Depression is a complex illness which is a result of interaction between biological, psychological, and social factors, and medications, known as antidepressants, play an important role for the treatment of depression. The main aim of the treatment is to relieve the symptoms of moderate or severe depression and prevent them from coming back.
Multiple studies have proven the effectiveness of antidepressants and medical professionals typically recommend them in combination with psychotherapy, education and support, and control of unhealthy behaviors. In mild cases, psychotherapy, education and family support, and control of unhealthy behaviors, might be sufficient and antidepressants might not be recommended.
In particular, antidepressants are effective in relieving depressive symptoms such as feeling very down and exhausted and are meant to make you feel emotionally stable again and help you to follow a normal daily routine. In addition, the medications are also effective in relieving symptoms such as restlessness, anxiety, and sleep problems, and to prevent suicidal thoughts.
Types of Antidepressants
Antidepressants can be divided into different classes:
- Selective serotonin reuptake inhibitors (SSRIs) – some of the common SSRIs include
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) – some of the common SSRIs include duloxetine, and venlafaxine.
- Norepinephrine-dopamine reuptake inhibitors (NDRIs) – bupropion for example is one of the NDRIs
- Tricyclic antidepressants (TCAs) – nortriptyline is one of the common TCAs
- Monoamine oxidase inhibitors (MAOIs)
SSRIs, SNRIs, and NDRIs belong to the newer category of anti-depressants with relatively fewer side-effects, as compared to the older tricyclics and monoamine oxidase inhibitors (MAOIs) (Note: although the older antidepressants are associated with more side effects, they may be the best option for some people, please consult a medical professional).
How to select the right antidepressant?
At present, there is no way to identify which antidepressant will work best on an individual level. Through empirical evidence, we do know that certain medications work better than the others, but there is no way for a medical professional to identify and determine which will work most effectively with certainty.
Typically, professionals initially prescribe medications that are safer and generally have fewer side effects, like the selective serotonin reuptake inhibitors or SSRIs. In addition, based on the symptoms that the patient presents, the provider will adjust their prescription. For example, an individual who presents symptoms of anxiety would not be prescribed the Bupropion as a first choice as it does not help with anxiety symptoms. So, it is extremely important to be open about all the symptoms that the individual maybe experiencing and communicate them with the provider.
Further, the provider will also ask the patient and understand about their tolerance for potential side effects, their preferences for or against a particular medication if any, and family history with antidepressants. Certain medications lead to sexual side effects, stomach issues, or changes in weight and staying compliant with medication could be hard if they are not able to tolerate any particular side effects.
Also, ensuring that the medication aligns with any opinion or belief that the patient may have on the medications, and consistent with the information of what might have worked within the family in the past, increases the likelihood that the patient will remain compliant and will stick to the recommended treatment. Initially people will have side effects without benefits, and since medication can take up to four to six weeks to show improvement in symptoms, staying compliant to antidepressants is crucial.
Finding the right medication is an important step and can often take multiple trials before the ideal treatment strategy is reached. If the initial medication does not yield favorable results, or one is not able to stay compliant given any reason, your provider would switch to another class of antidepressants. Collaborating with your provider and asking your treatment team questions about the medication can help ease the anxiety associated with this process, and help you develop the optimal treatment strategy.
Some of the questions to ask your treatment team include:
- what medication am I taking, why am I taking it, and how to take it,
- what side effects should I watch out for,
- when can I expect my symptoms to begin improving and will I feel relieved of all my symptoms,
- if there are some disabling side effects, or side effects that I can’t manage, how do I reach out and will we be able to make changes to the medication
- what are the long-term effects that the medication can have on my mind and body
- will the medication impact the way I think, the way I feel, or the way I interact with others
- and so on…
Participating actively in your treatment journey can make your recovery process easier and allow you to resume your daily activities with better outlook.
