The nomenclature “antidepressants” can sometimes sound as inadequate in describing the therapeutic profile of this class of medication for some of us in the field of mental health. Although, I quite agree that as a class, antidepressants majorly resolve the neurochemical process of depression compared to other psychic disturbances. I have however enumerated over the reasons why antidepressants remain as the mainstay of most chronic anxiety disorders, obsessive-compulsive disorders, and somatic symptoms disorders? More interestingly, antidepressants are used as adjunctive pain therapy as well as for eating disorders or nicotine smoking addiction. We need to understand this class of medications as friends to many mental disorders aside from depression. This piece is to educate patients and their families more about the good aspects of these mood-regulating drugs as well as the concerns attributed to them.
Types of Antidepressants
The last time I reviewed, I think the antidepressants are further divided into 7 groups based on their mode of action on neurotransmitters that are involved in depression regulation. Tricyclic antidepressants (TCAs) such as Amitriptyline appear to be one of the earliest groups as they are still commonly used in developing and underdeveloped countries due to their low cost and easy availability (still obtained as OTC in most places). The selective serotonin reuptake inhibitors (SSRIs) such as sertraline are however more patronized in developed countries as prescription medication despite the relatively high cost. The TCAs and SSRIs are more popular from my experience with different side effect profiles while the Monoamine oxidase inhibitors (MAOIs) are not commonly used again due to the propensity to cause a hypertensive crisis when used with some food and drinks.
While this discussion will not go into details of the common side effect of the different members of this class, I would like to inform you that other members of this class of medications include the tetracyclic antidepressants (TeCAs), Norepinephrine, and dopamine reuptake inhibitors (NDRIs), Serotonin and norepinephrine reuptake inhibitors (SNRIs), Serotonin antagonist and reuptake inhibitors (SARIs), and the miscellaneous antidepressants to quench our appetite of knowledge of how large the class is. An important piece of information about their mode of action is that they may take up to 2-3 weeks before their therapeutic actions are felt. This should be emphasized to clients who may be discouraged about delayed or perceived inefficacy of the medications. While some of them such as the TCAs can cause dizziness as side effects, the SSRIs are notorious for causing insomnia, restlessness, and agitation. As such, these medications are better supervised by health practitioners.
Who Needs Antidepressants?
The use of antidepressants should be strictly based on prescription only by certified providers such as your such your primary care physician, or psychiatrists. My experience showed that the use of antidepressants especially in developing countries should are poorly monitored since some patients purchase them as over the counter (OTC) medication. A patient of mine gave a funny but rather “vital” testimony of how she prescribed Amitriptyline to a friend and later to her aunt with improvements in their symptoms which were clearly different from hers. I immediately ask her to desist from such an act and also encourage her to inform the “secondhand” patients to not only stop the medication but should see me or any other physician for assessment as soon as possible.
The dangerous side effect of this medication can include heart problems (cardiotoxicity) and hypotension. Sometimes, patients can complain of blurred vision, urinary retention, and constipation. These side effects will be worse or more likely in those without indication for the medication. The big question will now be who needs antidepressants? To me, the list includes moderate and severe depression because those with mild depression has defined by physicians based on standard criteria do not need antidepressants. This is very important because it only amounts to financial waste and increased risk of side effects. Those with anxiety disorders, eating disorders, somatic symptom disorders, and pain conditions such as migraine will also benefit immensely from the therapeutic efficacy of antidepressants. Bupropion, an NDRIs has proved very useful in the treatment of nicotine (cigarette) addiction.
Addressing Patients Concerns and Challenges
Let me state that antidepressants have multiple side effects which are however manageable when you work closely with your physician. Weight gain and erectile dysfunction are very disturbing side effects that have been documented in some cases, but the beauty of antidepressants is that you can shift to other groups if a particular one is giving you issues under the expert care of your doctor. While those in developed countries with good insurance coverage can enjoy the luxury of changing medications across the groups to address their concerns, the reverse is the case in developing nations due to the socioeconomic status of an average patient. I am eagerly looking forward to that time when insurance can cover the medication of patients with mental disorders so that they can benefit maximally from the professional review and adjustment in their medications. While we hope for this period soonest, I want to encourage patients on antidepressants to comply with their medications and also discuss with their doctors to address any concerns or challenges.
Dr. John Akinbote is a Chicago based Psychiatrist and Academic