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Antidepressants Medications
The history of antidepressants begins with the tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). Both of these classes of antidepressants were successful and were discovered be chance. The first antidepressants became available in thelate 1950s. Newer antidepressants such as the SSRIs have largely replaced older Tricyclic antidepressants and MAOIs as first-line drugs. However, Tricyclic antidepressants and MAOIs remain valuable alternatives for patients with moderate to severe depression. Newer agents such as venlafaxine (Effexor) and nefazodone appear to be as effective as SSRIs in the treatment of depression. Bupropion (Wellbutrin) may also be helpful in some patients. Use of antidepressants
Many medications are available for the treatment of depression. Antidepressants are effective treatment for 60-70% of all patients with depression. Whether antidepressant medication is the best treatment option depends on how severe the person's depression is, their history of illness, their age (psychological treatments are usually the first choice for children and adolescents), and their personal preferences. Most people do best with a combination of medications for depression and therapy. Antidepressants as a class of psychotropic medication have the following broad range of indications:
Classification of antidepressants
There are many different types of antidepressant. Antidepressants are put into groups based on which chemicals in the brain they affect. Main classes of antidepressant include: Non-selective antidepressants
Selective reuptake inhibitors
Receptor blockers
Tricyclic antidepressants are one of the oldest classes of antidepressants. Now there are newer, more popular types, such as SNRI and NDRI. SSRIs and SNRIs have largely replaced the first generation of antidepressants, which are as effective but more likely to produce side effects. How do antidepressants work
All antidepressants work on the principle of enhancing one or more of the neurotransmitters in the brain. Neurotransmitters are molecules that specialize in delivering packets of information from one neuron to another. Choosing the antidepressant
When choosing the antidepressant the important aspects are:
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors act only on the neurotransmitter serotonin, while tricyclic antidepressants and MAO inhibitors act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body. Selective serotonin reuptake inhibitors have fewer side effects than tricyclic antidepressants and MAO inhibitors. Some of the side effects that can be caused by SSRIs include dry mouth, nausea, nervousness, insomnia, headache and sexual problems. Tricyclic antidepressants
The tricyclics have been used to treat depression for a long time. They act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body. Common side effects caused by these medicines include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Serotonin and norepinephrine reuptake inhibitors works by slowing down the reuptake of both serotonin and noradrenaline, but more selectively than other drugs. Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)
NDRIs increase the levels of norepinephrine and dopamine. Bupropion is available in several forms: an immediate-release form taken three times a day; a slow release (SR) form that requires taking medication twice a day, and an extended release (XL) form that requires only a once-a-day dose. Combined reuptake inhibitors and receptor blockers
Trazodone and nefazodone are phenylpiperazine antidepressants. Trazodone is a serotonin reuptake inhibitor and is also a 5-HT2 receptor antagonist. This results in more serotonin to stimulate other nerves. This medication has sedative and antidepressant properties. Nefazodone works by inhibiting the uptake by nerves of serotonin and norepinephrine. Nefazodone is chemically related to trazodone, and shares its actions. Compared with trazodone, nefazodone has a lesser risk of priapism. Noradrenergic and Specific Serotonergic Antidepressants
The novel antidepressant mirtazapine has dual mode of action. It is a noradrenergic and specific serotonergic antidepressant that enhances noradrenergic and serotonergic neurotransmission. Mirtazapine has been proved effective in the treatment of patients who were resistant or intolerant to SSRIs. Monoamine oxidase inhibitors (MAOIs)
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