What Are Antidepressants?

Antidepressants are medical drugs specifically approved to manage depression, although they're also used for various other conditions such as :

• Anxiety DisordersAnxiety disorders
• Specific phobias
• Eating Disorders like bulimia
• Chronic pain management in certain physical ailments.

Who Can Prescribe Them?

The healthcare specialists with the authority to prescribe antidepressants include :

• General Practitioners (GP)
• Psychiatrists
• Specialist Nurse Prescribers
• Specialist Pharmacists.

While most antidepressants can be prescribed by a GP, some require the oversight of a mental health professional like a psychiatrist.

How Do Antidepressants Function?

While antidepressants are effective in alleviating the symptoms of depression and other mental health conditions, they don’t necessarily tackle the root causes.

Often, healthcare providers may recommend a combination of medication and talking therapies. Different kinds of antidepressants may suit different individuals based on their specific symptoms.

The Science

These drugs primarily function by enhancing or prolonging the activity of certain neurotransmitters like noradrenaline and serotonin, which are known to regulate mood. However, it’s important to note that there’s no concrete scientific evidence supporting that depression is solely due to a chemical imbalance that antidepressants correct.

Types of Antidepressants

There are various categories of antidepressants, including :

• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
• Tricyclics
• Monoamine Oxidase Inhibitors (MAOIs)
• Others not fitting into the above categories.

SSRIs

SSRIs primarily function by prolonging the action of serotonin in the brain. They are the most commonly prescribed type of antidepressant in the UK and generally have more manageable side effects compared to other types.

Some common SSRIs include :

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)

SNRIs

Similar to SSRIs, SNRIs also influence noradrenaline in addition to serotonin. These are often chosen for more severe cases of depression and anxiety, offering relatively manageable side effects.

Some common SNRIs include :

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Desvenlafaxine (Pristiq)
• Levomilnacipran (Fetzima)

Tricyclics

These antidepressants affect both serotonin and noradrenaline and have a more complex chemical structure, which might lead to a wider range of side effects.

Some common Tricyclics include :

• Amitriptyline (Elavil)
• Nortriptyline (Pamelor)
• Imipramine (Tofranil)
• Clomipramine (Anafranil)
• Doxepin (Sinequan)
• Desipramine (Norpramin)
• Trimipramine (Surmontil)

MAOIs

Monoamine Oxidase Inhibitors (MAOIs) prolong the activity of noradrenaline and serotonin by inhibiting their breakdown. However, they can have hazardous interactions with certain medications and foods, necessitating specialized prescription and dietary caution.

Some common MAOIs include :

• Phenelzine (Nardil)
• Isocarboxazid (Marplan)
• Tranylcypromine (Parnate)

Other Antidepressants

There are additional types of antidepressants that don't fit neatly into any of the above classifications. For more details on these, refer to our comprehensive comparison page on antidepressants.

Some include :

• Bupropion (Wellbutrin) - Primarily affects dopamine and norepinephrine.
• Mirtazapine (Remeron) - Affects serotonin and norepinephrine, and also has an antihistaminic effect.
• Trazodone (Desyrel) - Primarily used for insomnia but also has antidepressant properties. Affects serotonin and works as a serotonin antagonist and reuptake inhibitor.
• Vilazodone (Viibryd) - A serotonin modulator and stimulator; it works as both a serotonin reuptake inhibitor and partial serotonin receptor agonist.
• Vortioxetine (Trintellix, formerly known as Brintellix) - Affects multiple neurotransmitter receptors in the brain, considered a serotonin modulator and stimulator.
• Esketamine (Spravato) - A nasal spray that is a form of the anesthetic ketamine; used for treatment-resistant depression.

How Can Antidepressants Help?

Addressing Depression

If you're grappling with depression, you might :

• Consistently feel down or despondent
• Lose interest in activities you previously enjoyed
• Struggle to communicate your emotional state
• Find day-to-day tasks overwhelming
• Engage in self-harm or have suicidal thoughts, particularly in severe cases

Antidepressants can offer a mood boost, making previously daunting tasks and social interactions more manageable. They can also be used alongside other mental health support options. For more details, you can visit our page discussing various treatments for depression.

NICE Guidelines

The National Institute for Health and Care Excellence (NICE) offers healthcare guidelines, including best practices for prescribing antidepressants depending on the severity of your depression :

• For severe depression, antidepressants are often the first line of treatment and may be recommended alongside other therapies.
• With mild to moderate depression, you're more likely to be offered alternative treatments like talking therapies, such as Cognitive Behavioural Therapy (CBT), before medication. The potential side effects often outweigh the benefits for less severe cases.
• Antidepressants may also be effective for anxiety disorders and phobias, helping to create a sense of calm and openness to additional treatments like CBT.

Your healthcare provider should discuss various treatment options with you to determine what’s most suitable.

When Do Antidepressants Start Taking Effect?

Individual experiences vary, but most antidepressants require one to two weeks to kick in. Some people may notice improvements sooner, like better sleep quality.

Consult your healthcare provider if you don’t experience any benefits after 2-4 weeks of consistent use, or if your symptoms worsen. It might indicate that a different type of antidepressant could be more effective for you.