+1-617-394-8820 contact@baybiosciences.com

How Do Antidepressants Work?

by | Mar 7, 2024 | Info | 0 comments

Antidepressants Overview

Antidepressants are common prescription medications that can help treat depression and other conditions like anxiety and obsessive-compulsive disorder. 

These medications can help relieve the symptoms of depression and anxiety. Common examples include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta).

Antidepressants work by increasing neurotransmitters in the brain. Experts believe these brain chemicals are responsible for changes in mood and behavior.

Depression is a mood disorder that causes a persistent feeling of sadness and a loss of interest in things and activities you once enjoyed. It can also cause difficulty with thinking, memory, motivation, eating and sleeping.

There are several types of depressive disorders, some of which include:

  • Atypical depression 
  • Bipolar depression
  • Clinical depression (major depressive disorder)
  • Persistent depressive disorder (PDD)
  • Premenstrual dysphoric disorder (PMDD)
  • Seasonal depression (Seasonal affective disorder)

Antidepressants are one type of treatment for depression. While they can treat the symptoms of depression, they don’t always address its causes. This is why healthcare providers often recommend psychotherapy (talk therapy) in addition to depression medication.

Antidepressants were invented in the 1950s. Since then, researchers have developed several different types of the medication. Today, antidepressants are one of the most frequently prescribed medications in the United States.

Types of Antidepressants

Doctors usually divide antidepressants into following different types. These include:

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a first-line treatment option for depression.

Examples of SSRIs include:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac, Sarafem)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft) 

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs are a newer class of antidepressants compared with SSRIs. However, they work similarly.

Doctors may prescribe SNRIs for:

  • Anxiety disorders
  • Attention deficit hyperactivity disorder (ADHD) 
  • Chronic neuropathic pain
  • Obsessive-compulsive disorder (OCD)
  • Fibromyalgia
  • Menopausal symptoms

Examples of SNRIs include:

  • Desvenlafaxine (Pristiq)
  • Duloxetine (Cymbalta) 
  • Venlafaxine (Effexor XR)

Tricyclic antidepressants (TCAs)

Doctors may recommend TCAs for:

Examples of TCAs include:

  • Amitriptyline
  • Amoxapine
  • Clomipramine (Anafranil)
  • Desipramine (Norpramin)
  • Doxepin (Sinequan)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Protriptyline (Vivactil)
  • Trimipramine (Surmontil)

Monoamine Oxidase Inhibitors (MAOIs)

Due to their adverse side effects and drug interactions, doctors do not typically suggest MAOIs as a first-line treatment option for depression. However, they may be an option in the case of  treatment resistant depression. 

Examples include:

  • Isocarboxazid (Marplan)
  • Phenelzine (Nardil) 
  • Selegiline (Emsam, Eldepryl)
  • Tranylcypromine (Parnate)

Noradrenaline and Specific Serotoninergic Antidepressants (NaSSAs)

Doctors prescribe NaSSAs to treat anxiety disorders and depression.

Examples include mirtazapine(Remeron, Avanza, Zispin) and mianserin (Tolvon). Mianserin is not available in the United States.


Side Effects of Antidepressants

All drugs have side effects, not just antidepressants.

Different antidepressants have different side effects. However, not everyone experiences them.

SSRI and SNRI Side Effects

SSRIs and SNRIs can lead to the following:

SNRIs can also increase blood pressure. A person with a serious heart condition should not take the SNRI venlafaxine.

TCA Side Effects

TCAs may have the following side effects:


MAOI side effects

MAOIs can interact with other drugs. For example, if a person combines an MAOI with an SSRI, it could lead to serotonin syndrome. Serotonin syndrome is a serious condition in which a person has too much serotonin in their body.

MAOIs can also lead to:

MAOIs prevent the breakdown of tyramine. If a person consumes foods that contain tyramine, such as sausages, dried fish, and overripe fruit, it can lead to a  hypertensive crisis. This is a severe increase in blood pressure that can lead to a stroke.

NaSSA Side Effects

These antidepressants can lead to side effects similar to SSRIs and SNRIs. NaSSAs can also cause drowsiness and weight gain. They are less likely to cause sexual dysfunction.

Rarer Side Effects

Rarer side effects of antidepressants include the following:

  • Suicidal thoughts: According to the United Kingdom’s National Health Service (NHS), young adults and children may have a higher risk of suicidal thoughts when they first start taking antidepressants. If side effects are very unpleasant or include thinking about suicide, the person should speak with a doctor immediately.
  • Withdrawal symptoms: Some people who take SSRIs and SNRIs experience some withdrawal symptoms when they stop taking the medication. Withdrawal symptoms can last for 1–2 weeks and include:
    • Anxiety
    • Abdominal Pain
    • Dizziness 
    • Electric shock-like sensations in the body
    • Flu-like symptoms
    • Nightmares or vivid dreams


Effectiveness

Antidepressants tend to be effective. However, everyone responds to medication differently.

According to the Institute for Quality and Efficiency in Health Care, 40–60% of people who took an SSRI or SNRI for depression noticed some symptom relief within 6–8 weeks.

The research notes that the more severe the depression, the greater the benefits of antidepressants may be.

Alternative Options

People may wish to try the following:

Therapy

People with depression may wish to undergo therapy. Types of therapy that can help treat depression include the following:

  • Cognitive behavioral therapy (CBT)
  • Interpersonal therapy
  • Problem-solving therapy

St. John’s Wort

Hypericum, made from the herb  St. John’s wort, might help relieve depression in some people. It is available over the counter as a supplement.

However, there are some possible risks associated with taking hypericum:

  • When combined with certain antidepressants, it can lead to a potentially life threatening increase in serotonin.
  • It can worsen symptoms of biopolar disorder and schizophrenia.
  • This might reduce the effectiveness of some prescription medications, including antidepressants, birth control pills, some heart medications, warfarin, and some therapies for HIV and cancer.

If a person plans to take St. John’s wort, they should first talk with a doctor or pharmacist.

Light Box

People who experience seasonal affective disorder may benefit from light therapy.

It involves sitting in front of a light box first thing in the morning for 30–45 minutes.

Diet and Exercise

The Centers for Disease Control and Prevention (CDC) notes that regular physical activity can reduce a person’s risk of depression. People may wish to try three exercise sessions per week for 12–24 weeks.

Patients may also benefit from eating a balanced nutritious diet full of fresh and whole foods. They may wish to avoid or limit refined and  processed foods.

How Antidepressants Work?

While different antidepressants work in different ways, they all affect neurotransmitters. Neurotransmitters are chemicals brain cells use to communicate with each other.

Antidepressants work in the following ways:

  • SSRIs: These prevent serotonin from returning to where it came from, also known as preventing serotonin reuptake. This encourages serotonin to bind to its receptor to transmit a signal in the brain.
  • SNRIs: These work the same as SSRIs, except they work on both serotonin and norepinephrine.
  • TCAs: These work the same as SNRIs, except they are less effective at blocking norepinephrine reuptake than serotonin reuptake.
  • MAOIs: These target the brain enzyme monoamine oxidase, which helps break down neurotransmitters such as serotonin. This can lead to more stabilized moods and less anxiety.

How Long Does It Take for Antidepressants To Take Effect?

According to the NHS, people may begin to feel the benefits of an antidepressant after 1–2 weeks if they have not missed a dose.

Some people may stop taking their antidepressant because they believe the medication is not working. However, it is important to keep taking the medication exactly as a doctor prescribes.

If the patient has not noticed any benefit after 4 weeks, they should contact their doctor.

Frequently Asked Questions About Antidepressants

Below are some commonly asked questions about antidepressants.

Which Antidepressant Is Right for Me?

There are many types of antidepressants. They all work differently and have different benefits, risks, and side effects.

A person can speak with a doctor about their individual circumstances. The doctor can help them find the best treatment option for them.

Are Antidepressants Safe During Pregnancy?

The CDC notes there is a link between taking SSRIs during pregnancy and congenital abnormalities. However, this risk is very low.

For some people, the risks associated with stopping the medication are higher than those associated with continuing to take it.

If a person is pregnant and wishes to continue or begin taking antidepressants, they should speak with a doctor.

Tiny amounts of some antidepressants can enter breast milk. However, the CDC states most antidepressants will have no effect on milk supply or the child’s well-being.

How Long Should I Stay on Antidepressants?

According to the NHS, doctors typically suggest a person takes antidepressants for at least 6 months.

Patient’s should take their antidepressants exactly as their doctor has prescribed.

How to Stop Antidepressants Safely

When people stop taking antidepressants, they may experience withdrawal symptoms or a relapse. A doctor can advise on how to stop taking antidepressants safely and how to manage symptoms of withdrawal.

According to one study, about 20% of patients who suddenly stop taking antidepressants will experience symptoms, which doctors refer to as antidepressant discontinuation syndrome. The National Alliance on Mental Illness say that the number may be as high as 80%.

For this reason, experts recommend consulting a doctor before stopping the use of antidepressants. Antidepressants are not habit forming, so stopping them does not cause withdrawal. However, it can cause symptoms, which a doctor can help the person manage.

In this article, we look at why it can be hard to stop taking antidepressants. We also discuss the symptoms that can occur, how to relieve them, and tips for stopping these medications safely.

Why do Patients Stop Antidepressants?

Antidepressants cannot cure depression, but they can help reduce anxiety, low mood, and suicidal thoughts. They work by changing how the brain uses chemicals to balance mood or deal with stress.

When people start taking antidepressants, the drugs can take several weeks or longer to be effective. Antidepressants can also have side effects. Both of these factors can make a person want to stop taking them.

People might also wish to stop taking antidepressants because:

  • A medical professional has advised them to stop 
  • They are pregnant or plan to become pregnant
  • The medication is too costly
  • They feel as though they have recovered sufficiently

It can be hard to stop taking antidepressants after taking them for a long time.

People should seek a doctor’s advice and support when planning to stop using these medications. The doctor will help make a plan that may involve reducing the dosage gradually or switching to another drug.

Why is stopping Antidepressants Hard?

Although they do not lead to physical dependence, medications for depression change the chemicals in a person’s brain. The body adjusts to these changes, so stopping suddenly can cause a reaction.

Stopping antidepressants can have a mental and physical impact. A person may also worry that symptoms of depression will return.

Symptoms of Stopping Antidepressants

Six types of symptoms can occur when stopping antidepressants.

They are:


Comparing Antidepressants Side Effects

Stopping different antidepressants will result in different symptoms, depending, to some extent, on the half-life.

Antidepressants with a short half-life can cause more side effects and be harder to stop taking. However, people may still experience symptoms when they stop taking a drug with a longer half-life.

The half-life is the amount of time that it takes for the level of the substance in the body to reduce by half. The half-life varies among drugs, and it can also vary among individuals.

Antidepressants with a short half-life include venlafaxine (Effexor) and trazodone (Desyrel). Fluoxetine (Prozac) and citalopram (Calexa) have a long half-life.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs include medications such as citalopram and fluoxetine. Discontinuation symptoms include:

  • Appetite changes 
  • Ataxia, or loss of muscle coordination 
  • Agitation, anxiety, aggression, and low mood
  • Blurred vision
  • Difficulty with movements
  • Dizziness Electric shock sensations
  • Electric shock sensations
  • Flu-like symptoms
  • Headaches
  • Insomnia and nightmares
  • Lethargy
  • Numbness and tingling
  • Stomach pain and cramps
  • Tremor 
  • Vertigo


Monoamine Oxidase Inhibitors (MAOIs)

MAOIs include medications such as phenelzine (Nardil) and isocarboxazid (Marplan). Discontinuation symptoms include:

  • Agitation 
  • Catatonia, which is when a person is unable to move 
  • Delirium 
  • Feeling agitated or irritable
  • Headaches 
  • Hallucinations and delusions
  • Insomnia and nightmares
  • Jerky movements or muscle twitches
  • Low mood

Tricyclic Antidepressants (TCAs)

TCA medications include amitriptyline (Elavil) and doxepin (Silenor). Discontinuation symptoms include:

  • Abdominal and gastrointestinal disturbances, such as nausea, vomiting, cramping, and diarrhea 
  • Dizziness, lightheadedness, and vertigo 
  • Flu-like symptoms 
  • Feeling agitated or anxious
  • Headaches
  • Insomnia and nightmares
  • Lethargy
  • Low blood pressure
  • Problems with coordination and movement
  • Tremor

Atypical Antidepressants

These include venlafaxine (Effexor) and duloxetine (Cymbalta). Symptoms that can occur following discontinuation include:

  • Anxiety 
  • Appetite changes 
  • Dizziness and vertigo 
  • Electric shock, sensations and tingling
  • Flu-like symptoms
  • Headaches
  • Lethargy 
  • Low mood
  • Nausea and vomiting
  • Insomnia and nightmares

How to relieve symptoms

Symptoms usually appear within a few days of stopping an antidepressant. Knowing which symptoms to expect can help a person prepare.

In some cases, severe symptoms may make it necessary to take time off work.

Choosing a suitable time to stop taking antidepressants can help with the process. A person may be more at risk of a relapse of depression during periods of stress or emotional difficulty.

Flu-like symptoms

Some people experience flu-like symptoms. A doctor may recommend treating these by:

  • Getting rest
  • Staying warm 
  • Drinking plenty of fluids

Taking pain relievers to ease any discomfort is usually safe, but it is best to check with a doctor first.

Fatigue and Sleep Problems

The symptoms of tiredness, disrupted sleep, and irritation can make everyday activities more difficult.

Planning a quieter few days while stopping antidepressants can reduce stress.

Is it a relapse?

Sometimes, discontinuation symptoms can resemble a relapse. However, while discontinuation symptoms usually start within a few days, signs of a relapse take longer  typically 2–3 weeks, to appear.

If a patient has concerns that depression is returning, they might wish to seek medical advice. In some cases, a doctor may prescribe medication to help with discontinuation symptoms.

How Long Do Symptoms Last?

Discontinuation symptoms usually start within a few days. Research from 2017 says that they tend to last for 1–2 weeks, but it can be longer in some cases. Some newer research has shown that, although it is uncommon, discontinuation symptoms can last up to 79 weeks.

According to the American Psychological Association, a person can expect the symptoms to last “at least several weeks.”

Having a good support network in place or someone understanding to talk to during this time can be beneficial.

Getting sufficient rest, eating well, and exercising regularly can reduce symptoms for some patients.

Tips for Stopping Safely

Stopping antidepressants is a serious decision that can affect a person’s health. A doctor will be able to offer information and advice.

Know your drug

Being involved with the decision-making and planning at each stage of the treatment can help reduce the risk of an unpleasant experience.

For instance, a person can talk to the doctor about:

  • The drug and how to stop using it, even before they start
  • Reasons for stopping and a plan for stopping, for when they feel ready to do so
  • Which effects to expect, how long they are likely to last, and how to distinguish between adverse effects and a relapse

It may also help if the person keeps a chart to track their progress. They can share this with their doctor.

Stop Gradually

A doctor will often advise an individual to stop taking antidepressants gradually, which is known as tapering. A person slowly reduces the dosage of medication over time until they are no longer taking it.

The time that it takes to taper off antidepressants will depend on the drug and how long a person has been taking it. A doctor can advise on this process and the best way to approach it.

Switching Drugs

In some cases, a doctor may recommend switching to another medication as a step toward discontinuing the drug.

They may suggest switching to a drug with a longer half-life and then gradually lowering the dosage.

Seek Support

Family and friends can support a person while they stop taking antidepressants. Supportive psychotherapy may also help.


Summary

Antidepressants can help relieve symptoms of conditions such as depression and anxiety disorders. They work by increasing neurotransmitters in the brain.

Examples of antidepressants include SSRIs, SNRIs, TCAs, and NaSSAs. MAOIs may also be an option, though doctors prescribe these less often due to the risk of adverse side effects.

It can take several weeks for antidepressants to start working. People may experience side effects.

Alternatives to antidepressants include therapy, diet and exercise, and St. John’s wort. However, depression is a serious condition that may need professional treatment. Anyone who experiences the symptoms of depression should speak with a doctor.

Deciding to discontinue antidepressant use needs serious consideration. With appropriate support, many people stop safely, although they may experience uncomfortable adverse effects.

A person should always seek a doctor’s advice before stopping and follow the plan they suggest.

Withdrawal symptoms from certain medications can lead to suicidal thoughts. If this happens, it is vital to seek urgent support.

 

Bay Biosciences is a global leader in providing researchers with high quality, clinical grade, fully characterized human tissue samples, bio-specimens, and human bio-fluid collections.

Samples available include cancer (tumor) tissue, cancer serum, cancer plasma, cancer, peripheral blood mononuclear cells (PBMC). and human tissue samples from most other therapeutic areas and diseases.

Bay Biosciences maintains and manages its own biorepository, the human tissue bank (biobank) consisting of thousands of diseased samples (specimens) and from normal healthy donors available in all formats and types.

Our biobank procures and stores fully consented, deidentified and institutional review boards (IRB) approved human tissue samples and matched controls.

All our human tissue collections, human specimens and human bio-fluids are provided with detailed, samples associated patient’s clinical data.

This critical patient’s clinical data includes information relating to their past and current disease, treatment history, lifestyle choices, biomarkers, and genetic information.

Patient’s data is extremely valuable for researchers and is used to help identify new effective treatments (drug discovery & development) in oncology, and other therapeutic areas and diseases.

Bay Biosciences banks wide variety of human tissue samples and biological samples, including cryogenically preserved at – 80°C.

Including fresh frozen tissue samples, tumor tissue samples, formalin-fixed paraffin-embedded (FFPE), tissue slides, with matching human bio-fluids, whole blood and blood-derived products such as serum, plasma and PBMC.

Bay Biosciences is a global leader in collecting and providing human tissue samples according to the specified requirements and customized, tailor-made collection protocols.

Please contact us anytime to discuss your special research projects and customized human tissue sample requirements.

Types of Biospecimens

Bay Biosciences provides human tissue samples (human specimens) from diseased and normal healthy donors which includes:

We can also procure most human bio-specimens, special collections and requests for human samples that are difficult to find. All our human tissue samples are procured through IRB-approved clinical protocols and procedures.

In addition to the standard processing protocols, Bay Biosciences can also provide human plasma, serum, and PBMC bio-fluid samples using custom processing protocols; you buy donor-specific collections in higher volumes and specified sample aliquots from us.

Bay Biosciences also provides human samples from normal healthy donors; volunteers, for controls and clinical research, contact us Now.

  • 日本のお客様は、ベイバイオサイエンスジャパンBay Biosciences Japanまたはhttp://baybiosciences-jp.com/contact/までご連絡ください。