Antidepressants are medicines used in the treatment of depression. Treatment of depression – tablets are necessary. They increase the concentration of one or more types of neurotransmitters – chemical substances with which the communication between the brain and nerves is carried out. Different classes of antidepressants affect different neurotransmitters. Since there is not enough evidence that some antidepressants are more effective than others, when choosing a drug for treatment, the doctor usually takes into account the side effects and drug interactions of medications.
Monoamine oxidase inhibitors (MAO)
Antibiotics of this class were invented first. Recently, they are being written out more and more rarely from suspicions that have not yet been confirmed that they interact with certain foods and many drugs.
MAO inhibitors increase the levels of norepinephrine, serotonin, and dopamine by blocking the activity of an enzyme called monoamine oxidase. This enzyme breaks down norepinephrine, serotonin and dopamine, and when its activity is inhibited, the concentration of these chemicals in the brain increases.
Monoamine oxidase also has the ability to break down tyramine, a chemical that is found predominantly in old wine and cheese. Under the influence of MAO inhibitors, the level of tyramine in the body may increase, causing a hypertensive crisis. Before taking MAO inhibitors, patients are advised to make changes to their diet in order to reduce tyramine intake.
MAO inhibitors are not recommended to be taken with other drugs that increase the activity of serotonin, for example:
- Selective serotonin reuptake inhibitors (for example, sertraline and fluoxetine).
- Selective inhibitors of norepinephrine and serotonin reuptake, for example, venlafaxine and desvenlafaxine.
- Tricyclic antidepressants, for example, imipramine.
- St. John’s wort and the drugs that it contains
- Tramadol (Ultram),
- Propoxyphene (Darvon)
Simultaneous use of these drugs and MAO inhibitors can cause such complications as confusion, tremor, hyperactivity, coma and death.
Taking MAO inhibitors and vasoconstrictor drugs (such as epinephrine, pseudoephedrine, ephedrine, phenylpropanolamine, phenylephrine) can increase blood pressure to a dangerous level. Linezolid (Zyvox) also can not be taken simultaneously with MAO inhibitors – this antibiotic also blocks the activity of monoamine oxidase.
Intake of MAO inhibitors must be completed at least two weeks before the start of taking drugs that interact with them. If the patient is taking fluoxetine, it should be 5 weeks before the start of taking MAO inhibitors.
MAO inhibitors can cause headache and insomnia; with constant use, these symptoms become weaker. Side effects of these drugs can also be weight gain, erectile dysfunction, edema.
The first drug from the class of tricyclic antidepressants – imipramine, began to be used in the middle of the twentieth century. Tricyclic antidepressants increase the level of norepinephrine and, to a much lesser extent, serotonin. Some tricyclic antidepressants are also antihistamines or anticholinergics (block the action of the neurotransmitter acetylcholine). Thus, these drugs can be used not only to treat depression Depression – a little more than a bad mood.
Tricyclic antidepressants can block the antihypertensive effects of clonidine (Catapres); their simultaneous use can be very dangerous.
In combination with drugs such as Disopyramide (Norpace), Pimozide (Orap), Procainamide (Pronestyl, Procan SR, Procanbid), tricyclic antidepressants can cause serious heart problems.
Carbamazepine (Tegretol) breaks down tricyclic antidepressants and reduces their effectiveness.
How do antidepressants work?
The action of most antidepressants is based on slowing down the process of removing chemicals from the brain called neurotransmitters. Neurotransmitters are necessary for normal brain function. Antidepressants keep these substances in the brain for a longer time.
How long should antidepressants be taken?
As a rule, antidepressants should be taken within 4 to 6 months. In some particularly severe cases, doctors recommend taking antidepressants for a longer time.
What types of antidepressants exist?
Antidepressants are conventionally divided into groups according to the chemical substance they affect (pharmacodynamic principle). There are several different types of antidepressants, including:
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Citalopram (trade name: Celexa)
- Eskitalopram (trade mark: Lexapro)
- fluoxetine (trade name: Prozac)
- paroxetine (trade mark: Paxil, Pexeva)
- sertraline (trademark: Zoloft)
The side effects of these medications are minor compared with the side effects of other antidepressants. Here are some side effects of selective serotonin reuptake inhibitors: dry mouth, nausea, nervousness, insomnia, sexual dysfunction, and headache.
Tricyclic antidepressants (TCAs)
- amitriptyline (trademark: Elavil)
- desipramine (trade mark: Norpramin)
- Imipramine (trademark: Tofranil)
- Nortriptyline (trade name: Aventyl, Pamelor)
The most common side effects of tricyclic antidepressants are: dry mouth, loss of clarity of vision, diarrhea, pain when urinating, exacerbation of glaucoma. Glaucoma – blindness, impaired thought processes and rapid fatigue are possible in the future. These antidepressants also affect blood pressure and heart rate.
Serotonin and Norepinephrine Reuptake Inhibitors
- venlafaxine (trade name: Effexor)
- duloxetine (trademark: Cymbalta)
The most common side effects of serotonin and norepinephrine reuptake inhibitors: nausea, loss of appetite, anxiety. Anxiety – how to distinguish between normal and pathological? and nervousness, headache, insomnia, and fatigue. Also, dry mouth, diarrhea, weight loss, sexual dysfunction, accelerated heart rate and increased cholesterol levels are not excluded.
Norepinephrine and dopamine reuptake inhibitors
- bupropion (trade mark: Wellbutrin)
The most common side effects of norepinephrine and dopamine reuptake inhibitors are: anxiety, nausea, headache, loss of appetite, and insomnia. In some people, an increase in blood pressure is also possible.
Combined Reuptake and Receptor Blockers
- trazodone (trade name: Desyrel)
- Nefazodone (trade mark: Serzone)
- mirtazpin (trade mark: Remeron)
The most common side effects of reuptake inhibitors and receptor blockers are: drowsiness, dry mouth, nausea and dizziness. Nefazodone is contraindicated for people with kidney disease. Maprotiline is contraindicated in patients with epilepsy.
- isocarboxazid (trademark: Marplan)
- Phenelzine (trademark: Nardil)
- tranylcypromine (trade mark: Parnate)
Monoamine oxidase inhibitors are less common than other antidepressants. They can also have serious side effects, including weakness, dizziness, headache and tremor. Combining a monoamine oxidase inhibitor with other anti-depressants or anti-flu medicines and colds that can be given without a prescription can cause a dangerous reaction. Prescribing an antidepressant, the doctor must tell you what foods and alcoholic beverages should not be consumed while taking a monoamine oxidase inhibitor. This medicine can only be taken if you are ready to follow exactly the recommendations of the doctor regarding dietary restrictions. If you are taking a monoamine oxidase inhibitor, and your doctor wants to change the prescription and prescribe another antidepressant, then first you have to stop taking the first medicine, and only after some time start taking the second one. This time is necessary in order for the monoamine oxidase inhibitor to be completely removed from the body.
How do antidepressants interact with other medications?
Antidepressants come into strong interaction with other medications. Before taking an antidepressant, tell your doctor about all medicines you are taking, including over-the-counter medicines and herbal medicines. Be sure to check with your doctor about the possible consequences of the interaction of antidepressants with medications that you are constantly taking.