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A Beginners Guide to Antidepressants

Apr 10, 2008
Countless people often have false impressions about what antidepressants can do.

First of all, they are not quick fix pills; they don't artificially bring on a feeling of bliss, euphoria, or unrealistic well-being. Nor do antidepressants insulate you from life, make you not care about vital things, or make you unmoved to sorrow or loss.

What antidepressants do is put a stop to depressed persons from sliding into the blackest depths of depression when something awful happens. They can still feel upset, pain, and apprehension, but they feel these the way people normally do when they don't have depression. They also can help depressives overcome difficulties sleeping, increase their energy, and increase their ability to concentrate.

The way antidepressants work is interesting. There are two chemicals, serotonin and norepinephrine, that have to do with the transmission of impulses between nerve cells in the brain and seem to be associated with depression. It would appear as if depressed people use up these chemicals at an accelerated rate than other people. Antidepressants help to conserve these chemicals, apparently leading to feelings of reduced anxiety, more security, increased self-worth, assertiveness, and resilience.

There are a array of types of antidepressants, but they fall into a number of straightfoward categories. These are tricyclics, MAOIs, and lithium, and the newer medications: hetereocyclics and Prozac and Prozac-related drugs.

Until rather recently, tricyclics were the orthodox treatment for depression. These medications include imipramine (Tofranil), amitriptiline (Elacil), Vivactil, Norpramin, Pamelor, and Sinequan. Still in commonplace use today, 40 to 70 percent of depressed patients recover some substantially with tricyclics.

Although they are quite helpful medications, there are a number of disadvantages to their use. They usually take several weeks of regular administration to be useful, which is difficult to handle when people are especially distressed. Also, it is reasonably easy to take a serious overdose. In general, tricyclics should only be used on a short-term basis. They are not addictive, but they must be used with care, especially with people who have cardiovascular disease.

Monoamine oxidase inhibitors (MAOIs) include Marplan, Parnate, and Nardil. They are a different class of drugs and cause a different reaction in the brain. These drugs are helpful from some people who do not respond to tricyclics. These drugs can have unpleasant side effects, but the main disadvantage of MAOIs is that they can also cause a stroke if certain foods containing the compound tyramine are consumed while they are being used.

Lithium is generally the treatment of choice for bipolar disorder (the cycle of manic highs with depressed lows). In the correct dose, lithium reduces by about 50 percent the chances of another manic episode within a year. Mood swings become less, shorter, and less severe. The success rate for lithium treatment is 70 percent, and 20 percent of people become symptom-free. It is generally seen as a maintenance drug. Once the patient is on Lithium, they are on it for life.

One of the most well-known drugs on the market today is Prozac. It has been followed into the marketplace by many other new antidepressant medications like Zoloft and Paxil, two near cousins, Effexor and Serzone, and some more distant cousins, notably Wellbutrin, Desyrel, and BuSpar.

Unlike tricyclics, which affect the levels of both serotonin and norepinephrine in the brain, Prozac, Zoloft, and Paxil affect only serotonin. Hence they are known as selective serotonin reuptake inhibitors, or SSRIs, meaning that they counteract or slow down the reabsorption of serotonin. Effexor and Serzone affect both serotonin and norepinephrine, and the others have more complicated effects. All, however, have been shown to be helpful in the treatment of depression. The choice of which of these medications to use for a particular person has to do with their dosage and side-effect profile. Paxil, for example, seems to have a soothing effect on anxiety that Prozac lacks. Effexor has the reputation of being more energizing than Prozac.

Compared with tricyclics, the side effects of Prozac and its cousins are usually small. Tricyclics can give you dry mouth, make you constipated, and actually slow you down, whereas Prozac has none of these problems and gives you a little more energy. However, there are some side effects with the newer antidepressants which should be mentioned. Most notable among these is a reduction of interest in sex and trouble maintaining an erection. Although the male performance problems usually go away after a few weeks, many people on SSRIs report a continued diminished interest in sex, which can certainly add to marital problems.
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For more info on antidepressants visit A Guide to Antidepressant medications
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