Antidepressants.

Let me start this post off with a disclaimer: I am not a doctor, so when it comes to antidepressants, all I know is what I've researched over the last several hours or learned from my doctors over the years. I am not an expert and I might even get something wrong because, believe it or not, I'm not perfect :) Also, I try not to go too in-depth with any particular subject, but it can be a lot of information at once, so feel free to skip over some parts. Ok, antidepressants are grouped into several different classes of medications based on how they are thought to work. I say "thought to work" because we really don't know exactly how they work in the brain, but we know that they are often effective in treating depression, as well as a number of other conditions like anxiety, chronic pain, Obsessive Compulsive Disorder, sleep disorders, etc. I'm going to talk about the three most common types of antidepressants, although there are at least eight different classes of medications that classify as antidepressants.

Selective Serotonin Reuptake Inhibitors (SSRIs) are a type of antidepressant that are thought to work by preventing the reuptake of serotonin by the presynaptic neuron, which causes the synapses of the brain to have more serotonin in them. Basically it prevents serotonin from being cycled back into the presynaptic neuron so it is instead used by the brain. Serotonin, along with norepinephrine and dopamine, is a neurotransmitter that causes feelings of well-being and happiness. When someone is depressed, their brain tends to have lower levels of these three neurotransmitters, causing a chemical imbalance. The goal of antidepressants is to re-balance one or more of those chemicals in the brain. SSRIs balance out the levels of serotonin alone. The specific medications in this class of antidepressant include Celexa, Lexapro/Cipralex, Paxil/Seroxat, Prozac, Luvox, and Zoloft/Lustral.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), on the other hand, balance the levels of both serotonin and norepinephrine in the brain. They work similarly to SSRIs, only with both serotonin and norepinephrine. SNRIs prevent the reuptake of norepinephrine and serotonin, causing higher levels of these neurotransmitters in the brain. The medications in this class include Pristiq, Cymbalta, Ixel/Savella, and Effexor.

Finally, we have the Tricyclic Antidepressants (TCAs). TCAs were discovered in the 1950s, and were widely used in the decades to follow, but have mostly been replaced by the use of other types of antidepressants because they have more dangerous side effects and can be more lethal in the event of an overdose than other newer medications such as SSRIs and SNRIs. However, TCAs are still more effective in treating more severe, treatment-resistant forms of depression than newer classes of antidepressants. They are also not considered to be addictive, which is preferable when taken for an extended period of time. The list of TCAs is so lengthy that I will not mention all of them, but a few well-known medications within this class are Elavil/Endep/Tryptomer, Imiprex/Elepsin, and Depressin/Vagran.

As you may have already gathered, all antidepressant medications come with their own set of side effects, some more severe than others. One major problem with antidepressants is that on occasion they can have the opposite affect on the body, causing worsening depression and very severe suicidal thoughts or actions. That is why patients have to be monitored closely when starting a new antidepressant, because it is hard to tell on your own if you are more suicidal than you were previously, and people looking in from the outside can usually tell that something is wrong before you can. Other side effects include weight loss or weight gain, sleepiness or fatigue, diarrhea or constipation, headaches, dizziness, insomnia, nausea, decreased sex drive, dry mouth, tremors, etc.

Along with having possible adverse side effects, antidepressants are also known for taking a long time to build up in your system and begin to take effect. It typically takes four to six weeks before you know if an antidepressant is actually helping because it takes that long for your body to get used to the medication. Because of this, it can be a long and grueling process to find a medication that is right for you. In addition to the delayed effects when starting an antidepressant, it can also be difficult to switch over to another medication because you often have to ween off of antidepressants. Stopping cold-turkey can cause major problems, so it's best to listen to the doctor when they tell you to cut the pills in half for a week before completely stopping them. It also takes time to find out how much of an antidepressant you need to reach therapeutic levels. Your doctor will work with you to continue to increase the dose until you reach a level that is appropriate for you. As you can probably imagine, during this process of weening and beginning a new antidepressant, you may experience more severe symptoms of depression when you have weened off your old one, but haven't yet reached therapeutic levels of the new one. This is why people often complain about having to switch antidepressants.

For some reason, my depression is a treatment-resistant form of depression and most antidepressants are ineffective in adequately treating my symptoms. Typically they begin to work for a while when I first start taking them, but over time the effectiveness decreases until I have to increase the dose, and then the same thing happens. My doctor increases the dose until I have reached the maximum safe dose of one particular antidepressant before moving on to another one. I have tried 13 different antidepressants over the last seven years and none of them have been effective for longer than a few weeks. Like I said, it can be a very frustrating process. Hopefully I'll find one soon that works for me and when I start Dialectical Behavior Therapy, the two will complement each other just enough to be effective. By the way, I should mention one last thing before I finish: antidepressants alone are often not enough to be effective; typically a doctor prescribes medication but also recommends some kind of other therapy that will also help relieve symptoms of depression. I hope this overview has been helpful in addressing the basics of antidepressants.