Antidepressant Medications and Classes
Antidepressants are medications used to alleviate symptoms of depression. Some of these symptoms are sadness, difficulty concentrating, low energy, hopelessness, change in appetite, change in sleep patterns, and thoughts of suicide. There are several classes of antidepressants that are determined by the way the medication functions.
Antidepressants work to balance out the naturally produced chemicals in our brain that control mood and emotions. These chemicals are known as neurotransmitters. There are many different chemicals that are produced, but antidepressants generally target the specific neurotransmitters such as serotonin, dopamine and norepinephrine.
When a physician chooses a medication, the choice is based upon a number of criteria
- Signs and Symptoms of Depression
- Classes of Antidepressants
- Common Side Effects of Antidepressants
- Medications that the patient has successfully used in the past
- Financial factors
- Co-existing disorders
While all antidepressants are used for the medical treatment of depression, different people do not respond the same way to the same medications. It may take several trials to find the proper medication with the fewest side effects. It should also be noted that the use of antidepressants may have an impact on the symptoms of addiction, such as cravings. Other classes of drugs are used to treat specific addiction symptoms. Antidepressants are commonly prescribed to treat mood disorders and addiction, or dual diagnosis in drug rehab facilities.
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
- Tricyclic Antidepressants (TCA)
- Tetracyclic Antidepressants (MAOI)
- Atypical Antidepressants
Serotonin is a neurotransmitter in the brain. Neurotransmitters move messages from one brain cell to the next. This allows nerve impulses to move along a chain from one area of the brain to another, allowing communication between the cells, organs, muscles and body systems. Levels of serotonin determine how well the brain and body respond to the millions of types of communication needed from moment to moment between the brain cells and other systems in the body.
The body must be able to produce and reabsorb serotonin to maintain healthy functioning. Many doctors and researchers believe imbalances of serotonin, especially a relative lack of serotonin, influence mood. The depletion of serotonin leads to symptoms of depression and anxiety. Thus, selective serotonin reuptake inhibitors (SSRIs) have been developed to increase the level of serotonin; thus, improving brain function which in turn relieves the feelings of depression and other accompanying symptoms. SSRI medications include Prozac, Zoloft, Celexa, Lexapro, and Paxil. This class of antidepressants is the most commonly prescribed of all the classes and has a relatively safe side effect profile.
Determining the right SSRI medication can take time. However, DNA testing is now more commonly used to help determine the right medication.
These medications work to block the absorption of serotonin and norepinephrine, two neurotransmitters. For reasons unknown, the body of a depressed individual reabsorbs these chemicals too quickly, creating depletion. Once the reabsorption is blocked by medication, improved communication between cells and the rest of the body occurs.
SNRI medication raises the levels of serotonin and norepinephrine in the brain. Changing the chemical balance of these neurotransmitters seems to help brain cells send and receive messages, which improves mood. The increase in brain communication with the rest of the body also results in a decrease in symptoms associated with depression, specifically irritability and sadness. Sometimes SNRIs are used to treat other mental health disorders, for example, the medication treatment of anxiety.
Some popular SNRI medications are Cymbalta, Effexor, and Pristiq.
Tricyclic and tetracyclic antidepressants are one of the oldest classes of medications used to treat depression. These medications work in a similar way as other SNRI antidepressants by blocking the absorption of neurotransmitters, thus increasing levels of serotonin and norepinephrine. The increase of neurotransmitters effects communication between cells, muscles, and organs and has a direct impact on mood. These two classes of drugs have increased side effects that some other antidepressants do not.
These two classes of antidepressant medications also block the actions of another neurotransmitter, acetylcholine. Acetylcholine impacts the central nervous system as well as the peripheral nervous system. It is responsible for the speed of brain function and information processing. The effects of TCA and MAOI on acetylcholine can cause undesired side effects such as lethargy, sleepiness, blurred vision, and dry mouth. These medications can also be unsafe in large dosages due to an effect on the heart’s rhythm, as is described below.
While they cause some people to experience increased side effects, these two classes of drugs may still be the most successful in treating symptoms of depression. When these drugs are abused, toxicity can occur where levels rise to approximately ten times the normal dosage. Abuse of these drugs can also lead to heart arrhythmias which can be fatal.
Tricyclic antidepressant medications include Pamelor, Elavil, Tofranil, and Anafranil. Tetracyclic antidepressants include Remeron and Desyrel.
Atypical antidepressants are medications that relieve symptoms of depression that are not commonly used. One antidepressant from this group is Wellbutrin (bupropion). Like other antidepressants, these medications affect neurotransmitters including serotonin, norepinephrine and dopamine.
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