What are antidepressants?
Antidepressants are vital medication alongside psychotherapy in treatment for depression. They enhance brain cell signalling helping to restore the neurocognitive functions. The goal of therapy with antidepressants is primarily to eliminate depressive symptoms such as severe sadness, fatigue, sleeplessness and preventing relapses, restoring social interaction and normal daily routine.
What types of antidepressants are used in therapy for depression?
In the meantime, there are several groups of antidepressants or predecessors of such groups with unique profiles such as Agomelatine and Bupropion. However, the most frequently used and until now the most effective antidepressants belong to the below listed groups:
Most commonly used antidepressants:
- Selective Serotonin Reuptake Inhibitors (SSRI) like Citalopram, Fluoxetine, and Sertraline.
- Selective Serotonin-Norepinephrine Reuptake Inhibitors (SSNRI) like Venlafaxine and Duloxetine
- Tricyclic Antidepressants (TCA) like Amitriptyline and Clomipramine.
Tricyclic Antidepressants are the oldest and belong to the first generation of antidepressants. SSRI and SSNRI are second-generation antidepressants and are more commonly prescribed.
Less frequently prescribed antidepressants:
- Alpha-2 Receptor Antagonists such as Mirtazapine and Mianserin
- Selective Noradrenaline Reuptake Inhibitors like Reboxetine and Viloxazine
- Selective Noradrenaline/Dopamine Reuptake Inhibitors NDRI: Bupropion
- Melatonin Receptor Agonists and Serotonin-5-HT2C Receptor Antagonists like Agomelatine
Which antidepressant to use?
Antidepressants are the main medication for therapy of depression. Depending on several criteria psychiatrist makes the decision to use antidepressants and chooses a particular antidepressant’s class. The choice of an antidepressant depends on several factors such as type of symptoms, patient’s life situation, pre-existing conditions, and other medication the patient is taking.
Avoiding side effects
In general, the antidepressants shouldn’t cause any side effects. In case of side effects, the patient should consult his psychiatrist who can eliminate them by dosage reduction or prescribing alternative medication. For instance, if a particular antidepressant adds to weight gain, it’s not suitable to use it. The choice of an antidepressant is based also on past good or bad experiences with a specific medication.
How does the therapy for depression with antidepressants work?
Typically, treatment starts with a low dose, gradually and swiftly increasing. Treatment lasts several months, up to few years. In order to prevent relapse treatment with antidepressants should continue. The dosage reduction of antidepressants should take place first after stabilizing the patient’s status and suppressing all his symptoms. The reduction and later the discontinuation must kappen gradually.
The dosage of antidepressants shouldn’t be changed or stopped without consulting a psychiatrist. Abrupt cessation could trigger very unpleasant symptoms and aggravate the depression. It increases also the risk of recurrence of depression.
How long it takes to notice an effect of therapy with antidepressants?
Antidepressants do not provide instant relief with the first dose. Initial improvement may become evident after 2 weeks, with the full effect usually manifesting after approximately 3 to 4 weeks. The therapy with antidepressants should be strictly monitored by a psychiatrist evaluating in regular intervals patient’s progress. However, the full recovery often takes longer than the patient’s expectation.
Advantages of antidepressants
The effect of treatment with antidepressants appears faster than psychotherapy. Therefore, antidepressants are the first choice for treatment of moderate and severe depression.
The pharmacological treatment enables outpatient care and quick reintegration into work and society. The antidepressants are the “door opener” to psychotherapy and other therapeutic options.
Disadvantages of antidepressants
Especially at the beginning of therapy with antidepressants side effects may occur. The most common side effects might be fatigue, nausea, dry mouth, sometimes weight gain or loss of libido.
The aim of the treatment is removing the symptoms while avoiding the side effects. Antidepressants don’t work for everyone; finding effective medication teks time and requires close cooperation with an experienced psychiatrist.
Antidepressants don’t address external factors causing depression like work stress, relationship issues, or crises but they make patients more stress resistant helping them to cope with the difficulties. The relatively quick symptoms reduction wins time to apply psychotherapy and the necessary life changes.
The most efficient therapy for depression is the combination of antidepressants and psychotherapy. The effects of psychotherapy appear gradually speeding up the recovery process.
Psychotherapy helps to reduce and finally stop the medication resulting in fewer relapses compared with purely medication-based treatment.
Therapy for depression based on symptoms severity
Mild depression: first line therapy are low-intensity strategies such as psychotherapy, sport exercises and meditation.
Moderate and severe depression requires a combination of antidepressants and psychotherapy. Those patients also benefit from integrative treatment methods such as meditation, art and music therapy or acupuncture.
During the treatment with antidepressants a regular psychiatric monitoring is vital to assess effects and prevent complications.
Supportive communication in therapy for depression
The adverse effects of antidepressants usually occur during the initial weeks. The patient and his relatives must be informed about possible side effects. Regular communication with the psychiatrist is essential.
Changing the dosage or self-discontinuation of antidepressants can lead to major complications. Discussing patient’s concerns with the psychiatrist provides insights improving the treatment outcome. For example, one of such concerns is the unjustified fear of dependence, despite the fact that antidepressants are not addictive.
Therapeutic alliance in therapy for depression
Therapy with antidepressants for depression requires trusting doctor-patient relationship. Such therapeutic alliance influences treatment efficacy and is crucial for success. Personal factors, symptom severity, and past experiences shape treatment decisions.
Patient’s and his families’ input matters empowering collaborative approach and informed decisions in the treatment journey. This includes evaluation of treatment options, communicating worries and problems to the psychiatrist and psychologist.
In order to prevent relapse and to maintain well-being the antidepressants should be taken for at least four to nine months, often longer.