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Antidepressants

Millions of people across the globe use antidepressants to cope with depression, anxiety, and other mood disorders. Although not a cure, the right antidepressant can be incredibly helpful with treating symptoms.

The primary function of antidepressants is to restore healthy neurochemical function in your brain. Antidepressants have helped millions, however, like many pharmaceuticals, they do not come without the risk of side effects.

Depression

Mental health is just as important as physical health. Mental health tends to be taken less seriously, and people who suffer from mental illness are often stigmatised. As a result, there is less general knowledge about mental health conditions, making them harder to identify, especially since symptoms are not always straightforward. People are more likely to suffer longer from problems they don’t know can be treated.

Depression is a mood disorder that can affect anyone. Most people have experienced feelings of deep sadness or grief, but this is not the same as having depression. Depression is a persistent feeling of emptiness or sadness that can be debilitating. It is not something you can think yourself out of with a positive outlook—it’s a real illness that needs proper treatment.

Clinical depression can be categorised as mild, moderate, or severe. The root causes are not fully understood, however, it is clear that depression is connected to chemical imbalances in the brain, and can be triggered by major changes, losses, or traumas.

Symptoms of depression include sadness, numbness, emptiness, tiredness, feelings of worthlessness, quick irritation, anxiety, and a lack of interest in daily activities such as sleep, food, work, and physical and sexual activity. In severe cases, people develop suicidal thoughts and might even attempt to take their own lives.


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Types of antidepressants

Although antidepressants are commonly used to treat depression, they are also used to treat other disorders such as obsessive-compulsive disorder (OCD), generalised anxiety disorder, post-traumatic stress disorder (PTSD), and chronic pain. Simply put, they balance the levels of neurotransmitters—chemicals that are essential for normal brain function. Although generally successful in achieving the desired effect, the exact mechanisms of how antidepressants work is still under study, even after many decades.

Antidepressants are classified into five main types:

  • Serotonin and noradrenaline reuptake inhibitors (SNRIs)—used to treat depression, anxiety disorders, ADHD (attention deficit hyperactivity disorder), and OCD by raising serotonin levels.
  • Selective serotonin reuptake inhibitors (SSRIs)—mostly used to treat depression by blocking serotonin reabsorption in the brain.
  • Tricyclic antidepressants (TCAs)—used to ease depression, some anxiety disorders, and fibromyalgia.
  • Monoamine oxidase inhibitors (MAOIs)—used to treat general depression and mood disorders by helping the brain break down serotonin.
  • Noradrenaline and specific serotonergic antidepressants (NASSAs)—used to treat mood and personality disorders, and depression by antagonising serotonin receptors.


Antidepressants are used to treat symptoms but do not address the primary causes of depression. For more well-rounded treatment, antidepressants are often used in combination with therapy.

Side effects

Antidepressants are commonly accompanied by some side effects while the body adjusts to the chemical changes. These symptoms generally pass within a few weeks. The severity of side effects can vary from person to person, and from medication to medication. The most common side effects are:

Sexual dysfunction. Most antidepressants work by calming you down, however, the same mechanism is also responsible for your response to sexual triggers. Antidepressant usage is directly linked to sexual dysfunction in both men and women, but women tend to experience it more. It is characterised by the inability to reach orgasm, vaginal dryness, and erectile dysfunction.


Sexual dysfunction is described as the inability to perform, to be aroused sexually, or to reach orgasm. In women, this also leads to a lack of natural lubrication, discomfort, and pain during vaginal intercourse.

Women should take precautions if trying to conceive while using antidepressants because some types can lead to birth defects.

Weight changes. Many patients experience weight gain while taking antidepressants because these medications can deplete sodium from the blood. Low levels of sodium in the body increase the urge to eat salty food and food that is high in calories. On the other hand, potential side effects also include nausea and vomiting. Feeling nauseated can result in lower calorie intake and weight loss. Both conditions should be addressed because a lack of sodium can develop into hyponatremia (a condition when sodium concentration in the blood is dangerously low), while weight loss can cause malnourishment and contribute to eating and digestive tract disorders.

Insomnia and fatigue. When beginning treatment with antidepressants, the neurotransmitters in the brain need time to adjust to the chemical changes. This can sometimes cause insomnia, resulting in sleep deprivation, which dramatically lowers performance in areas such as attention, memory, mood regulation, and reaction speed. If insomnia persists, try an alternative antidepressant treatment.

Dizziness and sedation. Because of changes in the chemical reactions in the brain, a person taking antidepressants may also feel dizzy and sedated. Antidepressants can lower blood pressure, causing dizziness.

Suicidal thoughts. In cases where a person suffering from depression has established suicidal ideation, the increase in energy and motivation antidepressants provide can make it easier for them to follow through with suicide if their other emotional needs remain unmet. This is one among many reasons why it is necessary to evaluate a person’s mental state and emotional habits before putting them on medication.

Other common side effects of taking antidepressants include sweating, dry mouth, tremors, headaches, anxiety, heart palpitation, rash, constipation, blurred vision, and diabetes. If you are starting a trial of antidepressants, be sure to track your behaviour and symptoms from day one, and keep your healthcare professional informed of any developments. This is difficult to do when you are the person suffering. Some helpful apps have been developed that remind you to record your mood at set intervals. While this may seem to have little meaning in the moment, tracking changes over time can reveal patterns you wouldn’t notice otherwise. A friend or family member might step up to help with this in the first few weeks—it is hard to know how to help someone who feels helpless, but doing a specific task is often welcome for those who care.


Limiting the side effects of antidepressants

Although severe side effects are rare, the first medication your doctor prescribes may not be the best fit. If you are starting a trial of antidepressants, keep in mind that it might take a few attempts before you find a medication you’re happy with. Some people don’t benefit from antidepressants at all.

If you don’t feel relief from the side effects within the first few weeks, there are a number of steps you can take to ease them.


Any changes in prescription should be discussed with your healthcare professional.

Switching medication. Antidepressants do not provide a ‘one size fits all’ solution. Each person will react differently to different antidepressants. It is important to give a prescribed medication enough time to take effect—usually about 2 weeks—before deciding to make any changes. Mild side effects are common in the first few weeks of use, but these should wear off.

Changing the dosage. If side effects are getting in the way of your day-to-day activities or if you feel that the antidepressants you have been prescribed aren’t making a difference to your general mental health, discuss changing the dosage with your doctor. Lowering the dose might relieve the side effects, while increasing the dose could help with their intended purpose.


Withdrawal symptoms are common if you lower the dosage, switch to a different antidepressant, and even if you miss a dose. The most common symptoms are increased depression, anxiety, nausea, a flu-like feeling, irritability, headaches, and tiredness. Your healthcare professional can guide you through any changes safely.

Timing the intake. Sometimes taking a medication at a given time each day can help manage its side effects. For example, if an antidepressant makes you drowsy, consider taking it right before you go to sleep. If it causes nausea, taking it with food can help (as long as the foods you’re eating don’t cause any adverse effects in combination with your medication).

Avoiding certain substances. Be mindful of substances that could potentially worsen any symptoms you might be experiencing (e.g. alcohol and tobacco can contribute to feelings of dizziness or nausea).

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Other ways to treat depression

Today antidepressants play a major role in managing depression, but they are not the only option. Some people are incompatible with antidepressants or would rather try other treatments.

Mental and physical health are more intertwined than many people realize. What we are used to thinking about in a physical context (diet, for example) often impacts one’s mental health as well, and vice versa. This is not to say that depression is caused by a poor diet, rather than making sure your body is otherwise in good health gives you a better chance of tackling an illness. Certain foods have been linked to a decrease in serotonin levels, contributing to feelings of sadness, while others have been shown to elevate mood. Exercise can also increase serotonin levels. Both nutrition and physical activity should be taken into account when deciding on a treatment.

Talking with a professional therapist can be helpful when coping with depressive periods. Whether dealing with negative thought patterns or the long-term effects of trauma, understanding how to make your brain a kinder place to live in can make a world of difference. Therapy is not a cure for depression, but it can contribute to the healing process, especially when combined with other measures (antidepressants, diet, exercise, reducing stressors, etc.). If you don’t know where to begin to look for a therapist or what type of treatment would be best suited to your situation, you can consult a healthcare professional to ask for advice. Like antidepressants, finding a therapist who is a good fit can also be a matter of trial and error. Cognitive-behavioural therapy (CBT) has been shown to be effective in treating acute depression; it aims to evaluate, challenge, and modify dysfunctional beliefs.

Even if we have the experience to recognize that other states of mind are possible, the state of mind one is in at any given moment feels eternal. In a depressed state, it can feel impossible to reach out or even to get out of bed. That being said, low-stress, low-consequence actions can help inch a depressed person toward the possibility of relief from mental and emotional pain. Experiences that take you out of yourself are the most beneficial if treated as a practice—volunteering to help people who have needs you can meet in some way, keeping a gratitude journal, or taking the time to meditate have been known to help some.

Asking for help when you need it is not a sign of weakness. There is no person on earth that hasn’t needed help at some point. Happy people have more to give, so striving to heal yourself benefits you as well as the community you are a part of.

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