There are varying opinions on how helpful antidepressants alleviate depressive symptoms. Some question their efficacy, others view it as necessary. It's the same for these medications with other treatments: they can improve in some circumstances, just not in others. They are effective, though not mild, for moderate, serious, and persistent depression. They may have side effects as well. The doctor must assess the advantages and drawbacks of antidepressant medication.
The primary goal in therapy with antidepressants is to eliminate and avoid the recurrence of depressive symptoms such as extreme depression and fatigue. The drug can help to restore mental health and organize a regular daily life. But they can also ease inner restlessness, fear, or sleep disturbances and allow suicidal impulses to vanish.
This text deals with the drug treatment of the most common depressive illness, the so-called unipolar depression. The treatment of manic-depressive illness (bipolar disorder) is not described here.
What antidepressants are there?
There are many different active substances available for treating depression, which can be grouped. The following are primarily about the most commonly used antidepressants:
· Tricyclic antidepressants (TCAs)
· Selective serotonin reuptake inhibitors (SSRI)
· Selective serotonin- noradrenaline reuptake inhibitors (SSNRIs)
Tricyclic antidepressants have been around the longest. They are known as first-generation antidepressants. SSRIs and SSNRIs are second-generation antidepressants.
Less frequently prescribed are:
· Alpha-2 receptor antagonists
· Monoamine oxidase (MAO) inhibitors
· Selective norepinephrine reuptake inhibitors
· Selective norepinephrine/dopamine reuptake inhibitors
How do antidepressants work?
Nerve cells in the brain use various messenger substances to transmit stimuli. Even if all the details have not yet been clarified, experts assume that the balance of certain messenger substances such as serotonin is changed in depression and that some nerve connections are therefore inhibited. Antidepressants should improve the availability of these messenger substances in the brain again. The different active ingredients achieve this in different ways.
How is the treatment going?
Usually, antidepressants are administered regularly. The goal is to relieve the effects and allow the stress to move as far as possible in the first weeks and months. Care will proceed for at least 4 to 9 months if this target is reached. This so-called maintenance therapy is necessary to avoid symptoms from returning. Perhaps the drug is administered longer to avoid recurrence (relapse prevention). Among other factors, the length of usage relies on how the signs progress and whether repetition is raised. For several years, some individuals have been taking antidepressants.
Regular visits to the doctor are important during treatment. It will be discussed whether the symptoms have improved and whether any side effects have occurred. If necessary, the drug dose is adjusted. Under no circumstances should you increase or decrease the tablets yourself dosage: This can mean that the tablets do not work sufficiently or trigger more side effects.
At the end of treatment, the dose is gradually reduced over a period of weeks. When you stop taking it, you may experience temporary insomnia, nausea, or restlessness. Such symptoms are most common when antidepressants are stopped abruptly. Stopping the medication yourself as soon as you feel better also increases the risk of depression coming back. Unlike many sleeping pills and tranquilizers, antidepressants are not physically dependent or addictive.
How well do antidepressants relieve the symptoms?
There are many different drugs used for depression. How well a certain drug will help an individual is difficult to predict. Therefore, doctors often suggest an active ingredient at the start of treatment that they consider effective and relatively well tolerated. If the drug does not help as expected, there is an option to switch to another. Sometimes you have to try different remedies to find an effective one.
Studies show that the benefits depend on the severity of the depression: the more severe the depression, the more likely the benefits outweigh the benefits. This means that antidepressants are effective for chronic, moderate, and severe depression. They do not help with mild depression.
The various antidepressants have already been compared in many studies. Overall, the frequently used tricyclic antidepressants, SSRIs, and SSNRIs performed similarly. For adults with moderate or severe depression, studies show:
· Without antidepressants : In about 20 to 40 out of 100 people who took tablets without active ingredients (placebos), the symptoms improved within 6 to 8 weeks.
· With antidepressants: 40 to 60 of 100 antidepressants received better symptoms over 6 to 8 weeks. With antidepressants:
This means: in an additional 20 out of 100 people, the symptoms improved after taking the antidepressants.
Antidepressants can also relieve chronic depressive moods (dysthymia) and chronic depression and contribute to their disappearance.
The effects of an antidepressant can set in within 1 to 2 weeks. However, it can take longer for the depressive symptoms to improve.
Depressive symptoms can also be treated with two drugs at the same time. Maybe this will help alleviate the symptoms. For some people, it takes a long time for a remedy to help. For others, the symptoms persist even after several attempts with different drugs. Then you can discuss with the doctor which other treatment alternatives are possible.
How well do antidepressants prevent relapses?
To prevent relapses, antidepressants are usually taken for about 1 to 2 years, sometimes longer. Relapse prevention can be useful for people who
· I have had several relapses
· Want to avoid a relapse or
· Have chronic depression.
Studies in adults show that taking commonly used antidepressants such as TCAs, SSRIs, and SSNRIs lowers the risk of relapse but cannot prevent it entirely:
· Without prophylaxis: About 50 out of 100 people who took a placebo had a relapse within 1 to 2 years.
· With prophylaxis: About 23 out of 100 people who took an antidepressant had a relapse during this time.
What are the side effects of antidepressants?
Like all drugs, antidepressants can have side effects. Over half of people report it when they are treated with antidepressants. They usually appear in the first few weeks of use, and later they show up less often.
Some side effects are believed to be directly related to the effects of the drugs on the brain and are relatively similar for different drugs in a group. While taking antidepressants, patients report, for example, dry mouth, headaches, circulatory problems, inner restlessness, and sexual disorders. Such complaints are often perceived as side effects of the medication. However, some of these symptoms could also be the result of depression.
Whether, how often, and what side effects occur depends not only on the time of treatment but also on the active ingredient and the respective dosage. In addition, everyone reacts slightly differently. The risk of side effects increases if other medications are also taken. Then one remedy can increase the side effects of the other. Such interactions are common in the elderly or people with other chronic conditions who are taking multiple medications.
Therefore, it is important to discuss the advantages and disadvantages of the individual preparations with your doctor in detail.
Some side effects of such active substances are more common:
· SSRIs are more likely to cause diarrhea, headaches, insomnia, and nausea than tricyclic antidepressants.
· Tricyclic antidepressants are more likely than SSRIs to cause blurred vision, constipation, dizziness, dry mouth, tremors, and problems urinating.
The side effects of tricyclic antidepressants are often more distressing than those of SSRIs or SNRIs. As a result, tricyclic antidepressants are more likely to be stopped: in studies, around 15 out of 100 people did this - compared to around 10 out of 100 people who took SSRIs. In addition, with tricyclic antidepressants, there is a greater risk of serious side effects as a result of an overdose.
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