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There are many different types of medication available to treat this very common but rather serious condition, but in the past few years treatment options have changed.

New medications for depression have become available, safer and more effective than before, causing significantly fewer side effects. Although patients sometimes call them the perfect drugs, it is crucial to remember that all medications carry certain risks. 
 
There are several different classes of medications for depression but the three most commonly used are:
  1. Selective serotonin reuptake inhibitors (SSRI)
  2. Tricyclics (TCA)
  3. Monoamine oxidase inhibitors (MAOI)
Common SSRI medications include Paxil®, Luvox®, Zoloft®, Serozone®, and Prozac®. Effexor was at one time also considered an SSRI, but has now been reclassified as a SNRI.

Depression and SSRI

Depression is a serious mood disorder characterized by significant problems in both thinking and behavior. It is estimated that major depressive disorders affect about 5% of adolescents worldwide. Selective serotonin reuptake inhibitors (SSRI) can be extremely beneficial to children and adolescents with depressive disorders.
 
There is one major problem, however. Recently there has been some concern that the use of these medications may induce suicidal behavior in youths. That’s why US FDA has published a warning about an increased risk of suicidal thoughts or behavior in children and adolescents treated with SSRI antidepressant medications.

Mechanism of action

Depression is now believed to be all about missing certain neurotransmitters in the central nervous system. One of the most important of these is serotonin, also known as 5-hydroxytryptamine or 5-HT. SSRI are able to slow down the process of returning the serotonin to the end of the neuron it comes from. This leads to a longer presence of this neurotransmitter on the receptor, making it more likely that enough will build up to set off the impulse in the next neuron. In other words, these medications work by allowing the body to make the best use of the reduced amounts of serotonin that it has, at the time.  

Indications

As mentioned earlier, the main and primary indication for SSRI is clinical depression. SSRI are also prescribed for anxiety disorders such as social anxiety, panic disorders, obsessive-compulsive disorder (OCD), eating disorders, irritable bowel syndrome (IBS), and premature ejaculation.

Contraindications

SSRI are contraindicated with simultaneous use of MAOI (monoamine oxidase inhibitors), also a type of antidepressants. Research has confirmed that this can lead to increased serotonin levels which could cause a serotonin syndrome. They are also contraindicated for people taking pimozide (a diphenylbutylpiperidine derivative), analgesic tramadol hydrochloride, and others.

Most common adverse reactions

Like with any other drug, these antidepressants can cause several possible side effects and the most common are gastro-intestinal such as:
  • nausea
  • vomiting
  • indigestion
  • abdominal pain
  • diarrhea
  • constipation

Other side effects include:

  • irritability
  • anxiety
  • sleeplessness
  • drowsiness
  • headache
  • shaking
  • dizziness
  • convulsions
  • disturbance of sexual function
  • sweating
  • low sodium level
  • suicidal ideas
  • loss of appetite, weight loss
  • increased appetite, weight gain
  • allergic reactions
  • dry mouth
  • bruising
  • manic or hypomanic behaviour
  • abnormal movements

Suicidality

During the last couple of years there have been many cases of patient suicidal ideation and behavior. Families of the patients have blamed medications, but manufactures have denied any such link and have always blamed the disease rather than the treatment. In 2003 the UK Committee on Safety of Medicines, and in early 2006 GlaxoSmithKline, have issued a press release regarding clinical data which showed a statistically significant higher frequency of suicidal tendencies in patients treated with their SSRI, paroxetine (Paxil®). That’s why in the US today these medications have a box warning requirement noting a suicide risk in children (but not in adults).
Drug® generic name

Dose/day

Possible side effects

Effexor®/venlafaxine

75-375 mg

High blood pressure, sexual dysfunction

Paxil®/paroxetine

20-50 mg

Fatigue, sexual dysfunction

Prozac®/fluoxetine

20-80 mg

Anxiety, insomnia, sexual dysfunction

Serzone®/nefazodone

30-600 mg

Drowsiness

Welbutrin®/buproprion

300-450 mg

Weight loss, slight (.4%) risk of seizures

Zoloft®/sertraline

50-200 mg

Drowsiness, insomnia, sexual dysfunction

Sexual side effects

The selective serotonin reuptake inhibitors (SSRI) can cause various types of sexual dysfunction such as:

  1. anorgasmia

  2. erectile dysfunction

  3. diminished libido
Fortunately, these dysfunctions tend to disappear spontaneously; in most cases issues are resolved after discontinuance, and it is believed that dysfunction is caused by an SSRI-induced reduction in dopamine. Other research has shown that the antidepressants used alone can't cause this, but when used with medications such as bupropion, buspirone, Methylphenidate, mirtazapine, amphetamine, pramipexole and ropinirole, they can be the cause of the aforementioned sexual side effects.  

Discontinuation syndrome (withdrawal)

It is important to point out that these antidepressants are not addictive in the conventional medical use of the word. Therefore, a person can stop using them at will, but suddenly discontinuing their use is known to produce both Somatic and psychological withdrawal symptoms. Patients claim they feel extremely uncomfortable if they miss a few doses or discontinue using these drugs suddenly. 

They report:

  • sweating
  • chills
  • nausea
  • insomnia
  • headache
  • shakiness
  • weakness
  • nervousness
  • jitters
  • visual disturbances
  • inability to concentrate

Loss of effect

Patients have also complained about loss of effect, and this represents a serious problem with long-term use of SSRI. The phenomenon could be due to regulation of the neuro-receptors, and may occur more often with SSRI than with other antidepressants.

Overdose

SSRI appear to be safer in overdose when compared with traditional antidepressants such as the tricyclic antidepressants. This is supported by case studies of deaths per numbers of prescriptions.
That’s why SSRI represent the most commonly used antidepressants today. Most patients will have mild or no symptoms following moderate overdoses. 

The most commonly reported severe effect following SSRI overdose is:

  1. serotonin syndrome
  2. serotonin toxicity
  3. coma
  4. seizures
  5. cardiac toxicity

“Good” Side effects

Patients have also reported some strange but favorable side effects. One of the "best" side effects of using SSRI is appetite reduction and weight loss. In fact, that was one of the reasons that Prozac found fame so fast.

Wonder Drugs

One of the most commonly used (sometimes even called the ‘wonder drug’) antidepressant that has appeared in recent years is Prozac®. This powerful drug operates at a deep level of the brain to correct a biochemical imbalance that not only seems to underlie depression, but a variety of other body/mind problems as well.

Is there an alternative?

Of course, due to the expensive cost and side effects of medications for depression, people in the United States have increasingly turned to natural medications for depression. Patients should be aware that they will not get a “wonder plant” cure, and although many natural supplements are low-quality and don’t work as well as prescription medications for depression, a few high-quality natural depression supplements do exist.