Antidepressants may give the brain a chance to recover from depression, but more is needed.
Antidepressants may give the brain a chance to recover from depression, but more is needed.
It is well-known that common antidepressants have little to no effect for up to 50 percent of people.Ms Silvia Poggini, author of a study on the subject, said:
“There is no doubt that antidepressants work for many people, but for between 30 percent and 50 percent of depressed people, antidepressants don’t work.No one knows why.This work may explain part of the reason.
The research suggests it is at least partly down to people’s environment whether or not antidepressants work.Antidepressants may give the brain a chance to recover from depression, but more is needed.The rest could be down to being exposed to relatively low levels of stress.Ms Poggini explained:
“In a certain way it seems that the SSRIs open the brain to being moved from a fixed state of unhappiness, to a condition where other circumstances can determine whether or not you recover.”
The researchers tested their theory on a group of stressed mice.Some mice were later moved to a more comfortable environment, while others were kept under stress.The results showed that the unstressed mice showed fewer signs of depression after being treated with antidepressants.The stressed mice continued to show the biological signs of bodily inflammation, as well as higher levels of depression.Ms Poggini said:
“This work indicates that simply taking an SSRI is probably not enough. To use an analogy, the SSRIs put you in the boat, but a rough sea can determine whether you will enjoy the trip.For an SSRI to work well, you may need to be in a favorable environment.This may mean that we have to consider how we can adapt our circumstances, and that antidepressant treatment would only be one tool to use against depression.”
The study was published in the journal Brain, Behavior, and Immunity (Alboni et al., 2016).
Find out which antidepressants are best for treating depression and anxiety. A simple guide to options, side effects, and choosing wisely.
This article explores the most effective antidepressants, the types available, and how to choose the right one.
Understanding the efficacy of antidepressants
Antidepressants are commonly prescribed to treat depression and related mental health conditions.
However, their effectiveness can vary depending on the individual.
Studies have shown that some antidepressants are more effective than others in alleviating symptoms of depression.
This article aims to guide you through the options and help you understand what might work best for you.
What are the most effective antidepressants?
Selective Serotonin Reuptake Inhibitors (SSRIs) are among the most widely prescribed due to their effectiveness and relatively mild side effect profile.
Examples include sertraline, fluoxetine, and escitalopram.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) like venlafaxine and duloxetine are also highly effective for many people.
These medications target multiple neurotransmitters, which can be beneficial for certain types of depression.
Tricyclic Antidepressants (TCAs) such as amitriptyline and nortriptyline are effective but often reserved for more severe cases due to their potential side effects.
Monoamine Oxidase Inhibitors (MAOIs) are another option, though they require dietary restrictions and are typically used when other treatments have failed.
Emerging medications and combination therapies are also being researched, offering new hope for individuals who struggle with traditional treatments.
5 most effective antidepressants
One study of the five most effective antidepressants has found that they are (Cipriani et al., 2018):
Amitriptyline (known as Elavil and others)
Agomelatine (known as Melitor, Thymanax and Valdoxan)
Escitalopram (known as Cipralex, Lexapro and others)
Mirtazapine (known as Remeron and others)
Paroxetine (known as Paxil, Pexeva, Seroxat and others)
The four least effective antidepressants (although they still worked) were:
Fluoxetine (known as Prozac, Sarafem, Adofen and others)
Fluvoxamine (known as Faverin, Fevarin, Floxyfral, Dumyrox and Luvox)
Reboxetine (known as Edronax and others)
Trazodone (known as Desyrel, Oleptro, Trazorel and many others)
Factors influencing antidepressant effectiveness
Each of these factors plays a crucial role in determining the success of an antidepressant regimen.
Severity of depression
Individual biology and genetics
Concurrent medical conditions
Adherence to prescribed dosage
Interaction with other medications
Ongoing monitoring and adjustments are often necessary to achieve optimal results.
Types of antidepressants
Understanding the different categories of antidepressants can help you and your healthcare provider make an informed choice.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs work by increasing the availability of serotonin, a neurotransmitter that influences mood.
They are usually the first-line treatment due to their safety and tolerability.
These medications are often prescribed for a variety of conditions beyond depression, including anxiety disorders and obsessive-compulsive disorder (OCD).
Safer alternatives should be considered by doctors, the researchers advise.
Safer alternatives should be considered by doctors, the researchers advise.
Antidepressants that have an anticholinergic effect are linked to an increased risk of dementia, research finds.
Anticholinergic antidepressants include drugs such as Amitriptyline (known as Elavil), Dosulepin and Paroxetine (known as Paxil and Seroxat).
(A longer list of drugs is at the bottom of this article.)
Although often older, many millions of people still take these type of antidepressants.
The longer people take these drugs, the researchers found, the higher their risk of dementia.
More modern antidepressants, like Prozac and Xanax, generally have a lower anticholinergic effect, and were not linked to a higher dementia risk.
Dr George Savva, who led the study, said:
“We studied patients with a new dementia diagnosis and looked at what anticholinergic medication they were prescribed between four and 20 years prior to being diagnosed.
We found that people who had been diagnosed with dementia were up to 30 per cent more likely to have been prescribed specific classes of anticholinergic medications.
And the association with dementia increases with greater exposure to these types of medication.
What we don’t know for sure is whether the medication is the cause.
It could be that these medications are being prescribed for very early symptoms indicating the onset of dementia.
But because our research shows that the link goes back up to 15 or 20 years before someone is eventually diagnosed with dementia, it suggests that reverse causation, or confounding with early dementia symptoms, probably isn’t the case.
The conclusions come from the medical records of 40,770 patients aged over 65 who were diagnosed with dementia.
These were compared to 283,933 without dementia.
The results showed the link between dementia and anticholinergic drugs.
Other common anticholinergic drugs also linked to dementia include those prescribed for bladder conditions and Parkinson’s (e.g. Tolterodine, Oxybutynin, Solifenacin and Procyclidine).
No link, though, was found between antihistamines (used to treat allergies) and dementia, as previous research had.
Dr Noll Campbell, study co-author, said:
“These results suggest we should prioritise safer alternatives to anticholinergic medications long before symptoms of dementia are recognised.”
Professor Chris Fox, study co-author, said:
“Doctors and patients should therefore be vigilant about using anticholinergic medications.
They need to consider the risk of long-term cognitive effects, as well as short-term effects, associated with specific drugs when weighing up risks and benefits.
We don’t know exactly how anticholinergics might cause dementia.
Further research is needed to understand possible reasons for this link.
In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their doctor or pharmacist.”
Here are some common drugs that have a definite anticholinergic effect:
Amitriptylline
Brompheniramine
Chlorpheniramine
Clomipramine
Clozapine
Dimenhydrinate
Diphenhydramine
Hydroxyzine
Paroxetine
Promethazine
These drugs also have an anticholinergic effect, although it is lower than the list above:
Amantadine
Belladona
Cyclobenzaprine
Cyproheptadine
Carbamazepine
Loxapine
Meperidine
Molindone
Oxcarbazine
Pimozide
These drugs may have an anticholinergic effect:
Alprazolam
Atenolol
Captopril
Codeine
Diazepam
Digoxin
Furosemide
Prednisone
Nifedipine
Warfarin
Note that this is not a complete list of drugs and it only contains the drug names not the brand names under which each is sold.
Despite being perceived as safe by the general public, herbal medicines actually carry considerable risks.
Despite being perceived as safe by the general public, herbal medicines actually carry considerable risks.
St John’s Wort — a popular herbal treatment for depression — can have serious side-effects, research finds.
These include dangerous changes in body temperature and blood pressure.
The research compared the side-effects of St John’s Wort with those of fluoxetine — an antidepressant also known as Prozac, Animex-On, Sarafem, Adofen and Deprex.
The side-effects of St John’s Wort were just as serious as for the antidepressant.
These included:
anxiety,
panic attacks,
dizziness,
vomiting,
amnesia and aggression.
St John’s Wort can also interact with other drugs, such as blood thinners, the contraceptive pill and other antidepressants.
Mrs Claire Hoban, the study’s first author, said:
“There is a common belief that because something is natural and can be purchased from a health food shop without a prescription, it’s safe.
However, people need to start thinking of St John’s Wort, and other herbal medicines, as a drug and seek advice from a qualified healthcare practitioner to be sure they use it safely.
It’s concerning to see such severe adverse reactions in our population, when people believe they are doing something proactive for their health with little risk.
During 2000-2013, we found 84 reports of adverse reactions to St John’s Wort and 447 to fluoxetine.
While there were fewer confirmed cases of side effects for St John’s Wort, we know that less people use St John’s Wort and adverse reactions for herbal medicines largely go unreported because they are not considered drugs.
Furthermore, we found that the reported reactions for St John’s Wort were very similar to fluoxetine, which included anxiety, panic attacks, dizziness, vomiting, amnesia and aggression.”
St John’s Wort is available in many countries without a prescription.
Dr Ian Musgrave who co-authored, the study, said:
“It’s important that doctors and pharmacists know about all the drugs their patients take, not just prescription drugs, because herbal medicines like St John’s Wort can have serious reactions with some pharmacy medicines, like antidepressants, the contraceptive pill and some blood thinners.
Based on this research, I’d also like to see bottles of St John’s Wort containing improved warnings of the potential adverse reactions.”
The study was published in the journal Clinical and Experimental Pharmacology and Physiology (Hoban et al., 2015).
Largest ever survey of long-term antidepressant use.
Largest ever survey of long-term antidepressant use.
Over half of people experience withdrawal symptoms when trying to quit antidepressants, research finds.
Antidepressant withdrawal symptoms — which typically last around two to three months — include headaches, nausea and anxiety.
In addition, almost one-third of people report becoming addicted to antidepressants.
Despite these high numbers, only 1% of people could recall the prescribing doctor mentioning withdrawal problems as a possible side-effect.
Particularly high rates of withdrawal symptoms were reported for Paroxetine, which is known commercially as Paxil, Seroxat and others.
Professor John Read, who led the study, said:
“This study was not designed to definitively answer the question of whether or not antidepressants are addictive because there are a range of expert definitions of addiction.
But what it did set out to do was make a significant contribution to the estimated rates of long-term usage in relation to self-reported withdrawal and addiction by directly asking users about their experience.
The results point to a significant number of people prescribed antidepressants who have experienced some withdrawal effects and who believe the drugs are addictive.”
The results come from a survey of 1,829 New Zealanders who were asked about their experience of antidepressants.
The results showed that 54.9% had experienced at least some withdrawal symptoms.
Among these, 25.1% reported severe withdrawal symptoms.
Of the 27.4% of people who reported some level of addiction, 6.2% rated it ‘severe’, 9.4% said it was ‘moderate’ and 11.8% said ‘mild’.
The remainder reported that they had not become addicted.
Some people went back on antidepressants to avoid the withdrawal symptoms.
Rise in antidepressant prescription
Around 10% of people in some countries, such as the US and the UK, are prescribed antidepressants each year.
Professor Read said:
“Given some evidence from research conducted in the UK, it appears that the rise in antidepressant prescriptions can be explained by repeat prescriptions rather than new patients.
So given that people are staying on antidepressants for longer, the issue of whether or not people feel addicted and whether or not those who stop taking them are experiencing withdrawal symptoms becomes important.”
The study was published in the International Journal of Mental Health Nursing (Read et al., 2018).
Two aspects of personality linked to depression are changed by antidepressants.
Two aspects of personality linked to depression are changed by antidepressants.
Antidepressants can change two aspects of personality that are linked to depression, research finds.
Neuroticism — which is characterised by negative thinking in a range of areas — was reduced in people taking a common antidepressant.
At the same time, people’s extroversion was increased, making them feel more outgoing and sociable.
Extroversion is also linked to feeling more positive emotions.
The antidepressant tested in the study is called paroxetine, which is known commercially as Paxil and Seroxat, among other names.
The studies authors write:
“Patients taking paroxetine reported 6.8 times as much change on neuroticism and 3.5 times as much change on extraversion as placebo patients matched for depression improvement.”
For the study, 120 depressed patients took paroxetine and were compared to people given cognitive therapy and a placebo over 12 months.
All three groups saw improvements, even the placebo group.
However, only those taking the antidepressant experienced changes to their personality.
They authors explain:
“Neuroticism and extraversion are 2 of the 5 primary personality dimensions in the Five-Factor Model of Personality.
Neuroticism refers to a tendency to experience negative emotions and emotional instability; extraversion encompasses social extraversion, dominance, and a tendency to experience positive emotions.”
While antidepressants can be effective, still relatively little is known about how they work.
The study’s authors write:
“One possibility is that the biochemical properties of SSRIs directly produce real personality change.
Furthermore, because neuroticism is an important risk factor that captures much of the genetic vulnerability for major depressive disorder, change in neuroticism (and in neurobiological factors underlying neuroticism) might have contributed to depression improvement.”
The study was published in the journal Archives of General Psychiatry (Tang et al., 2009).
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