Can A Placebo Replace Your Antidepressant
Media outlets were abuzz early this year with the news that antidepressant drugs don’t get rid of depression. The source was a Jan. 6, 2010, report in the prestigious Journal of the American Medical Association analyzing data from six clinical trials of antidepressants conducted between 1980 and 2009, involving 718 patients. The study concluded that when people with mild or even moderate depression took a pill, their symptoms improved. The kicker: The improvement was the same, on average, whether the pill was a real drug or a lookalike placebo. Only among people with more severe symptoms did the real drugs have an edge over the placebo.
Studies like those make great headlines. Far more complicated is how to apply the findings in real life. You can’t diagnose or track depression with a blood test or an X-ray. Assessing improvement relies completely on the patient’s subjective reporting of his or her state of mind. Plenty of studies have shown that the drugs work, though placebo effects are notoriously high in antidepressant trials, and the drugs’ advantage over placebos is usually modest.
If you’re not sure you need an antidepressant any more, talk with your doctor about reducing the dose or weaning off of it. Never stop an antidepressant suddenly or on your own you may be risking severe withdrawal symptoms.
Can Antidepressants Give You Suicidal Thoughts
In 2004, the FDA issued a black box label warning for suicidal ideation among 18- to 24-year-olds for common antidepressant drugs. This warning is the FDAs strictest warning for labeling prescription drugs.
The effect of suicidal thoughts is most common with SSRIs, occurring in about 4% of people who take them. However, untreated depression is considered to be much more of a suicide risk than taking antidepressants.
What About The Side Effects Of Antidepressants
Different antidepressants have different side effects and risks. The most common side effects of antidepressants are usually mild. Side effects should improve within a few days or weeks of treatment, as your body gets used to the medicine.
- At the start of treatment: Some people can experience agitation and anxiety in the first few weeks of starting their antidepressant medicine. You may feel that your depression symptoms worsen at first because of the initial side effects. Keep in mind that things will get better and these side effects are likely to pass as your body gets used to the new medication. Tell your doctor if these effects are ongoing or troublesome.
- Do not stop taking your antidepressant medicine without checking with your healthcare provider. Stopping your medicine suddenly may make your symptoms worse.
- SSRIs: A few people experience sexual problems, weight changes or sleep problems when taking SSRIs. Read more about SSRIs.
- SNRIs such as venlafaxine have similar side effects to the SSRIs, and may also cause loss of appetite.
- Mirtazapine: Common side effects with mirtazapine include weight gain and drowsiness.
- TCAs: Side effects are more common with TCAs, and these can include drowsiness, blurred vision, weight gain, constipation and difficulty urinating , a dry mouth and sexual problems.
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Top 5 Antidepressants To Treat Depression
There are different types of antidepressants based on the way they work , which include the following:
1. Selective serotonin reuptake inhibitors
The most prescribed antidepressants by physicians are due to the low side effects experienced with these drugs.
SSRIs work by increasing the serotonin levels in the brain that are comparatively low during the depression. Serotonin is a hormone that stabilizes moods and causes feelings of well-being and happiness.
Other functions of serotonin include:
Once the serotonin exhibits its function, the nerve cells reabsorb the serotonin to terminate their action. When serotonin levels are low, reuptake can restrict the amount of serotonin being circulated actively in the brain. SSRIs prevent serotonin reuptake, thereby increasing the serotonin levels circulating in the brain.
Some of the commonly prescribed SSRIs include:
- Sexual problems
2. Serotonin and norepinephrine reuptake inhibitors
They are often prescribed due to their superior efficacy and safety profile. SNRIs work by increasing serotonin and norepinephrine levels in the brain. Norepinephrine is a hormone and a neurotransmitter responsible for transmitting signals across nerve endings.
Some of the functions of norepinephrine in the brain include:
Different Medications For Different Anxiety Disorders
One of the issues that comes from recommending a medication is that doctors have found that each medicine works differently on each individual. It starts with determining the disorder you suffer from. What works for generalized anxiety disorder may not work for panic disorder, and what works for panic disorder may not work for obsessive compulsive disorder, and so on.
No one can truly recommend a medication without knowing your own personal history, and you must never take a medication that affects your mental health without a doctor’s supervision.
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What Medications Are Used To Treat Anxiety Disorders
When treating anxiety disorders, antidepressants, particularly the SSRIs and some SNRIs ,Ã Ã have been shown to be effective.
Other anti-anxiety drugs include the benzodiazepines, such as as alprazolam , diazepamÃ , buspirone ,Ã and lorazepam . These drugs do carry a risk of addiction or tolerance , so they are not as desirable for long-term use. Other possible side effects include drowsiness, poor concentration, and irritability. Some anticonvulsant drugs , some blood pressure medications , and some atypical antipsychotics are also occasionally used “off label” to treat anxiety symptoms or disorders.
Why Was This Study Needed
Depression is a common condition, affecting an estimated 1 in 10 adults at some point in their lives. Antidepressants are widely prescribed in primary and secondary care, along with psychological interventions such as cognitive behavioural or interpersonal therapy. There is conflicting evidence to guide which antidepressants should be prescribed first-line, although NICE recommends a selective serotonin reuptake inhibitor .
There has been uncertainty in recent years about the effectiveness of antidepressants. Their mode of action is poorly understood, and improvement in mood tends to be modest. One 2008 meta-analysis suggested that antidepressants gave little benefit over placebo for mild to moderate depression.
This new analysis went to some lengths to find unpublished studies and additional data from published studies, to give us the best overview of the current state of research.
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Suicide Risk And Anxiety
Patients with anxiety disorders may experience suicidal ideation, so this risk should always be assessed. Research suggests that the risk of a suicide attempt is most likely to be elevated when there is a comorbid depression. Agitation and akathisia are potential adverse effects of SSRIs and may also be associated with an increased risk of suicide.
New Antidepressants For Old People
Depression is common in elderly people. Old people are at greater risk of developing adverse events while taking any medicationincluding antidepressantsbecause of concurrent illness, consumption of other prescribed and over the counter drugs, dose miscalculation because of forgetfulness, and altered drug kinetics. The efficacy and safety of antidepressants in elderly people is therefore an important treatment issue. In all age groups the use of tricyclic antidepressants for depression has been declining in favour of serotonin reuptake inhibitors. Although views differ on whether serotonin reuptake inhibitors should be used as first line treatment in depression, the drop out rates from treatment are similar for both classes of drugabout a third in each group. What is the evidence for efficacy and safety of serotonin reuptake inhibitors and other newer classes of antidepressants drugs in elderly depressed patients?
It is claimed that fluoxetine, citalopram, and moclobemide are more effective than placebo in trials involving subjects aged 65 and over who are defined as depressed using either the ELDRS score or DSM-IIIR criteria. In virtually all comparator trials of antidepressants both of the drug treatments show similar efficacy. As might be expected, fluvoxamine, milnacipran, paroxetine, sertraline, and venlafaxine are said to show similar efficacy when compared with a tricyclic antidepressant in the treatment of DSM-IIIR defined depression.
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Special Benzodiazepine Risk Factors
Anyone who takes benzodiazepines can experience unpleasant or dangerous side effects. But certain individuals are at a higher risk:
People over 65. Older adults are more sensitive to the sedating effects of benzodiazepines. Even small doses can cause confusion, amnesia, loss of balance, and cognitive impairment that looks like dementia. Benzodiazepine use in the elderly is associated with an increased risk of falls, broken hips and legs, and car accidents. Long-term benzodiazepine use also increases the risk of Alzheimers disease and dementia.
People with a history of substance abuse. Because theyre physically addicting and on their own and dangerous when combined with alcohol and other drugs, anyone with a current or former substance abuse problem should use benzodiazepines only with extreme caution.
Pregnant and breastfeeding women. Benzodiazepine use during pregnancy can lead to dependence in the developing baby, with withdrawal following birth. Benzodiazepines are also excreted in breast milk. Therefore, pregnant women need to have a thorough discussion about the risks and benefits of these medications with their prescribing doctor. If medication is necessary, the goal is the smallest effective dose.
The connection between benzodiazepines and accidents
In Our Quest To Find The Best Anxiety Medication With The Least Side Effects We Now Take A Look At The Other Big Oneantidepressants
Antidepressants, like for example SSRIs, are very often prescribed for anxiety as well as for depression. They are not as effective at instantly killing anxiety as the benzos but they are generally somewhat safer to use long term than benzodiasepines
they DO however come with a host of, often nasty, side effects. Some of them include:
Not everyone who uses them experiences any of these, but the sad truth is that antidepressants are notorious for their unwanted, and often, intolerable side effects
In addition to this they do not work for everyone and, just as with the benzos, I also have first hand experiences with using antidepressants and I can happily say that it has now been five years since I stopped taking them.
and my plan is to stay off them for good.
When it comes to antidepressants, here too, I would be very careful recommending them to anyone
I believe that long term use can affect our brain in a very negative way and I know, from both research and first hand experience, that comming off of them can potentially be PURE HELL, and is often accompanied by some form of burnout and sick leave.
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What Do Antidepressant Medications Do
Antidepressant medications increase the activity of chemicals called neurotransmitters in the brain. Increasing the activity of the neurotransmitters serotonin, norepinephrine and dopamine seems to help lessen the symptoms of depression and anxiety. However, the brain is a very complex organ and the reasons why these drugs work are not yet fully understood.
We do know that these drugs help to relieve symptoms of depression and anxiety in up to 70 per cent of people who try them. This rate is even higher when people who dont get relief with one type of antidepressant try a second type.
Medication For Anxiety And Depression
There are many medications for anxiety and depression that are available for patients experiencing both disorders. The antidepressants below can treat panic disorder, social anxiety disorder, generalized anxiety disorder, or phobias, in addition to depression. Antidepressants increase the activity of certain neurotransmitters, such as serotonin or norepinephrine, in the brain.
The best treatment depends on which anxiety disorder a patient has. For generalized anxiety disorder , both SSRIs and SNRIs are first in line, says Danielle Plummer, Pharm.D. She adds that the most commonly prescribed medications to treat both depression and anxiety are SSRIs and SNRIs.
The Severity Of Side Effects
During a consultation with your doctor, you will be asked whether you experienced any side effects while using antidepressants in the past.
A doctor also strives to select one with the fewest side effects if you take any other medicine with side effects that you cant stand. You may have to try a few before finding the right one.
What Happens If You Dont Respond To One Antidepressant
Its tough for many people to find the proper medication, and some never respond to standard antidepressants. Its estimated that only30 to 35 percent of people will respond well to their first antidepressants.
A range of different antidepressants is available to treat depression. Some medications may work, and others may not. In that case, changing remedies could be beneficial.
Other Medications Used To Treat Anxiety
In addition to antidepressants, several other types of medications are used as treatments for anxiety disorders. Other medications used to treat anxiety include:
Benzodiazepines.Benzodiazepines such as alprazolam , diazepam and lorazepam are often used to treat generalized anxiety disorder and several other anxiety disorders.Benzodiazepines have both advantages and disadvantages as anxiety treatments. While theyre usually effective and begin working quickly, people treated with benzodiazepines can quickly develop a tolerance and, in some cases, become dependent on them.
Buspirone.Buspirone is a non-benzodiazepine medication thats used to treat anxiety disorders, particularly generalized anxiety disorder . Its often used when SSRIs arent effective or produce unpleasant side effects.Buspirone can take several weeks to start working effectively. Unlike benzodiazepines, theres no risk of dependence or withdrawal in people treated for anxiety disorders with buspirone.
Beta-blockers. Beta-blockers, which are commonly used to treat hypertension , are also used to treat the physical symptoms of anxiety.Beta-blockers start working quickly and are effective for controlling shaking, trembling, rapid heartbeat and other physical anxiety symptoms for short periods, such as during an event, performance or other anxiety-producing situation.
Can I Have Depression And Anxiety At The Same Time
Depression and anxiety are two different mental health disorders that are often comorbid. Meaning, they occur at the same time.
Depression is a mental disorder that is commonly identified with intense feelings of hopelessness, despair, worthlessness, and overwhelming sadness. More than 16% of Americans will experience depression at some point during their lifetime, according to theCleveland Clinic. While most people will experience feelings of sadness at some point, with depression, these feelings are prolongedlasting two weeks or moreand severe enough to impact daily life.
Anxiety disorders are characterized by excessive worry, nervousness, or fear that impacts everyday functioning. Without treatment, anxiety can get worse over time. There are a number of anxiety disorders, with their own set of unique symptoms.
About 2% of people in the U.S. have generalized anxiety disorder . According to Richard Shelton, MD, a psychiatrist and the vice chair of research at the University of Alabama at Birmingham, GAD symptoms include persistent fear and worry that is often difficult to control. Other anxiety disorders include:
- Panic disorder
- Post-traumatic stress disorder
Depression and anxiety may share some of the same signs and symptoms, such as avoiding activities that were once previously enjoyed, headaches or changes in appetite, and exhaustion.
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Selecting The Best Antidepressant For Depression And Anxiety
People with either depression or anxiety go to great lengths to relieve their distress, whether using medication or trying different natural remedies.
For depression and anxiety, antidepressants are among the most commonly prescribed medications.
In general, this class of drug is considered to be effective in treating depression and anxiety.
People must seek the best options for medications, especially if they suffer from depression or anxiety.
Using antidepressants for relieving these conditions can empower you to achieve your goals and dreams minus the pain and frustrations.
This is a comprehensive guide to arm you with knowledge about the best antidepressants for treating depression and anxiety.
What Are Ssris And Snris
Selective serotonin reuptake inhibitors like Zoloft and Prozac, and serotonin and norepinephrine reuptake inhibitors like Effexor and Pristiq are antidepressant medications, but they can help with anxiety symptoms as well. For this reason, many providers will prescribe an SSRI or SNRI if you have a combination of depression and anxiety.
SSRIs and SNRIs are not an instant fix for symptoms associated with an anxiety disorder, nor do they even provide immediate relief, Alonzo said. They work by interacting with the neurotransmitters and receptors in your brain, which can help regulate mood, sleep and energy levels. It is important for patients to understand that these medications may take four to six weeks for full effect.
Some patients may respond better to one of these medications than others. If after taking the medication for two weeks and symptoms have not improved, talk to your provider to have your medication regimen adjusted. Treatment trials with more than one medication are not uncommon.
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What Are The Possible Side Effects Of Antidepressants
Some people may experience sexual side effects such as decreased libido or delayed or less powerful orgasm, sleepiness, and weight gain.
Others may experience common side effects such as:
- Dry mouth
It takes about a week for most of the initial side effects to subside.
Contact your doctor if you experience side effects for a long time. You can ask your clinician for assistance in finding the right drug for you from among the many choices.
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