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What
are Antidepressants? (FAQs)
Antidepressants are a group of medicines that affect mood. The most commonly prescribed antidepressants are the SSRIs, which stands for Selective Serotonin Reuptake Inhibitors. The SSRIs currently available are Prozac, Zoloft, Paxil, Celexa, Luvox, and Lexapro. Other antidepressants include Effexor, Remeron, and Wellbutrin.
Q: How do antidepressants work?
A: At present we do not have a full understanding of how anti-depressants work. We do know that most all anti-depressants seem to affect a certain group of chemicals in the body called “monaoamines.” The monoamines affect how we think and feel. The most commonly known monoamine is serotonin. It is suspected that by changing the levels of monoamines in our brains, the antidepressants help alleviate depression. What we are sure of is that many people who take these will, over time, experience a change in their emotional response.
Q: How long do they take to work?
A: Most people need about two weeks of an adequate dose to notice any difference. Sometimes change can take as long as six weeks.
Q: What are the chances that anti-depressants will be helpful for me?
A: About 2/3 of people who have Depression will feel better from these drugs. A little less than half will feel completely recovered. Unfortunately, it is impossible to predict for a given individual whether they will be helped by anti-depressants. However, the shorter the duration of the depression, the more likely that a person will get better from antidepressants.
Q: What is the “placebo effect”?
A: “Placebo effect” is said to occur when a person taking a medication improves not due to the effect the medication, but because of the individual's expectations. The classic example is a person taking a sugar pill that they think is a pain-killer and feeling less pain. There appears to be a placebo effect for anti-depressants as well. Research shows that people who are given a sugar pill get over their depression almost as much as people taking anti-depressants.
Q: Are there side effects I need to worry about?
A: Virtually every medication has some side effects and antidepressants are no exception. The good news is that many of the side effects fade after the first couple of weeks. (The exception to this rule is the sexual side effects.) Listed below are the major side effects for each.
●
SSRIs – headache, nausea, diarrhea,
sexual side effects, brief
increase in anxiety
●
Remeron – tiredness, weight gain, some
sexual side effects, but less
than SSRIs.
●
Effexor – similar to SSRIs, but at higher doses can be associated with
increase in blood pressure as well.
●
Wellbutrin – this antidepressant is least associated with
sexual side effects. The
disadvantage is that it can make people anxious and interfere with sleep.
It can also cause an increases in blood pressure.
Q: How do I know which antidepressant is right for me?
A: Since all antidepressants have about the same degree of effectiveness, the choice of which one to take is generally made by asking, which side effects would be least bothersome for me? You should talk to your doctor about the side effects, the chances that you might experience these side effects, and and other factors that bear on which antidepressant would be best for your circumstances.
Q: There’s been a lot of talk lately about the dangers of some antidepressants. Do I need to worry?
A: Recently, it has come to light that some children may be at greater risk for suicide by taking these medications. Of course, this is very serious. However, there is no clear evidence that this is the case with adults.
Q: I’ve been on an antidepressant for a while, but I’d like to see how I feel off of it now. What will happen if I stop taking it?
A: Many people have a withdrawal syndrome when coming off antidepressants. Symptoms can include nausea, anxiety, difficulty with sleep, vivid dreams, and the most characteristic symptom, an electric shock-like feeling throughout the body often brought on by turning the head. Of course, return of depression is also a possibility. It’s a good idea to discuss any changes in how you’re taking your medication with your doctor.
Q: Side-effects, placebo effects, withdrawal syndromes… Is it really worth it for me to take an anti-depressant? If not, what can I do about my mood?
A: Whether the choice is right for you depends on a number of factors: how severe is your depression, how much the side-effects would impact you, and whether you have the option of pursuing the main alternative treatment, psychotherapy. For more information on psychotherapy, click here.
[About Nicholas Schwartz, M.D.]