Indications and Procedures (Magill’s Medical Guide, Sixth Edition)
Antidepressants are prescribed most often to individuals suffering from symptoms of clinical depression, a severe form of depression that interferes with the person’s ability to function (for example, to hold down a job or to handle the responsibilities of being a student). The symptoms of depression should be present for at least several months before a diagnosis is made and medication is recommended.
Fortunately, several classes of antidepressants can be considered as treatment options. Each class of drugs acts on the nervous system in its own unique way, and each class produces different kinds of side effects. Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants are regarded as two different classes of first-generation drugs. These two classes and the new-generation selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac), all affect the nervous system by increasing the availability of neurotransmitters such as norepinephrine or serotonin.
Although physicians have several classes of drugs at their disposal to combat the effects of depression, no single drug or class of drugs has been found to be significantly more effective in treating symptoms. In fact, no reliable test exists to discover which antidepressant will be most effective for a particular patient. However, it is clearly the case that most patients will respond favorably to one class of drugs over the...
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Uses and Complications (Magill’s Medical Guide, Sixth Edition)
For a single episode of depression, antidepressants will be prescribed for six to twelve months to minimize the possibility of a relapse. In instances of chronic depression, it is not unusual for someone to remain on antidepressants for several years. Since all antidepressant medications cause some adverse side effects, physicians will periodically attempt to adjust the amount of a drug that a patient takes to find the minimum clinically effective dose. It is also important to realize that some groups of patients (for example, adolescents, teenagers, and persons of certain racial backgrounds) may be more sensitive to a given drug’s effects. Such sensitivities may require more frequent monitoring, adjustments of dose, and surveillance for severe adverse reactions such as suicide attempts.
In terms of specific side effects of drugs, MAOIs may produce a serious adverse side effect known as a hypertensive crisis, which results in a rapid elevation of blood pressure. This condition can be caused by an interaction of the drug with foods containing tyramine, such as aged cheeses, aged meats, and red wines; thus, these foods must be avoided. Less serious side effects produced by MAOIs include constipation, diarrhea, and difficulty falling asleep.
Tricyclic antidepressants may produce dry mouth, blurred vision, or weight gain. However, the most serious aspect of tricyclics is the danger if an overdose is taken, as...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
Since the introduction of Prozac in 1987, those suffering from depression have had access to a medication that has been every bit as effective as other classes of antidepressants without producing many of the adverse side effects. Investigators are also learning that antidepressants can help patients with other psychological conditions, such as bipolar disorders, anxiety disorders, panic attacks, and obsessive-compulsive disorder.
Despite the successes that have come with the availability of several classes of antidepressants, there still remains a group of patients suffering from depression who do not benefit from them. Investigators are continuing to look for more effective drugs, particularly ones that can alleviate the symptoms of depression more quickly.
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Rev. 4th ed. Arlington, Va.: Author, 2000.
Depression and Bipolar Support Alliance. http://www.dbsalliance.org.
Diamond, Ronald J. Instant Psychopharmacology: Up-to-Date Information About the Most Commonly Prescribed Drugs for Emotional Health. 2d ed. New York: W. W. Norton, 2002.
Feldman, Robert S., Jerrold S. Meyer, and Linda F. Quenzer. Principles of Neuropsychopharmacology. Sunderland, Mass.: Sinauer, 1997.
Lickey, Marvin E., and Barbara Gordon. Medicine and Mental Illness: The Use of Drugs in Psychiatry. New York: W. H. Freeman, 1991.
National Institute of Mental Health. http://www.nimh .nih.gov.
Ray, Oakley, and Charles Ksir. Drugs, Society, and Human Behavior. 13th ed. New York: McGraw-Hill, 2009.
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Antidepressants (Encyclopedia of Psychology)
Medications used to treat depression.
The two most common types of antidepressants are tricyclic antidepressants (TCAs) and selective serotonin re-uptake inhibitors (SSRIs). Examples of TCAs include nortriptyline (also known by the brand name Pamelor), imipramine (Tofranil), and desipramine (Norpramin). Examples of SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). Clinical studies have shown that some people benefit from these medications.
Tricyclic antidepressants (TCAs)
Before using TCAs, it is necessary to have a medical history and examination of the patient, including an electrocardiogram (EKG). Not everyone develops side effects when taking TCAs, but the most common side effects include: dry mouth, impaired ability to focus vision at close range, constipation, urinary hesitation, dizziness, weight gain, and sedation. TCAs may produce minor cardiovascular changes such as orthostatic hypotension (low blood pressure when the person stands up, often causing light-headedness), hypertension, rapid heart beat, and minor changes in the electrical activity of the heart, which may show in the electrocardiogram (EKG). Most of these side effects can be minimized by slowly adjusting the dose of the drug.
During treatment with TCAs, patients...
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Antidepressants (Encyclopedia of Children's Health)
An antidepressant is a medication used primarily in the treatment of depression. Depression can occur if some of the chemicals called neurotransmitters in the brain are not functioning effectively. There are three specific chemicals that can affect a person's mood: serotonin, norepinephrine, or dopamine. Antidepressants affect one or more of these chemicals in different ways to help stabilize the chemical imbalance often seen in depression. Antidepressant drugs are not happy pills, and they are not a panacea. They are prescription-only drugs that come with risks as well as benefits and should only be taken under a doctor's supervision. Because children and adolescents experience depression just as adults do, they are sometimes prescribed antidepressants by their physician.
Antidepressants are medicines used to help people who have depression. Antidepressant medications may be indicated for those children and adolescents with bipolar depression, psychotic depression, depression with severe symptoms that prevent effective psychotherapy or counseling, and depression that does not respond to psychotherapy. However, given the psychosocial dynamics that often coexist with depression, antidepressants are usually insufficient as the only...
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Antidepressants (Encyclopedia of Drugs and Addictive Substances)
- What Is It Made Of?
- Are There Any Medical Reasons for Taking This Substance?
- September 11, 2001
- Testing New Drugs
- News from Around the Globe
- Reactions with Other Drugs or Substances
- The Law
What Kind of Drug Is It?
Antidepressant drugs are used to relieve the symptoms of depression and anxiety. Depression is a mood disorder that causes people to have feelings of overwhelming and lasting hopelessness, sadness, despair, and self-blame. The condition can also bring on changes in sleeping and eating habits, a loss of pleasure, feelings of apathy, and even suicidal thoughts. Anxiety is a disorder that causes feelings of being extremely overwhelmed, restless, fearful, and worried. Symptoms of anxiety include loss of sleep, dizziness, sweating, and shaking, among others.
Antidepressants play an important role in the treatment of depression and anxiety. They help to rebalance brain chemistry so the symptoms of depression and anxiety are alleviated. A large number of people take antidepressants. Richard Jerome, writing in People, reported that "133 million prescriptions for antidepressants were written in 2002" in the United States alone.
Depression is a condition that affects the way people feel, think, and act. "Ten to 20 percent of adults in the United States experience depression at some point in their lifetime," noted Adrienne Z. Ables and Otis L. Baughman III in an article for the journal American Family Physician.
Sometimes depressive episodes are sparked by an especially upsetting event in life such as the death of a loved one, the breakup of a relationship, a change in jobs, separation from friends or family, or a severe illness. Because depression seems to run in families, scientists are investigating possible biological causes for the condition. The authors of "Depression: Help Is at Hand," a publication of the Royal College of Psychiatrists (RCP), stated that people who have a parent who has become severely depressed "are about eight times more likely to become depressed" themselves. This may be due to an abnormality in the brain involving chemical messengers called .
Depressed people often have a hard time tracing their sadness to a particular cause. Certain medicines and even some physical illnesses such as the flu can bring on depression, so it is extremely important for people to educate themselves about its signs, symptoms, and treatments.
Symptoms of depression include:
- A long-lasting sad mood
- A change in sleep patternsither sleeping all the time or having difficulty getting enough sleep
- A change in eating habitsome people eat more when they get depressed, others stop eating altogether and begin losing significant amounts of weight
- A loss of interest in activities or hobbies that used to bring pleasure
- Self-destructive thoughts or actions
- Difficulty making decisions
- A loss of confidence
- Increased irritability
- Problems with school or work
- Problems with friends or family members
- A feeling of hopelessness, as if things will never be any better.
Depression occurs in people of all ages, from small children to the elderly. "In contrast to the normal emotional experiences of sadness, loss, or passing mood states, depression is extreme and persistent and can interfere significantly with an individual's ability to function," stated the authors of the "Depression Research" page of the National Institute of Mental Health (NIMH) Web site.
A study sponsored by the World Health Organization and the World Bank is cited in "Depression Research." The study noted that major depression was found "to be the leading cause of disability in the United States and worldwide." Regardless of what triggers their depression, those who suffer from it require medical assistance. This assistance might include psychotherapyThe treatment of emotional problems by a trained therapist using a variety of techniques to improve a patient's outlook on life., medication, or a combination of both. Many depressed people from all age groups have responded well to treatment.
Anxiety, which is often associated with depression, can also be helped by medication. Severe anxiety can result in . These attacks can make a person feel like he or she is dying. They cause rapid heartbeat, tightness in the chest, shaking, shortness of breath, and dizziness. Antidepressants can help a person focus on dealing with his or her fears before an attack occurs, and the drugs can alleviate the physical symptoms of an attack.
An Accidental Find
Chemists seem to have stumbled upon drugs with antidepressive effects while working on treatments for other medical problems. The very first antidepressants, iproniazid (sold under the brand name Marsilid) and imipramine (sold under the brand name Tofranil), were developed in the 1950s. Since then, great strides have been made in understanding how the human brain works. These strides contributed to the creation of the four main types of antidepressant drugs known as of 2005: 1) tricyclics, 2) monoamine oxidase inhibitors (MAOIs), 3) selective serotonin reuptake inhibitors (SSRIs), and 4) "others," including serotonin and norepinephrine reuptake inhibitors (SNRIs). All of these drugs get their names from the way they act on chemicals called neurotransmitters located in the human brain.
Tricyclics and MAOIs were available years before the SSRIs came on the scene. Richard DeGrandpre, writing in Nation, stated that "SSRIs have not been clinically proven to be more effective" than the older tricyclics. The SSRIs gained a reputation for safety because they are generally less toxic, or harmful to the body, when taken in overdoses. In normal doses, however, both the new and the old classes of antidepressants have been shown to relieve the symptoms of depression in some patients. Because each patient will respond differently to the various antidepressants, physicians may try several different kindsr even combine one with anothern the search for the most effective treatment for a particular patient.
The Ultimate Problem Solver?
The most popular antidepressants are the SSRIs. Prozac was the first SSRI approved for use in the treatment of depression. It became available in 1987, received extensive coverage in the media, and within a few years became a household name. Some people were under the impression that Prozac was the ultimate problem solver sort of "happy pill" that gave everyone who took it a more positive outlook on life. It had no reported side effects and was even thought to help in weight loss. What most people failed to realize, however, is that antidepressants have no psychological effects on people who don't suffer from depression. They only help depressed patients reach a normal level of functioning.
Still, the market for antidepressants grew wildly in the 1990s and early 2000s. According to The Pill Book, seven of the top fifty prescriptions written by U.S. doctors in 2003 were for antidepressants. Associated Press reporter Bruce Smith, as recorded on the ABC News Web site, noted that 32.7 million prescriptions for Zoloft, another SSRI, were written that year. This made Zoloft the most widely prescribed antidepressant in the United States.
What Is It Made Of?
A variety of substances have antidepressant actions. The anti-depressants available in the United States are classified in two main ways: 1) by their chemical structure, as in the case of tricyclics (three-ring structure), or 2) by their actions on neurotransmitters, as in the case of MAOIs, SSRIs, and SNRIs. Tricyclics work to increase the levels of the neurotransmitters and serotoninA combination of carbon, hydrogen, nitrogen, and oxygen; it is found in the brain, blood, and stomach lining and acts as a neurotransmitter and blood vessel regulator. in the
brain. These neurotransmitters are usually at low levels in people who suffer from depression. The problem with tricyclics is that they can affect other neurotransmitters as well, causing a number of side effects. MAOIs stop the protein in the brain known as monoamine oxidase from breaking down serotonin, norepinephrine, and another neurotransmitter called dopamine after they deliver their messages to the brain. This leaves high levels of these chemicals in the brain and subsequently keeps depression at bay.
However, MAOIs also keep monoamine oxidase from destroying tyramine (found in various foods), which can cause fatal increases in blood pressure. SSRIs were specifically designed by scientists to stop the "reuptake," or reabsorption, of only serotonin in the brain, allowing levels of serotonin to build and remain high while not affecting the levels of other chemicals. They are the most prescribed forms of antidepressants because they usually have fewer side effects and interactions with other drugs. SNRIs focus on stopping the reuptake of serotonin and norepinephrine so that they both build and remain at a high level.
How Is It Taken?
Prescription antidepressants are taken orally, usually once a day, and usually in capsules or tablets. Some are available in liquid form for swallowing. It is very important that patients on antidepressants take their medications exactly as prescribed, even if the drugs do not seem to be working at first. In some cases, three to four weeks of antidepressant use may be needed before the effects of the drug can be observed.
The usual daily dose prescribed of an antidepressant can differ. For the SSRI Prozac, a patient is typically prescribed 20 to 40 milligrams per day. In higher doses, it has been used to treat and the eating disorder bulimiaPronounced bull-EEM-eeh-yuh; an eating disorder that involves long periods of bingeing on food, followed by selfinduced vomiting and abuse of laxatives.. In 2002, Prozac became available in a once-a-week capsule-form that contains 90 milligrams of fluoxetine granules that are released over time. The effect of one of these capsules is equivalent to seven daily doses of 20 milligrams of Prozac.
Dosages of Zoloft, another SSRI, typically begin at 50 milligrams per day for adults and may be raised to 100 or 200 milligrams per day. When the SSRI Paxil is prescribed for depression, the initial dose is usually 20 milligrams per day. This dose may be increased to about 40 milligrams per day. Citalopram (Celexa) and escitalopram (Lexapro) are SSRIs that are gaining popularity for two reasons. First, their side effects are said to be minimal. Second, the risk of harmful interactions with other drugs is low. As of 2005, drug
researchers noted a definite increase in the number of prescriptions being written for these two particular antidepressants.
Are There Any Medical Reasons for Taking This Substance?
Antidepressants are used mainly to relieve the symptoms of depression, which include feelings of sadness, helplessness, and hopelessness. They may also be used to treat severe anxiety, panic attacks, , obsessive-compulsive disorders, eating disorders, chronic pain, severe premenstrual syndromeSymptoms that occur in some women about a week before the start of their monthly period and may include irritability, fatigue, depression, and abdominal bloating., and postpartum depression. Affecting more than one in ten new mothers, postpartum depression causes sadness, anxiety, irritability, tiredness, interrupted sleep, a loss of enjoyment or desire to do anything, and guilt over not being able to care properly for the baby.
Sometimes severely ill individuals become depressed. The symptoms of depression can have very negative effects on their recovery. patients are especially vulnerable to depression. After-stroke, or post-stroke, effects can include a loss of voluntary movement (usually on one side of the body), a loss of sensation (especially in affected limbs), weakness, and difficulty speaking. The long process of rehabilitation for stroke patients is often hampered by depression. Antidepressants have proven very effective in post-stroke patients. A positive attitude is crucial to recovery and helps patients stick to their intensive and often exhausting physical therapy schedules. Treating post-stroke depression improves the chances of the stroke patient regaining both physical strength and mental sharpness.
"I think the categorical belief is that depression is something you get over rather than something you take medication for," stated Dr. Zachary N. Stowe in an interview with Laurie Tarkan for the New York Times. Indeed, some "four out of five people with depression will get completely better without any help," noted the authors of "Depression: Help Is at Hand." Episodes of depression frequently last for eight months to a year before going away. For some depressed people, however, the symptoms hang on even longer.
Of the one in five people with depression that does not go away on its own, treatment is recommended. Without help, those people are twice as likely to fall into a pattern of repeated depressive episodes. A 2003 Time magazine article pointed to the potential seriousness of the condition. "Untreated depression has a lifetime suicide rate of 15 percentith still more deaths caused by related behaviors like self-medicating with alcohol and drugs."
The Debate over SSRI Safety and Suicide Risks in Children and Teens
As more and more children and teens are diagnosed with depression, the effects of the drugs used to treat it must be evaluated in young people. Some experts worry that anti-depressants may act differently in people under the age of eighteen because their brains are not yet fully mature. "Our knowledge of antidepressant treatments in youth, though growing substantially, remains limited when compared with what we know about treatment of depression in adults," stated the authors of the NIMH article "Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers."
According to Christian Science Monitor correspondent Patrik Jonsson, two separate congressional hearings revealed that the U.S. Food and Drug Administration (FDA) had "known about problems with [antidepressant] drugs since 1996, but failed to take decisive action." These "problems" included higher rates of aggression and an increase in suicidal thinking among young patients being treated with antidepressants. By 2000, even more studies had emerged "showing a possible link between hallucinations and aggression in children and teens taking Zoloft, Paxil, and Prozac," reported "FindLaw" columnist Elaine Cassel on CNN.com. Despite these findings, in January of 2003 the FDA approved the use of Prozac in depressed children as young as seven years old. As of 2005, only ProzachasbeenapprovedtotreatdepressionandOCDinchildren. Zoloft, Luvox, and Anafranil are only approved for children for OCD. As of 2005, no other antidepressant is approved for use in children.
Treatment for Adolescents with Depression Study (TADS):
To gain more information on the effects of antidepressants in young people, the NIMH spent $17 million on the Treatment for Adolescents with Depression Study (TADS), which was conducted between 2000 and 2003. More than 400 depressed adolescents were divided into groups that received varying forms of treatment. One group was treated with Prozac alone. Another group received a combination of Prozac and (BT), a type of psychotherapy that stresses positive thinking. A third group received CBT without the Prozac. A fourth group received only a placeboPronounced pluh-SEE-boh; a 'sugar pill' or 'dummy pill' that contains no medicine..
The results of the study were released to the press by the NIMH in August of 2004. The participants were monitored for improvement in their depression and for trends in their suicidal thinking. The combination of medication and therapy proved the most effective in relieving the symptoms of depression. The data concerning suicidal thinking were more difficult to interpret.
The results of TADS revealed that 7 percent of adolescents receiving Prozac either attempted suicide or threatened to do so. Only 4 percent of participants in the placebo group had a suicide-related event. Still, the NIMH concluded that "it is extremely difficult to determine whether SSRI medications do or do not increase the risk ofsuicide, especially since depression itself increases the risk for suicide." Experts believe that a larger study is needed to resolve unanswered questions.
Results Lead to "Black Box" Warnings
In 2004, the FDA examined information from more than twenty studies, including TADS, on antidepressants and adolescents. Together, the studies involved about 4,300 patients under the age of eighteen. Overall, the results mirrored the TADS findings. The rate of suicidal thinking or behavior was twice as high among adolescents taking SSRIs as it was in adolescents who were not. This prompted the FDA to announce in late 2004 that "black box" labeling of antidepressants would become mandatory. In "Antidepressant Medications for Children and Adolescents," the authors noted: "A black-box warning is the most serious type of warning in prescription drug labeling." Black box warnings for antidepressants state that the drugs may be linked with an increased risk of suicidal thinking or behavior. On its Web site, the FDA specifies the language to be used on the black box warnings. Part of the standard warning follows:
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [drug name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.
According to MSNBC.com, antidepressant use among children and teens has declined by about 10 percent since the information on suicide risks was released.
Effects on the Body
Neurotransmitters, such as serotonin and norepinephrine, are chemical substances that transmit information from one nerve to another. By the middle of the twentieth century, researchers had found that depressed people seemed to have lower concentrations of neurotransmitters coating the nerve endings in their brains. Antidepressants help stop the reuptake of these chemical substances in the brain, creating a kind of bath of neurotransmitters like serotonin for the nerve endings to soak in. Raising the concentration of neurotransmitters in the brains of depressed individuals works to reduce the symptoms of their depression.
The actions of antidepressants on the brain are not fully understood, but scientists are learning more about them every day. Studies show little difference in the effectiveness of the various antidepressants, but some individual patients appear to do better on one drug than another. In the search for the most effective drug for a particular patient, a physician may prescribe various antidepressant drugs or even try some in combination.
General side effects of antidepressants can include stomach upset, agitation, anxiety, dizziness, , and a dry mouth (which usually increases a user's thirst). Since SSRIs were discovered, the older MAOIs are prescribed less often for the treatment of depression. Side effects of MAOIs can be severe and include a sudden elevation of blood pressure. Tricyclics may cause dryness of the mouth and eyes. A dry mouth can lead to the formation of dental cavities, and dry eyes can result in blurred vision. Use of tricyclics may also result in reduced urine output, constipation, and weight gain. Older patients are cautioned against tricyclic use because the drugs can disrupt the normal rhythm of the heartbeat. SNRIs should not be used by people with heart problems.
The Question of Addiction
Until the early 2000s, antidepressants were not believed to cause addiction in users. A traditional feature of addictive substances is the "highDrug-induced feelings ranging from excitement and joy to extreme grogginess." or "buzz" they cause in users. "Antidepressants will not make you high," stated Andrew Weil and Winifred Rosen in From Chocolate to Morphine.
Ables and Baughman mentioned in 2003 that some degree of occurs with all antidepressants. This contradicts the belief that antidepressants are not addictive. The withdrawal symptoms, which are usually mild, begin about a week after the antidepressant medication is stopped. They include dizziness, nausea, headache, and flu-like symptoms, but agitation and even panic attacks may occur. Withdrawal symptoms usually end within three weeks for SSRIs. However, "withdrawal from paroxetine [SSRI Paxil]," explained Ables and Baughman, "was shown to cause more severe symptoms that may occur more quickly, even after the second missed dose."
Researchers in the United Kingdom noted similar findings. According to the Royal College of Psychiatrists, "up to a third of people who stop SSRIs and SNRIs have withdrawal symptoms. These include: stomach upsets, flu-like symptoms, anxiety, dizziness, vivid dreams at night, and sensations in the body that feel like electric shocks." These symptoms are more often associated with paroxetine (sold under the brand name Paxil in the United States and Seroxat in the United Kingdom) and venlafaxine (sold under the brand name Effexor in the United States and Efexor in the United Kingdom) than any other SSRIs and SNRIs. Research continues on the still-baffling question of addiction and withdrawal issues among antidepressant users.
Reactions with Other Drugs or Substances
Anyone prescribed an antidepressant should consult with a physician before taking any other drug, including over-the-counter medications. Patients taking MAOIs must avoid certain foods such as aged meats, cheeses, and pickles because they contain tyramine, which can cause harmful reactions when combined with MAOIs. These foods should not be consumed until well after a person stops taking the drug.
It is important to know that the effects of alcohol are greatly increased when combined with antidepressants. In addition, combining large amounts of caffeine with antidepressants may intensify the jitters and agitation that sometimes accompany depression.
The reactions of with antidepressants are unpredictable and possibly very dangerous. The symptoms of depression are often intensified by illicitUnlawful. drug use. To help avoid problems, it is important that patients taking antidepressants stick to their prescribed dosage and stay away from other drugs, unless prescribed by a physician. In addition, the effectiveness of a drug can only be measured when the prescription is followed accurately.
Treatment for Habitual Users
Antidepressants are not abused in the traditional sense. This means that they are not taken by users to get high. If antidepressant drug therapy is discontinued, it should be done under a doctor's care using the "stepdown method" in order to reduce the risk of side effects. This method involves gradually lowering the dose of the drug until the patient is weaned off it entirely.
Depression and anxiety can interfere with a person's happiness, success, and relationships. The symptoms of depression and anxiety should not be ignored. About 80 percent of people with depression respond very positively to treatment, but that leaves a significant numberhe other 20 percentithout help. Thus, an important goal of NIMH research is to advance the development of more effective treatments for depression, especially those "hard-to-treat" forms that don't respond well to currently available medications and/or counseling.
Major depression can occur just once in a person's lifetime, but it is usually recurring. Depressive episodes will interfere with the ability to work, eat, sleep, concentrate, and take pleasure in formerly enjoyed activities. Treatment for depression is often a long-term process, but it can help those with the condition lead fuller and happier lives.
Taking antidepressants for depression and/or anxiety does have consequences. They all have side effects, some dangerous, that need to be monitored. A number of people believe that taking drugs for depression and/or anxiety is not necessary. In fact, they claim, it can even be harmful. In 2005, actor Tom Cruise spoke out against the use of antidepressants, citing vitamins and exercise as better alternatives. However, others state that their lives have greatly improved since they started taking antidepressants.
Antidepressants are only available by prescription. It is illegal for people to take drugs that have not been prescribed for them. It is also illegal for patients to share prescribed drugs with other people. Since users of antidepressants do not achieve a high with these drugs (as may occur with the drugs amphetaminesPronounced am-FETT-uh-meens; stimulant drugs that increase mental alertness, reduce appetite, and help keep users awake. and other drugs of abuse), they are rarely abused. No market for the illegal sale of antidepressants has been reported.
For More Information
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Breggin, Peter R. The Antidepressant Fact Book. Cambridge, MA: Perseus, 2001.
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Morrison, Andrew L. The Antidepressant Sourcebook. New York: Broadway Books, 1999.
Schull, Patricia Dwyer. Nursing Spectrum Drug Handbook. King of Prussia, PA: Nursing Spectrum, 2005.
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See also: Herbal drugs
Antidepressant (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
Antidepressants are a diverse group of drugs that demonstrate a capacity to produce improvement in the symptoms of clinical depression, and they are used to treat the abnormal mood states that characterize depressive illnesses. The word depression is used commonly to describe a state of sadness; but health professionals use the term in a more restricted or defined manner to describe several psychiatric disorders characterized by abnormal moods. One of these is bipolar disorder, in which periods of depression (marked by dejection, lack of energy, inactivity, and sadness) alternate with periods of manic behavior (marked by abnormally high energy levels and increased activity). Another is major depression, which is often a recurring problem characterized by severe and prolonged periods of depression without the manic swing. A third is dysthymia, a chronic mood state characterized by depression and irritability, which was once referred to as depressive neurosis. The signs and symptoms of depressive mood disorders may occur as part of other medical and psychiatric disorders (i.e., following stroke); as a result of endocrine disorders; or as a consequence of excessive drug use. Often these abnormal mood states may not meet established criteria for one of the major psychiatric mood disorders, but they may nevertheless respond to one of the antidepressant drugs.
Antidepressants can also be useful in a number of medical and psychiatric disorders where depression is not the major feature. For example, some categories of antidepressants can be used to treat anxiety and panic disorders, and they are often useful as adjunctive medications for chronic pain. Antidepressant drugs are not generally helpful for short-term depressed moods that are part of everyday life or for the normal period of grief that follows the loss of a loved one.
New categories of antidepressants are being continuously developed and tested. There are now at least five categories in use. These include tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, lithium, nontricyclic antidepressants, and serotonin-reuptake inhibitors (SSRIs). The chemical structures of some of these are shown below.
The tricyclic antidepressants, which have been used for many years in the treatment of depression, include such compounds as imipramine (Tofranil), nortriptyline (Aventyl), and desipramine (Norpramin). In addition to being used to treat depression, imipramine is sometimes used to treat alcoholism and cocaine withdrawal. Desipramine is also sometimes used to treat depression associated with cocaine withdrawal. In terms of dosage, most of the tricyclics can be given in a single dose at bedtime. The tricyclics as a group, however, have two major drawbacks. First, the patient must take a specific tricyclic for a period of 2 to 4 weeks before signs of clinical effectiveness occur. Second, the tricyclics have a relatively narrow margin of safety, which means that it is easier for a depressed patient to take an overdose. As a rule, physicians are cautious about prescribing tricyclic antidepressants if the patient appears to be at risk for suicide.
The monoamine oxidase (MAO) inhibitors are generally used as second-line drugs for depressed patients who do not respond to tricyclics, because they require certain dietary restrictions (patients are not allowed liver, aged meats, most cheeses, red wine, soy sauce, etc.) The MAO inhibitors are, however, first-choice drugs for treatment of panic disorder and of depression in the elderly. They include phenelzine sulfate (Nardil), isocarboxazid (Marplan), and tranylcypromine sulfate (Parnate). These antidepressants may be given in either the morning or the evening, depending on their effect on the patient's sleep.
Although lithium (Eskalith, Lithonate) is useful in treating manic states and in preventing depression in bipolar disorders, it is not generally used for other types of depression. Lithium may have serious side effects and may be toxic at high dosages. Exposure to lithium in early pregnancy is associated with an increased frequency of birth defects, and the long-term use of lithium damages kidney function. It also seems to have no significant value in treating cocaine dependence or alcoholism.
The serotonin reuptake inhibitors (SSRIs) are the newest category of antidepressant medications. They have become the most widely used drugs for depression; fluoxetine (Prozac) has been the best-selling antidepressant since the mid-1990s. Other SSRIs include paroxetine (Paxil) and sertraline (Zoloft). A fourth drug, bupropion (Wellbutrin), is not an SSRI but is often grouped with them because it is a newer antidepressant. The SSRIs have several advantages: They can often nip mild depression "in the bud" before it develops into a major depressive episode. They can also be used to treat bulimia, obesity, and obsessive-compulsive disorder as well as depression. Since insomnia is a common side effect of SSRIs, they are usually given as a single dose in the morning. The SSRIs also have several disadvantages, including a long response time (patients may need to wait 4 weeks to see any improvement); the same failure rate as the older tricyclics (20-40percent of patients); side effects that include sexual dysfunction; and high cost ($2-3 per tablet).
When a patient does not respond to a specific antidepressant after a trial of 2 to 4 weeks, the physician may prescribe another medication. If the new drug is from the same group as the first antidepressant, the physician can rapidly decrease the dosage of the first drug while increasing the dosage of the second. If, however, the new antidepressant is from a different category, a "washout time" must be allowed in order to prevent drug interactions. A washout period of 2 to 3 weeks is necessary when the patient is switched from an MAO inhibitor to a tricyclic; a period of 4 to 5 weeks is necessary when switching from an SSRI to an MAO inhibitor.
AMERICAN PSYCHIATRIC ASSOCIATION. (1994). Diagnostic and statistical manual of mental disorders, 4th ed. (DSM-IV). Washington, DC.
BALDESSARINI, R. J. (1991). Drugs and the treatment of psychiatric disorders. In: A. G. Gilman et al. (Eds.), Goodman and Gilman's the pharmacological basis of therapeutics, 8th ed. New York: Pergamon.
EISENDRATH, S. J. (1998). Psychiatric Disorders. In L. M. Tierney et al. (Eds.), Current Medical Diagnosis & Treatment, 37th ed. Stamford, CT: Appleton & Lange.
GEORGE R. UHL
REVISED BY REBECCA J. FREY