When it comes to types of antidepressant, there is an overwhelming amount of choice. At a time when you may already be finding it difficult to make decisions, it can be bewildering to try and understand the different types of antidepressants, the different medicine names within these types, and which will work best for you.

Here we have tried to simplify the different types of antidepressants and how they work so that you have the information you need to make the right choices.

Antidepressants: what they can and can’t do

Antidepressants aren’t a cure for depression, but they can be very useful for managing symptoms. This can be helpful for giving you manageable time, should you think that your depression will be best improved through other non-medication options, such as psychotherapy or lifestyle changes.

There are many different types of antidepressant available. This means that if the first one you try doesn’t work for you, don’t give up. It may just be that you haven’t yet found the right one for you.

Different types of antidepressant work in different ways. This means that you need to think about your kind of depression and other factors that are unique to you, before deciding which is most likely to be suitable. You want to think about:

·Your symptoms

Not everyone’s experience and symptoms of depression are the same. For example, some people experience sleep disturbances, when others find they sleep too much. Some antidepressants make you drowsy, so this could be a favorable effect, or an unfavorable one, depending on your particular symptoms.

·Potential side effects

No medication comes without side effects, but side effects can vary notably from one person to another and one medication to another. Weight gain may not be a troublesome side effect for some people, but for others who are already overweight or obese, it could be problematic.

·Interactions

If you are already on medications for other conditions, or for depression, then care needs to be taken to check how different medications interact. Some medications can enhance the effects of antidepressants, and vice versa.

·Pregnancy and breastfeeding

Some antidepressants are considered safe to use during pregnancy and breastfeeding. However, the types of antidepressant used should be carefully considered.

·Wider health

It’s very important that your whole health is considered when taking antidepressants. Indeed, some antidepressants are actually prescribed for non-depressive issues, such as duloxetine or amitriptyline for fibromyalgia and chronic pain. It’s important to discuss your wider health with your prescribing doctor so that you can find the right antidepressant for you.

It may also be relevant for you to consider the relative costs of different antidepressants. Often there are generic versions of brand name medications available, which can be considerably more affordable.

The different types of antidepressants

There are various causes of depression. It’s not as simple as saying it is a chemical imbalance which can be corrected through replacing missing chemicals through medication. Indeed, scientists don’t know exactly what causes depression or even why some antidepressants work.

However, most antidepressants work by affecting different neurotransmitters in the brain, specifically serotonin, norepinephrine and dopamine. There are broad types of antidepressants which affect the neurotransmitters in different ways.

·Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are commonly prescribed antidepressants and often the first medication tried when someone is first trying an antidepressant. They are usually very effective and tend to have few troublesome side effects.

SSRIs include fluoxetine (Prozac), sertraline (Zoloft) and citalopram (Celexa).

·Serotonin and norepinephrine reuptake inhibitors (SNRIs)

These are relatively new antidepressants which work by preventing the reuptake of serotonin and nonrepinephrine.

SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor XR).

·Norepinephrine and dopamine reuptake inhibitors (NDRIs)

Much less commonly, NDRIs are used. There is only one antidepressant in this class called bupropion (Wellbrutin).

All of these types of antidepressant are types of reuptake inhibitors. In normal brain functioning, you absorb released neurotransmitters, like serotonin, back into your nerve cells. These types of medication prevent this reuptake, ensuring the neurotransmitter stays longer in the synapse. It’s thought that this helps to regulate mood.

·Tetracylics

These also affect neurotransmitters but they work differently. They stop the neurotransmitters from binding with certain nerve receptors. This causes serotonin and norepinephrine to build up in the synapses.

Tetracylics include amoxapine and maprotiline.

·Serotonin antagonist and reuptake inhibitors (SARIs)

These prevent the reuptake of serotonin but they also prevent the binding that stops them going to the most desired nerve cells.

SARIs include trazodone.

·Tricyclic antidepressants

These antidepressants work by blocking the reuptake of serotonin and epinephrine once released. These are often referred to as old-style antidepressants and one of the first drug treatments for depression. They often come with more side effects than the newer antidepressants above and so most doctors tend to recommend trying something else first. However, tricyclic antidepressants are used for a range of other conditions including migraines.

Tricyclic antidepressants include amitriptyline and doxepin.

·Monoamine oxidase inhibitors (MAOIs)

MAOIs work quite differently from other antidepressants. They block the effects of an enzyme that breaks down various neurotransmitters.

MAOIs are only usually tried if other types of antidepressant have been ineffective because they can have severe side effects. They are also quite difficult to manage as a patient as you must take care to avoid certain foods in your diet, such as certain cheeses and wines, and other medications and supplements, such as decongestants and painkillers. They must not be combined with SSRIs.

MAOIs include tranylcypromine (Parnate) and phenelzine (Nardil).

Can antidepressants increase the risk of suicide?

It’s been worrying to hear of issues in the news over recent years about the association between some types of antidepressants and suicide. The American Food and Drug Administration (FDA) require all antidepressants to be labelled with black box warnings, for this reason.

Evidence shows that the increased risk of suicide and suicidal ideation is usually most critical in the earliest weeks of starting a new antidepressant or increasing the dosage, and so you should be closely monitored during this time. The increased risk of suicide with antidepressants is higher in young people under the age of 25.

It is often a case of balancing risks and benefits overall. Longer term use of antidepressants is likely to reduce the risk of suicide and suicidal ideation because it helps to alleviate low mood.

Taking antidepressants

It can be a big decision when you decide to start antidepressants. We recommend that you:

·Chat with your doctor

It’s important to be monitored when taking antidepressants, and it’s vital to get medical advice about which antidepressant will best suit you. You also need your doctor’s advice should you want to change the antidepressant you are taking or want to change dose.

·Take your antidepressant accurately

It’s important that you take your antidepressant at the correct dose and regularly, according to your prescription. Some antidepressants are incredibly difficult to stop taking, due to their side effects. Don’t stop taking your antidepressant without support from a healthcare professional.

·Be patient

Antidepressants all take time to work. It’s not uncommon for it to take as much as six weeks or more for the antidepressant to be fully effective. Consider managing your symptoms in different ways in the shorter term. Additionally, many of the side effects of antidepressants calm down over time. As you get used to the antidepressant, these tend to become less bothersome.

·Take a multi-pronged approach

Antidepressants are one way of treating depression. You may find that it is beneficial to combine a number of different strategies from psychotherapy to cognitive behavioral therapy (CBT), as well as lifestyle changes such as increasing your exposure to natural light, doing some light exercise if possible, and eating a balanced and healthy diet. You may also find it helpful to reduce your use of alcohol and recreational drugs as these can worsen your depression symptoms.

Choosing the right antidepressant

It’s really important, especially when starting an antidepressant during an acute phase of depression and low mood, to have the support of a medical professional helping you make the right decisions. As yet, we don’t know why many antidepressants work, but we know they do, but it can be a difficult process starting your antidepressant treatment and managing the early months of taking the medication.

It’s also important to note that your depression may not be caused by a chemical imbalance, which is what antidepressants seek to treat. You may need to consider other options, such as talking therapy, to learn more about your own depression and help manage symptoms.

Please remember that the information provided by International Pharmacy is intended to be guidance only. Always discuss your medical situation with your physician before taking prescribed medication.