The 5 Major Classes Of Antidepressants
An antidepressant, as the name implies, is a type of drug primarily used for the treatment of depression. Depression is a common disorder that affects the chemistry and function of your brain. Antidepressants can help correct the dysfunction by altering the circuits and chemicals that pass signals along nerve routes to the brain.
Antidepressants are grouped into classes based on how they affect the chemistry of the brain. While the antidepressants in a class will tend to have similar side effects and mechanisms of action, there are differences in their molecular structures which can influence how well the drug is absorbed, disseminated, or tolerated in different people.
There are five major classes of antidepressant and several others that are less commonly used. Each has its own benefits, risks, and appropriate uses. While some may be considered preferred options, the drug selection can vary based on your symptoms, history of treatment, and co-existing psychological disorders.
Prevalence Of Mental Health Conditions In Those With Chronic Pain
Chronic pain, one of the most common reasons adults seek medical care, has been linked to activity limitations, dependence on opioids, anxiety and depression, and reduced quality of life.
Research shows that those with chronic pain are four times more likely to have depression or anxiety than those who are pain-free.
In 2016, approximately 20 percent of U.S. adults had chronic pain , and eight percent of U.S. adults had high-impact chronic pain.
High-impact chronic pain is pain that has lasted three months or longer and is accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school, or do household chores. These people report more severe pain, more mental health problems and cognitive impairments, more difficulty taking care of themselves, and higher health care use than those who have chronic pain without these activity restrictions.
How Is Depression Diagnosed
If your mood has been low for a while and you are having difficulty coping with day to day activities, talk to your doctor or a trusted professional. Your doctor will ask you questions about your symptoms and your medical history and may ask you to complete a questionnaire that may help to diagnose depression or refer you to a psychiatrist.
You can also call the National Suicide Prevention Hotline at 1-800-273-8255, 24 hours a day, 7 days a week, or have an online chat . All information is confidential and free.
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Gabapentin And Alcohol Use Disorder
Gabapentin may be helpful in treating alcohol use disorder and withdrawal. Between 2004 and 2010, The Veterans Affairs Department conducted a double-blind, placebo-controlled, randomized dose-ranging trial of 150 men and women over 18, struggling with alcohol dependence.3 The results of the study showed that gabapentin was effective in safely treating alcohol dependence and relapse-related symptoms including insomnia, dysphoria, and cravings.
Guidelines For Taking Antidepressants
The more you know about your antidepressant, the better equipped youll be to deal with side effects, avoid dangerous drug interactions, and minimize other safety concerns.
Follow instructions. Be sure to take your antidepressant according to the doctors instructions. Dont skip or alter your dose, and dont stop taking your pills as soon as you begin to feel better. Stopping treatment prematurely is associated with high relapse rates and can cause serious withdrawal symptoms.
Beware of drug interactions. Drinking alcohol can lessen the effects of some antidepressant medications. Dangerous drug interactions can also occur when SSRIs or SNRIs are taken with blood thinners, prescription painkillers, or antihistamines found in many over-the-counter cold and allergy medicines and sleep aids. Always talk to your doctor or pharmacist before combining medications.
Monitor side effects. Keep track of any physical and emotional changes youre experiencing and talk to your doctor about them. Contact your doctor or therapist immediately if your depression worsens or you experience an increase in suicidal thoughts. See your doctor on a regular basis.
Be patient. Finding the right drug and dosage is a trial and error process. It takes approximately four to six weeks for antidepressant medications to reach their full therapeutic effect. Many people try several medications before finding one that helps.
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Antidepressants For Chronic Pain Without Co
While antidepressants are primarily prescribed to elevate the mood of clinically depressed patients by affecting neurotransmitters in the brain, antidepressants may also be prescribed as a primary treatment for chronic pain, anxiety disorders, or sleep disorders.
When they are used for chronic pain their purpose is most often as adjuvant analgesics. This means that they are prescribed along with other pain medications rather than used alone as a pain treatment.
The precise mechanism by which antidepressants work to manage pain is largely unknown, though it appears that the way in which they help chronic pain may be unrelated to the mechanisms by which they alleviate depression.
It is generally thought that antidepressants have an effect on the neurotransmitters serotonin and norepinephrine, especially along descending spinal pain pathways. Antidepressants may also work through histamine receptors or sodium channels.
How Long Will You Have To Take Antidepressants
Usually, these drugs must be taken regularly for at least 4 to 8 weeks before their full benefit takes effect. You are monitored closely during this time to detect the development of side effects and to determine the effectiveness of treatment.
In order to prevent a relapse of depression, medicines are generally prescribed for 6 to 12 months after a first-time depression. When you and your provider determine that you are better, you should expect to continue the medication for at least 4 to 6 additional months. After this, your provider may gradually taper you off your medicine.
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Combined Reuptake Inhibitors And Receptor Blockers
Combined reuptake Inhibitors and receptor blockers may be used for depression, sleep conditions, or chronic pain off-label and include:
Common side effects include drowsiness, dry mouth, nausea, and dizziness, and these drugs should not be used by people with a history of liver problems.
Using Cymbalta To Treat Pain
As with depression, no one is quite sure exactly why antidepressants help the body feel relief from pain. But scientists believe that the same neurochemicals regulate both pain and mood.
Along with other Serotoninnorepinephrine reuptake inhibitors , Cymbalta, targets levels of serotonin and norepinephrine two chemicals that are believed to help nerve cells communicate with one another. Scientists believe low levels of these chemicals may cause depression and they also believe the two chemicals called neurotransmitters may also affect how a person feels pain.
Theres some degree of an emotional component to pain. For example, if you’re feeling really good, you might not notice your finger’s cut. If you’re feeling more morose, it’s probably going to be bit more of a stronger sensation. Todd Christiansen, Washington, D.C. based child and adolescent psychiatrist
Christiansen said it doesnt appear that SNRIs affect nerve receptors at the source of the pain, but appear to be affecting the way the brain processes the sensation. This may be in part because of the way Cymbalta interacts with pain messages traveling to and from the brain along the bodys pain pathways.
Pain pathways are categorized as either ascending pathways, those running from the point of pain to the brain, and descending pathways, those running from the brain into the dorsal horn of the spinal cord. The dorsal horn receives certain sensory information from the body.
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How Antidepressants Work In Pain Management
The explicit way in which antidepressants are effective in pain management remains unknown, but multiple mechanisms are likely to be involved. Perhaps the most popular theory is that antidepressants exert their effects on serotonin and norepinephrine, particularly along the descending spinal pain pathways. Antidepressants may also exert adjunctive therapeutic influences through histamine receptors as well as modulation of sodium channels.
Serotonin And Norepinephrine Reuptake Inhibitors
This class of antidepressants increases serotonin and norepinephrine by stopping their reuptake into brain cells. Increased levels of these chemicals help maintain mental balance and reduce the amount of pain you feel. Duloxetine and milnacipran are SNRIs that doctors commonly prescribe for chronic pain, particularly when it’s associated with .
Another example of an SNRI is venlafaxine , though it is less often prescribed for back pain.
Side effects of SNRIs include dizziness, insomnia, and drowsiness. To combat the sleep problems associated with SNRIs, your doctor may also prescribe a tricyclic antidepressant to curb any sleep disruptions. If you experience serious side effects, including extreme nausea or blurred vision, seek medical help immediately.
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How Is Depression Treated
Depression is treatable with high rates of success. Treatments may include:
- Antidepressants, such as Selective Serotonin Reuptake Inhibitors , Serotonin Norepinephrine Reuptake Inhibitors , tricyclic antidepressants , monoamine oxidase inhibitors .
Responses to antidepressants vary, and most antidepressants take 4 to 6 weeks for full effect. About 50% of patients respond to the first treatment, whereas others may have to try a few different types of antidepressants before they find the best one for them.
There are several things you can do to help with your symptoms as well, such as:
- Setting realistic and daily goals
- Developing strategies to work through crises situations
- Developing coping and problem-solving skills
- Learning how to develop positive relationships
- Replacing negative thoughts with positive ones.
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.
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Side Effects Of Antidepressant Medications
All medications can have side-effects. Some people experience no side-effects. Others may find the side-effects distressing. In most cases, side-effects lessen as treatment continues.
Treatment is usually started at a low dose, to minimize side-effects, and then slowly increased until the ideal dose is found. The ideal dose is one that provides the greatest benefit with minimum side-effects.
If you are experiencing side effects, check the information given to you by your doctor or pharmacist on the specific effects of any drug you have been prescribed. If side-effects are not mild and tolerable, it is best to continue taking your medication as prescribed but let your doctor know as soon as possible. Your doctor may:
- encourage you to wait a little longer for the side-effects to fade
- adjust your dose
- suggest you take the medication at a different time of day
- prescribe other medications to help control side-effects
- change your medication
- stop medication treatment and suggest a different type of treatment approach.
Side-effects vary depending on the type of medication. More information on side-effects is included for each type of types of antidepressant.
You can help to control possible side-effects on your own by:
Do antidepressants increase the risk of suicide?
Before starting treatment, prepare for the possibility of feeling worse before you feel better. Know what supports are available to you and who you can call.
Repetitive Transcranial Magnetic Stimulation
rTMS is a newer type of brain stimulation that may be an alternative to and more accessible than ECT.
In rTMS, a technician places an electromagnet on the scalp that generates magnetic field pulses roughly to the strength of an MRI scan. These pulses pass readily through the skull and may stimulate the cerebral cortex.
Potential benefits of rTMS that have been observed include:
- no systemic side effects such as: weight gain, sexual dysfunction, sedation, nausea, or dry mouth
- no adverse effects on concentration or memory
- reduced risk of device-drug interactions
Seizures are also much less likely to occur as a side effect compared to other brain therapies.
The most common adverse event related to treatment was mild to moderate scalp pain or discomfort during treatments, which lessened after the first week of treatment.
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Should You Treat Your Depression With Medications
You might be asking your healthcare provider this question if you have been feeling low and your friends and family have mentioned this to you. Your provider might have mentioned medication if your mood interferes with work, family or socializing for more than two weeks. Some people with depression might even have legal troubles linked to outbursts.
Drugs Approved For Chronic Pain Vs Off
When talking about the use of antidepressants for chronic pain it’s important to distinguish drugs that are approved for this use versus those that are used off-label. When a drug is FDA approved for a particular use it means that the FDA has reviewed the studies and has found that the drug may be effective and relatively safe for that use.
Off-label use, however, refers to drugs that are FDA approved for one condition but may be used for another reason .
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Why Antidepressants Act Against Pain
Studies have clearly shown that antidepressants act as anti-inflammatory agents in both depression and chronic pain states.12,13 Antidepressant therapy improves the clinical symptoms of depression and chronic pain and appears to positively impact immune/cytokine deregulations. Research data indicate that antidepressants can reduce levels of inflammatory cytokines, such as tumor necrosis factor- and interleukin-6.14-16 Other non-pharmacological interventions, such as cognitive-behavioral therapy, yoga, and exercise, interestingly also show the same positive and salutary effects on the immune and cytokine system.17
In addition to anti-inflammatory properties, data clearly show that antidepressants have antinociceptive properties.18 Multiple studies reveal that even in the absence of depression, these antidepressants have efficacy in multiple chronic pain conditions irrespective of comorbid chronic clinical depression.19
Table 1 reviews various types of antidepressants used for pain management.20-25
How Long Does Treatment Last
According the United Kingdoms Royal College of Psychiatry, 5 to 6 people out of every 10 will experience a significant improvement after 3 months.
People who use medication should continue for at least 6 months after starting to feel better. Those who stop before 8 months of use may see a return of symptoms.
Those who have had one or more recurrences should continue the treatment for at least 24 months.
Those who regularly experience recurrences depression may need to use the medication for several years.
However, a literature review published in 2011 found that long-term use of antidepressants
In the United States, 8 percent of women are reported to use antidepressant drugs during pregnancy.
The use of SSRIs during pregnancy has been linked with a higher risk of pregnancy loss, preterm birth, low birth weight, and congenital birth defects.
Possible problems during delivery include excessive bleeding in the mother.
After birth, the newborn may experience lung problems known as persistent pulmonary hypertension.
A study of 69,448 pregnancies found that using SNRIs or TCAs during pregnancy may increase the risk of pregnancy-induced hypertension or high blood pressure, known as pre-eclampsia. However, it remains unclear whether this is due to the drugs or the depression.
A lab study found that rodents that were exposed to citalopraman SSRI antidepressantjust before and after birth showed considerable brain abnormalities and behaviors.
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Escitalopram May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- changes in sex drive or ability
- problems with thinking, concentration, or memory
Escitalopram may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
Listen To Upbeat Music
There’s no doubt that music can have an impact on how you feel, so choosing the right music when you’re feeling down might be an effective way of lifting your mood.
Research has found people who are depressed may have a tendency to choose music that intensifies rumination, sadness, and emotion-focused coping. So while you might be tempted to turn to somber tearjerkers when you’re feeling down, consider listening to more upbeat songs to boost your mood and inspire positive feelings.
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Can Antidepressants Help People With Rheumatoid Arthritis
Depression is common in many people with rheumatoid arthritis. Learn how antidepressants can treat depression and ease RA symptoms such as pain and sleep problems.
Depression is very common in people with rheumatoid arthritis . Up to 41 percent of people with RA will experience at least some symptoms of depression, compared to about 7 percent of Americans overall. Managing arthritis symptoms and the stress of living with a chronic, painful disease makes people with RA more likely to feel down. Depression can lead to more severe arthritis pain, which can negatively affect quality of life. Antidepressants can help to combat this cycle by relieving both depression and pain. Also, researchers are exploring whether some antidepressants might even work on the overactive immune system to reduce inflammation.
Antidepressants for depression Selective serotonin reuptake inhibitors like citalopram , escitalopram , fluoxetine , paroxetine , and sertraline are the most commonly prescribed antidepressants. They work by altering levels of brain chemicals like serotonin and dopamine, and by changing the way nerve cells communicate. These drugs are very effective against depression, and they can also help with anxiety. But its important to discuss your symptoms with your rheumatologist so you can get a referral for depression screening. A psychiatrist or other mental health professional can help determine whether your mood warrants antidepressants or another treatment.