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IMPORTANT INFORMATION.
By reading this site, the reader acknowledges their personal respnsibility in choices for mental health for themselves and their children, and agrees that the AYCNP or anyone associated with this site, bears no responsibility for one's personal decisions in choices for mental health. Anyone coming off medication should do so gradually rather than abruptly, and under a doctor's supervision. Anyone experiencing thoughts of suicide should seek support.
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Page last updated: August 27, 2009 |
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Frequently used antidepressant drugs
Antidepressants: Types, uses and side effects
Psychiatric Drugs-Types
There are three main classes of antidepressants being used.
Two older types that are still sometimes prescribed are tricyclic antidepressants and MAOIs. The newer type of commonly prescribed antidepressants, which includes Prozac, are referred to as SSRIs (Selective seretonin reuptake inhibitors) and have less side effects that the older two classes of drugs. Additionally, there is the recently introduced selective serotonin and norepinephrine reuptake inhibitor (SNRI) drug class. While SSRIs block serotonin from being reabsorbed, SNRIs block both serotonin and norepinephrine. Up till now, 2 of these drugs have been approved as antidepressants in Germany: venlafaxine and duloxetine.
While these drugs are comparable with SSRIs in their benefit in depression, aenlafaxine is reported as working better than duloxetine, the side effects are worse with SNRIS than SSRIs.
See eScience News, (August 25, 2009). http://esciencenews.com/articles/2009/08/25/antidepressants.benefit.snri.proven
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2.4 billion drugs were prescribed in visits to doctors and hospitals in 2005 in the US. Of those, 118 million were for antidepressants. High blood pressure drugs were the next most-common with 113 million prescriptions. Britain issued 31 million perscriptions of antidepressants in 2006.
Photo: Tom Varco. 2006
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Addressing symptoms - not the illness
The most important thing to remember about antidepressants is that they address symptoms, they do not treat the underlying condition. With that in mind one needs to be realistic about what antidepressants can accomplish, there is no miracle drug, as Prozac was once thought to be.
And second, that it is difficult to find the right drug combination. Antidepressants help up to 55% of those who use them, but approximately 45% will find little or not help with the use of antidepressants. The gains that are made with antidepressants are not necessarily dramatic. Also, it is very diffiult to sustain the positive results of antidepressants over extended periods of time.
It can be difficult to successfully come off using antidepressants. Also, it can become difficult, once an antidepressant has lost its effectiveness, to find a replacement drug.
Sexual dysfunction through use of antidepressants, effects approximately 50% of users. This is the most common reason for discontinuation of their use.
Side effects, such as "feeling high," are not common, but reportedly can result from taking certain types of antidepressants. Feeling nervous and jittery is a side effect that also can result from antidepressant use for some.
Also of note is that the rate of success for placebos in comparison to antidepressants, in one mega-analysis was comparable.
The only antidepressant currently approved for
children is Prozac, (which also has side effects for both adults and children) although some doctors might also prescribe other drugs off-label, that is, which are not currently approved by the FDA (a legal practice).
For some, the positive benefits of antidepressants are noticed rather quickly, for others, more commonly, it may take a matter of up to eight weeks. For some, the positive benefits of antidepressants cannot be sustained for more than a few months, for others, it might be sustained for years.
Some have experienced a "crash" after having been on antidepressants (such as Prozac), successfully for a year or two. (Prozac poop-out is one coined phrase). Others have "crashed" and had a very difficult time coming up again, after having been on antidepressants for a long period of time (5-9 years).
So while antidepressants have helped some people to overcome depression, for mild to moderate depression, exercise, diet and nutrition are almost always a better solution. Additionally, for some, interpersonal therapy, or cognitive-behavioral therapy is of more value and can be of greater benefit in terms of depression than antidepressants. Teens and children, especially, can benefit from interpersonal therapy, in many cases.
For those who have been abused as children, talking things out with a mate, close friend, minister, or professional is essential to recovery.
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Antidepressants and most other pharmaceutical drugs for mental health are similar to aspirin, in that they treat symptoms but not the illness itself.
Photo: Ragesoss. 2008
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Sedation:
Both triicyclics and MAOIs can be sedating, as a common side effect, wereas, in general, SSRIs do not have as strong of a sedating quality.
Suicidality and antidepressants
Additionally, in children,
teens and those in the 18-24 age group, use of all antidepressants carries the risk of doubling (from 2% to 4%) risk of suicidality. There seems to be no evidence of increased suicidality in general amongst those in the 24-55 year age group. However in seniors, some reports may indicate that there may be an increased risk of suicidality.
Types
There are approximately 20-22 different types of antidepressants that are being prescribed at this time. The following is not an exhaustive list, but will give the reader a good idea of the types of antidepressants that are available.
Tricyclics and related drugs
Generic: impramine
Trade Name: Tofranil
Generic: amitriptyline
Trade Name: Elavil
Generic: desipramoine
Trade Name: Norpramin
Generic: nortriptyline
Trade Name: Aventyl
Generic: protriptyline
Trade Name: Vivactil
Generic: doxepin
Trade Name: Sinequan
Generic: trimipramine
Trade Name: Surmontil
Generic: clomipramine
Trade Name: Anaframil
Use: Used to treat relatively severe depression, especially of psychotic severity and unipolar (not bipolar, only depression). Also used in treatment of panic disorders,
OCD, and
bulimia. An older antidepressant, more than 50 years in use. Not popular, has been supplanted by SSRIs, but still used in certain situations, and when clients don't respond to SSRIs. Works similar to SSRIs, but has worse side-effects, especially in terms of sedation or cognitive slowing. They are used in clients who do not respond to SSRIs or other antidepressants.
Monoamine Oxidase (MAO) inhibitors
Generic: phenelzine
Trade Name: Nardil
Generic: tranylcypromine
Trade Name: Parnate
Generic: selegiline
Trade Name: Eldepryl
Use:
Depression, panic disorder, and social phobia.
Effects and side effects: Multiple side effects, some of them can be dangerous, including sedation. Dietary restrictions are necessary. Again, an older class of drugs, which are not as frequently used today as SSRIs.
Selective serotonin reuptake inhibitors (SSRIs)
Atypical antidepressants: Newer drugs, most commonly prescribed antidepressants.
Generic: fluoxetine
Trade Name: Prozac
Generic: fluvoxamine
Trade Name: Luvox
Generic: sertraline
Trade Name: Zoloft
Generic: paroxetine
Trade Name: Paxil
Use: Depressive symptoms,
OCD, panic disorder,
bulimia.
Effects and side effects
Positive effects can take about 3 weeks. The side effect profile is not as intense as tricyclics and MAOIs. Some side effects can be, nausea, insomnia, sexual dysfunction (in about 50% of those who take SSRIs, the most common reason persons discontinue their use).
Other:
Generic: trazodone
Trade Name: Desyrel
Generic: bupropion
Trade Name: Wellbutrin
Generic: nefazodone
Trade Name: Serzone
Anyone wishing to come off antidepressants should do so gradually rather than abruptly.
Also to be noted that there are always new antidepressants being developed, and this article is a large sampling rather than a definitive list.
Source adapted from: Carson, C. C., Butcherr, J. N. Mineka, S. (2000). Abnormal Psychology and Modern Life. Eleventh Edition. Boston: Allyn and Bacon.
Antidepressants, miscarriages and birth defects
Birth Outcomes in Pregnant Women Taking Fluoxetine [Prozac].
March 16, 2009
Christina D. Chambers, B.A., Kathleen A. Johnson, B.A., Lyn M. Dick, B.A., Robert J. Felix, B.A., and Kenneth Lyons Jones, M.D.
University of Pittsburgh. off-site link.
Conclusions: Women who take fluoxetine [Prozac] in the third trimester are at increased risk for perinatal complications. [premature birth]
Antidepressants and antidepressant side effects:
Internal bleeding and increased risk of blood trasnfusion
SSRI antidepressants contibute to bleeding, and result in a 4 times higher rate of blood transfusions according to this clinical study from the Netherlands.
Relationship of Serotonergic Antidepressants and Need for Blood Transfusion in Orthopedic Surgical Patients. Arch Intern Med. 2003;163:2354-2358.
http://archinte.ama-assn.org/cgi/content/full/163/19/2354
Antidepressants and sexual dysfunction:
By far, the side effect which affects the most who take anti-depressants is sexual dysfunction. Some put the percentage at around 50%, some between 30-70%.
Mayo clinic states,
"Some people have sexual dysfunction with antidepressants such as Prozac, Paxil, Effexor, Cymbalta, Zoloft or Celexa, and some do not. We cannot predict who will have what side effect and to what degree at this time."
The article Antidepressants & Female Sexual Dysfunction states accurately, (off-site link).
"Half of the women with major depression included in the survey reported decreased sexual interest and reduced levels of arousal. And, unfortunately, sexual dysfunction also is a common side effect of antidepressant treatment, particularly pharmacotherapy with SSRIs. In fact, treatment-emergent SSRI-induced sexual dysfunction ranges from approximately 30 percent to 70 percent of patients treated for depression."
Some clinicians add Viagra to even the drug regimen of females (and males) to try to control this side effect.
"Tricyclics and monoamine-oxidase inhibitors (MAOIs) commonly affect all three phases of the sexual cycle, including libido, arousal and orgasms and should be suspect as causative agents."
SSRI's also effect sexual dysfunction in both men and women.
From journal: Advance for Nurses. (Vol. 8 -Issue 13 - Page 29)
www.advance.com
Antidepressant Drugs References:
1. Antidepressants & Female Sexual Dysfunction. (Vol. 8 -Issue 13 - Page 29). Advance for Nurses. http://nursing.advanceweb.com/Editorial/Content/Editorial.aspx?CC=132767
2. Carson, C. C., Butcherr, J. N. Mineka, S. (2000). Abnormal Psychology and Modern Life. Eleventh Edition. Boston: Allyn and Bacon.
3. Christina D. Chambers, B.A., Kathleen A. Johnson, B.A., Lyn M. Dick, B.A., Robert J. Felix, B.A., and Kenneth Lyons Jones, M.D.,
University of Pittsburgh. (March 16, 2009). Birth Outcomes in Pregnant Women Taking Fluoxetine. University of Pittsburgh (UPMC).
http://www.upmc.com/MediaRelations/NewsReleases/2009/Pages/wisner-AJP.aspx
4. Cohen, E. (July 9, 2007). CDC: Antidepressants most prescribed drugs in U.S. CNN Health. (off-site link). http://www.cnn.com/2007/HEALTH/07/09/antidepressants/index.html
5. Rose, David, (May 14, 2007). Britain Becomes a Prozac Nation. Times Online. (off-site link). http://www.timesonline.co.uk/tol/life_and_style/health/article1784993.ece
Antidepressants page sponsor:
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