PFOTO: KAL VISUALS
Text: Alejandra Misiolek
The antidepressants have an unfortunate name because it indicates that they are medication for depression and their use is much broader.
On the other hand, it is important to understand their action mechanism to take them properly and minimize possible side effects.
Let’s have a look at the 5 things that we think you should know before taking them.
Don’t be surprised that your doctor prescribed an antidepressant if you don’t have depression. Antidepressants are prescribed not only for depression, but also for anxiety, obsessive compulsive disorder, phobias, bulimia, chronic pain, ADHD, and addictions, among others. Therefore, they are antidepressants and tranquilizers at the same time.
Also, they are not a homogeneous group because there are different groups of antidepressants and each group has a different action mechanism. The most frequently prescribed antidepressants, also called new generation antidepressants, are Selective Serotonin Reuptake Inhibitors (SSRIs) such as Fluoxetine, Citalopram or Escitalopram; Selective Serotonin and Noradrenaline Reuptake Inhibitors (SNRI) such as Duloxetine, Desvenlafaxine or Venlafaxine, or Selective Dopamine and Noradrenaline Reuptake Inhibitors (IRDN) like Bupropion. This group of antidepressants inhibits the reuptake of the neurotransmitter (serotonin, norepinephrine or dopamine) secreted by the neuronal terminal to pass to the next neuron. What does this mean? That this medication interferes with our body’s natural way of maintaining balance (which is to remove excess of neurotransmitter before it passes to the next neuron) and inhibits the neurotransmitter from being degraded, causing that there is more of it and it does more effect.
The antidepressants do not cure but rather treat symptoms. By causing that there is more serotonin, which is the neurotransmitter that regulates mood, social behavior, appetite, digestion, sleep, memory, desire and sexual function, the antidepressant causes changes in these functions while its effects last. Once the medication is withdrawn, the neurotransmitter returns to its previous levels. However, the relationship between the neurotransmitter and mood is bidirectional; the neurotransmitter modulates how we feel, but our environment and our reactions also modulate the amount of the neurotransmitter.
The antidepressants are not addictive. They can be taken for years and when withdrawn, there are no “craving” effects or withdrawal symptoms. However, they are usually withdrawn by decreasing the dose little by little over a few days or weeks, just as they are started gradually, to reduce the side effects produced by changes in the receptors that appear and disappear according to the levels of the neurotransmitter. To understand it, it is worth understanding its mechanism of action: antidepressants begin to produce the desired effect not because there is more serotonin or norepinephrine, but because of the fact that there is more serotonin and norepinephrine, more receptors are produced to receive it. The high level of serotonin would not do us any good if there was nowhere to receive it. These receptors are produced or eliminated by our neurons in response to the levels of the neurotransmitter that they receive. And these receptors take about 2-4 weeks to be produced. For this reason, the effects of antidepressants do not start earlier. However, its side effects such as dizziness, headache, insomnia, which occur because serotonin receptors are also found in other parts of the body, such as the digestive tract, and not only in the brain, decrease in a matter of weeks because these receptors become saturated.
You shouldn´t stop taking the antidepressants before 6-12 months since you started taking them. Studies show that clinically depressed patients who stopped medication before this time more frequently relapsed. It is a recommendation, not an absolute indication, however, since it takes 2-4 weeks for the antidepressant to start working and another 2-4 weeks to stop, it makes a lot of sense to take it for at least 6 months.