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Antidepressants & Anti-AnxietyAntidepressants were first developed in the 1950s and have been used on a regular basis since then. Antidepressants are medications used to treat depression. Depression is a disorder that affects your thoughts, moods, feelings, behavior and physical health. People used to think it was "all in your head" and that if you really tried, you could "pull yourself out of it." Depression is not a weakness, and you can't treat it on your own. It's a medical disorder with a biological and chemical basis. Most people with depression get better with treatment that includes antidepressants. Most antidepressants are believed to work by slowing the removal of certain chemicals (serotonin and norepinephrine) from the brain. These chemicals are called neurotransmitters and are needed for normal brain function. Antidepressants help relieve the symptoms of depression by making these natural chemicals more available to the brain and thus restoring the brain's chemical balance. Antidepressants are used to treat mental depression as well as childhood bed wetting, anxiety, panic, eating disorders, obsessive compulsive disorder, social anxiety, and premenstrual depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you're severely depressed, initial treatment usually is with medications or electroconvulsive therapy. What are antidepressants? Antidepressants relieve the symptoms of depression, anxiety, and some other mental disorders. They are the third most prescribed class in the United States. There are almost thirty different kinds of antidepressants available today and there are five main types:
How do antidepressants work? Neurotransmitters are the chemicals which transmit signals between the cells in our brains. In depression, some of the neurotransmitter systems, especially those of serotonin, dopamine and norepinephrine, don't seem to be working properly. Antidepressants affect neurotransmitters, in particular, boost the amounts of serotonin and norepinephrine. This gradually causes changes in how your brain cells behave. It can take several weeks before you can tell if your mood is improving. The problem is that they also affect other brain cells, disrupting nerve signals and causing side effects. Are antidepressants addictive? Antidepressants don't cause the addictions that you get with tranquillizers, alcohol or nicotine, in the sense that. You don't need to keep increasing the dose to get the same effect. You won't find yourself craving them if you stop taking them. However, stopping taking antidepressant abruptly may cause withdrawal symptoms. These include: stomach upsets, flu-like symptoms, anxiety, dizziness, headache, nausea. It is wise to taper off the dose rather than stop it suddenly. Antidepressants are put into groups based on which chemicals in the brain they affect. Selective serotonin reuptake inhibitors (SSRIs) Selective serotonin reuptake inhibitors (SSRIs) are a newer class. They relieve symptoms of depression by blocking the reabsorption of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which enhances neurotransmission - the sending of nerve impulses - and improves mood. SSRIs are called selective because they seem to affect only serotonin, not other neurotransmitters. Some SSRIs are available in extended-release forms or controlled-release forms, often designated with the proper letters. The researchers found that two SSRIs, Sertraline and Escitalopram, are superior to many other medications. The choice between them may be a reasonable starting point in many situations. Serotonin and norepinephrine reuptake inhibitors (SNRIs) SNRIs were developed more recently, and there are relatively few of them. Their efficacy as well as their tolerability appears to be somewhat better than the SSRIs. Serotonin and norepinephrine reuptake inhibitors, known as dual reuptake inhibitors, increase the levels of both serotonin and norepinephrine by inhibiting their reabsorption into cells. Although the precise mechanism of action isn't clear, it's thought that these increased levels enhance neurotransmission and thereby improve and elevate mood. This group include duloxetine, venlafaxine and desvenlafaxine. Duloxetine and venlafaxine are similarly effective with regard to alleviating depressive symptoms. Desvenlafaxine is an active metabolite of venlafaxine, a chemical that is manufactured by the body from venlafaxine. Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs) Norepinephrine and dopamine reuptake inhibitors (NDRIs) are a type of antidepressant medication that increase the levels of both norepinephrine and dopamine by inhibiting their reabsorption into cells. The precise mechanism of action isn't clear. But it's thought that these increased levels help enhance neurotransmission - the sending of nerve impulses - and thereby improve and elevate mood. Bupropion (Wellbutrin) is the only NDRI approved by the FDA. Tricyclic antidepressants Tricyclic antidepressants (TCAs) inhibit the reabsorption of serotonin and norepinephrine, and to a lesser extent, dopamine. They also block certain cell receptors, which accounts for many of their side effects. They're called tricyclic because of their chemical structure. They were among the earliest of antidepressants, hitting the market in the 1960s, and they remained the first line of treatment for depression through the 1980s, before newer antidepressants arrived. Other Trazodone (Desyrel) is an antidepressant chemically unrelated to tricyclic, tetracyclic, or other known agents. It is a triazolopyridine derivative. Alpha-2 receptor blockers Depression is associated with reduced levels of monoamines in the brain. Noradrenergic and specific serotonergic antidepressants (NaSSAs), such as mirtazapine, have a dual mechanism of action that increases the concentration of 5-HT and noradrenaline in the synaptic cleft to within the normal range. NaSSAs bind to and inhibit both noradrenaline a2-autoreceptors and noradrenaline a2-heteroeceptors. This action prevents the negative feedback effect of synaptic noradrenaline on 5-HT and noradrenaline neurotransmission, and neurotransmission sustained. Remeron (mirtazapine) is a new antidepressant that enhances both noradrenergic and serotonergic activity and is currently the only member of NaSSA class. Further reading: Best Antidepressants for various conditions. Last Updated: March 2012 |
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