

How SSRIs Work:

SSRIs work by increasing serotonin levels in the brain. Serotonin is a neurotransmitter that influences mood, emotion and sleep. 

After carrying a message, serotonin is usually reabsorbed by the nerve cells. This is known as “reuptake”. SSRIs work by “inhibiting” reuptake. This means more serotonin is available to pass additional messages between nearby nerve cells.

SSRIs Include:

  • citalopram (Cipramil)
  • escitalopram (Cipralex)
  • fluoxetine (Prozac or Oxactin)
  • paroxetine (Seroxat)
  • sertraline (Lustral)

Possible Side Effects of SSRIs:

  • feeling anxious, shaky or agitated
  • feeling sick
  • vomiting
  • dizziness
  • blurred vision
  • low sex drive
  • difficulty achieving orgasm
  • erectile dysfunction

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are often prescribed if SSRIs have been tried without result. Like SSRIs, they generally cause fewer side effects than other types of antidepressants.

How SNRIs Work:

SNRIs are very similar in action to SSRIs, but they act on noradrenaline as well as serotonin.

SNRIs Include:

  • venlafaxine (Effexor)
  • duloxetine (Cymbalta and Yentreve)

Possible Side Effects of SNRIs:

  • feeling anxious, shaky or agitated
  • feeling sick
  • vomiting
  • dizziness
  • blurred vision
  • low sex drive
  • difficulty achieving orgasm
  • erectile dysfunction

Atypical Antidepressants

Atypical antidepressants don’t fit into any of the other categories. They are usually prescribed if SSRIs or SNRIs have been tried without result.

How Atypical Antidepressants Work:

Each antidepressant in this category has a unique mechanism of action. However, like other antidepressants they affect the levels of neurotransmitters in the brain.

Atypical Antidepressants Include:

  • mirtazapine (Remeron)
  • bupropion (Wellbutrin, Aplenzin, Forfivo XL)
  • trazodone (Desyrel, Desyrel Dividose, Oleptro)

Possible Side Effects of Atypical Antidepressants:

Side effects are as unique as their mechanisms of action. Possible side effects include:

  • dry mouth
  • constipation
  • dizziness
  • light headedness
  • mirtazapine and trazodone cause drowsiness and are usually taken at bedtime

Tricyclic Antidepressants

Tricyclic antidepressants tend to have more unpleasant side effects than the the types already covered. Tricyclics aren’t prescribed unless those other types have been tried first with no improvement.

How Tricyclic Antidepressants Work:

Tricyclics work by prolonging the action of noradrenaline and serotonin in the brain.

Tricyclic Antidepressants Include:

  • amitriptyline (Elavil)
  • doxepin (Sinequan)
  • imipramine hydrochloride (Tofranil)
  • nortriptyline (Pamelor)

Possible Side Effects of Tricyclic Antidepressants:

  • suicidal feelings
  • serotonin syndrome –
  • hypomania or mania
  • diabetes
  • decreased alertness

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs can have serious side effects. They will only be prescribed when other medications have failed.

They can have dangerous interactions with certain foods. These foods include certain types of cheese, pickles and wine. Therefore, a strict diet is needed when taking MAOIs.

MAOIs can also have dangerous interactions with other medicines.

How MAOIs Work:

MAOIs work by blocking the activity of monoamine oxidase. Monoamine oxidase is an enzyme that breaks down norepinephrine, serotonin, and dopamine.

MAOIs Include:

  • tranylcypromine (Parnate)
  • phenelzine (Nardil)
  • isocarboxazid (Marplan)

Possible Side Effects of MAOIs Include:

  • suicidal feelings
  • serotonin syndrome –
  • diabetes
  • decreased alertness

Summary

I’ve explained how the best antidepressant for you is determined. You now know the key facts a doctor or psychiatrist should consider when prescribing one.

I’ve told you what you need to know before starting on antidepressants. You should now be better prepared for what to expect.

I’ve also covered the different types of antidepressant. I know the choice can be confusing, but hopefully everything makes more sense now.

I said earlier that you should be prepared for a bumpy ride. With this information, I hope things will be a lot easier for you.

If you have any questions or concerns, let me know in the comments section below . . .

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