What are antidepressants? Uses, examples, safety

Depression is a very common mood disorder that can exhibit severe symptoms when left untreated. There are different types of depression, but each one can affect how you feel and approach daily activities such as sleeping, working, or eating. 

Depression is diagnosed when you experience specific symptoms for most of the day, each day, for two weeks. The symptoms include persistent sad or anxious mood, feelings of hopelessness, guilt, or worthlessness, a loss of interest in hobbies, or decreased energy. There are other symptoms of depression, and your primary or psychiatric healthcare provider may go into more detail with you if they suspect you suffer from depression. 

Depression is a treatable disorder. Treatment options include psychotherapy, exercise, medications, or a combination of these. For more severe cases, electroconvulsive therapy (ECT) and other types of brain stimulation may be helpful. In terms of medication treatment options, antidepressants are the general class of medications used to treat depression. There are many subtypes of antidepressants, and we will discuss their various properties, common brand names, and their safety.

Other antidepressants

• Priligy (dapoxetine)

• Variza (gepirone)

• Tofranil (imipramine)

• Eldepryl (selegiline)

• Surmontil (trimipramine)

What are antidepressants?

Antidepressants are a large class of medications prescribed for the treatment of various types of depressive disorders. These may include major depression, persistent depressive disorder, postpartum depression, psychotic depression, seasonal affective disorder, and bipolar disorder. 

There are different types of antidepressants and they each work in a different way to relieve depression symptoms. Many antidepressants have more than one approved indication as some may help treat other disorders including anxiety, panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and premature ejaculation.

How do antidepressants work?

In broad terms, antidepressants work by altering various aspects of neurotransmitters that affect mood. Each class of antidepressants works in a different way. Generally speaking, serotonin, norepinephrine, and dopamine are neurotransmitters in the central nervous system (CNS) which are associated with mood. Higher levels of these transmitters are associated with better mood and disposition. Each class of antidepressants increases one or more of these neurotransmitters in a unique way. 

What are antidepressants used for?

• Depression

  • Major depressive disorder

  • Postpartum depression

  • Seasonal affective disorder

  • Bipolar disorder

  • Psychotic depression

• Anxiety disorder

• Obsessive-compulsive disorder 

• Panic disorder

• Fibromyalgia

• Hot flashes

• Migraine prevention

• Post-traumatic stress disorder (PTSD)

• Premenstrual dysphoric disorder

Types of antidepressants

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs inhibit the reuptake of serotonin in the synapse (junction) between nerves in the brain. This effectively leaves more free serotonin available, and this increase in free serotonin is associated with less depression symptoms and a better mood. SSRIs are considered a first choice in the treatment of depression because they are effective with relatively minimal side effects.

Examples of SSRIs: Lexapro, Paxil, Celexa, Prozac, Zoloft

Serotonin norepinephrine reuptake inhibitors (SNRIs)

SNRIs inhibit the reuptake of both serotonin and norepinephrine in the nerve synapse. These increased free levels of both transmitters have been shown to be effective against the symptoms of depression. SNRIs are equally as effective as SSRIs and can be used as first-line treatment against depression.

Examples of SNRIs: Cymbalta, Effexor, Pristiq, Fetzima

Norepinephrine and dopamine inhibitors (NDRIs)

NDRIs block the reuptake of dopamine and norepinephrine in the nerve synapse, increasing the concentration of these two neurotransmitters. This class of drugs has also been proven effective in the cessation of smoking. 

Examples of NDRIs: Wellbutrin

Tricyclic antidepressants (TCAs)

TCAs increase the levels of norepinephrine and serotonin while also blocking acetylcholine and histamine, which may have a negative effect on mood. TCAs are the oldest class of antidepressants and are generally considered a second-line treatment behind SSRIs and SNRIs because they are not as easy to tolerate.

Examples of TCAs: Tofranil, Pamelor, Norpramin

Monoamine oxidase inhibitors (MAOIs)

MAOIs block the actions of monoamine oxidase enzymes. This increases the concentrations of dopamine, norepinephrine, and serotonin. MAOIs can have significant drug interactions with many other classes of drugs and are not considered a first-choice treatment for depression.

Examples of MAOIs: Marplan, Nardil, Parnate

Who can take antidepressants?

Adults

Adult men and women can take antidepressants. Caution should be used in any patient if they have ever had a hypersensitivity reaction to other antidepressants. Antidepressants are associated with an increase in suicidal thoughts in young adults under the age of 25, and this age group should be monitored closely for signs of suicidal ideations.

Seniors 

Certain types of antidepressants should be used cautiously in seniors. TCAs tend to cause a significant amount of drowsiness and may put an older patient at an increased risk for falls. If liver or kidney function is decreasing, your doctor may consider starting you at a lower dose.

Children

Some antidepressants have approved indications in children and adolescents. However, most also carry a strong warning against their use due to the increased incidence of suicidal thoughts. Use in children should be limited to cases where other safer treatment options have failed, and the potential benefit outweighs the risk. Children and adolescents should be monitored closely.

Are antidepressants safe?

Antidepressants recalls:

• International Laboratories, LLC: Voluntary recall of bupropion XL tablets labeled as pravastatin, February 2018

• AvKARE: Voluntary recall of sildenafil and trazodone due to mix-up, December 2020

Antidepressants restrictions

Do not take antidepressants if you have a history of hypersensitivity reactions to other antidepressants. 

Patients with a history of psychological illness including suicidal ideation or psychosis should use caution when taking antidepressants, In some cases, antidepressants can exacerbate these disorders. These patients should be monitored closely by their healthcare providers. 

Serotonin syndrome can occur in patients taking drugs with serotonergic activity, especially if they are taking more than one. Serotonin syndrome is the result of too much free serotonin and can cause symptoms such as agitation, confusion, rapid heartbeat, profuse sweating, and diarrhea.

Some antidepressant drugs are not recommended in patients with liver or hepatic impairment. Make sure your doctor is aware of all of your medical conditions when discussing treatment options.

Antidepressants should not be stopped suddenly or without the consent of your healthcare provider. Withdrawal symptoms may occur.

Can you take antidepressants while pregnant or breastfeeding?

SSRIs are generally acceptable in pregnancy and while breastfeeding with the exception of Paxil (paroxetine). It is the only SSRI that has been shown to cause harm. If you were on Paxil prior to becoming pregnant, your doctor will likely suggest other options. The use of SNRIs may be acceptable after your doctor does a risk-benefit analysis. Most other antidepressants should generally be avoided during pregnancy and breastfeeding.

Are antidepressants controlled substances?

Most antidepressants are not controlled substances because most are not habit-forming or cause dependency. One exception is Spravato (esketamine), which is a schedule III controlled substance classified by the Drug Enforcement Agency (DEA). 

Common antidepressants side effects

Antidepressants can cause a variety of side effects. These will vary slightly by type of antidepressant and are oftentimes dose-dependent. This means that some side effects may be more likely with a higher dose of the medication.

The most common side effects for  antidepressants are:

• Nausea

• Insomnia

• Dizziness

• Constipation

• Drowsiness

• Anorexia

• Fatigue

• Orthostatic hypotension

• Hyperhidrosis

• Xerostomia

• Erectile dysfunction

• Anxiety

• Dyspepsia

• Tremor

• Weight gain

• Dry mouth

• Withdrawal symptoms

• High blood pressure

How much do antidepressants cost?

Almost all classes of antidepressants are available in generic form. Through the use of SingleCare coupons, a month’s supply is less than $10 for many antidepressants even when you do not have insurance. There are a couple of new medications used to fight depression that do not have generics on the market yet. One example is Viibryd, which can be nearly $500 if you are not insured. A coupon from SingleCare can lower the cost of Viibryd to less than $300. Trintellix is another brand-only example of an antidepressant and is more than $700 on average without insurance. A Trintellix SingleCare coupon can lower the price to about $360—a significant saving. 

Your insurance may have formulary restrictions which will suggest that you try regimens of certain preferred drugs first before they will approve the use of more expensive medications to treat your depression. Before filling your antidepressant medication, always check with SingleCare to make sure you are paying the best price.