There is no known single source that results in an individual developing depression. It is commonly believed depression results from a culmination of circumstances such as stressful events, family history, biology, disconnection from others, and more. Of the many reasons, researchers believe an imbalance of neurotransmitters is a leading cause, especially for individuals who suffer from recurrent depressive episodes. Several different treatment methods can help someone rise out of their depression and rebalance the neurotransmitters. Of these methods, antidepressants are likely some of the most misunderstood. Overcoming depression takes effort. It takes discipline; for some people, the imbalance of chemicals may only be corrected by adding antidepressant medication(s) to their treatment.
The first line of treatment is typically psychotherapy. During sessions, a therapist or counselor may advise a change in diet, increase of exercise, and improved sleep habits. Some cases, however, require more – this is where many people have found a pivotal point in their treatment – the addition of antidepressants. If you or your therapist or counselor find this is the next step, they are likely to refer you to a psychiatrist. At Mindful Living Group, therapists, counselors, and psychiatrists work within the same facility. This creates a higher level of treatment as they are able to communicate effectively and work together, with more ease, in employing the optimal care for you.
Antidepressants, Their Types, And What They Do
Antidepressants are one of the primary categories of psychiatric medications. Within the category are several classes of the drug, each directed towards altering a particular neurotransmitter to restore balance. Neurotransmitters associated with depression are serotonin, dopamine, and norepinephrine. The imbalance occurs when one, or more, of these chemicals, are at a lower than average level.
Antidepressants are designed to work in many different ways, all with the goal of increasing the levels of neurotransmitters. One method in which this increase is accomplished is by inhibiting the reabsorption of neurotransmitters in the synaptic cleft by the postsynaptic neuron (neuron which releases the chemicals). To explain that statement: the brain communicates via pathways made from billions of neurons. The neurotransmitters are distributed from one neuron to another within a tiny space (the synaptic cleft). Once the presynaptic neuron has received the message, any neurotransmitters left in this space are taken back up by the postsynaptic neuron or metabolized by enzymes. Antidepressants such as SSRIs, SNRIs, or NRIs create a “block” at the points of reuptake on the postsynaptic neuron. This results in higher levels of neurotransmitters remaining in the synapse; nearby neurons may receive them if they contain the correct receptors.
The neurotransmitters associated with varying types of depression (serotonin, dopamine, norepinephrine, and the addition of epinephrine) are monoamine neurotransmitters. In cases where a person’s depression appears to be resistant to treatment, a psychiatrist may prescribe an antidepressant within the Monoamine Oxidase Inhibitor class. MAOIs are typically only prescribed if all other medication and treatment options have been unsuccessful. Antidepressants that fall under this drug class are considered highly effective. They are the last option because of the substantial lifestyle changes and awareness required and the associated health risks. An individual who is taking MAOIs must be cautious they do not consume foods containing tyramine (aged, fermented, and pickled foods, some beans and peas, a large sum of fruits – especially dried, alcoholic beverages, protein and other supplement powders and additives, and soy products, to name a few).
Classes Of Antidepressants
Below are the standard classes of antidepressants. The name of each class corresponds with the neurotransmitter(s) targeted and in what way. The most popular and generally first prescribed are SSRIs and SNRIs. TeCAs and TCAs are some of the oldest antidepressants and are not typically prescribed unless other options have not been successful.
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
- Monoamine Oxidase Inhibitors (MAOIs)
- Norepinephrine Reuptake Inhibitors (NRIs or NERIs)
- Tricyclic Antidepressants (TCAs)
- Tetracyclic Antidepressants (TeCAs)
- Serotonin Antagonists And Reuptake Inhibitors (SARIs)
- Serotonin Reuptake Inhibitors / Serotonin Modulators And Stimulators (SRI/SMS)
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Antidepressants have historically been found most effective when the person taking them willingly participates in psychotherapy. Our brains are powerful, and we have the phenomenal ability to create and strengthen neural pathways. They can change and adapt. This neuroplasticity is an essential factor in psychotherapy and our journey of growth and overcoming the issues we struggle with. As mentioned above, neurons communicate with each other in the synapse. The synapse is necessary to establish connections. The more this connection is used, the stronger it gets. Serotonin is a key element in the creation of the synapse. Hence, adding antidepressants, such as SSRIs, to psychotherapy helps individuals create these new neural connections.
The decision to start psychiatric medications takes place between you, your therapist, and/or psychiatrist. Suppose you have willingly participated in psychotherapy sessions, actively putting in the work at home and in therapy, and feel there has been no change. In that case, it is important to express this with your therapist. There is no shame in expressing whether you think the help of an antidepressant could be the missing puzzle piece to push you over the hump. At Mindful Living Group, therapists, counselors, and psychiatric nurse practitioners work within the same facility. Therapists and counselors can refer you to one of the psychiatric nurse practitioners that would be the best fit.
Who Prescribes Antidepressants?
For medication prescriptions and management, you may be referred to see a psychiatrist. Their technical level of training and years of meticulous education allow them to safely decide which medication and dosage are likely appropriate for each patient.
It is essential to take note of a few things when starting antidepressants. The first is your psychiatrist will perform a thorough evaluation of your symptoms; this may be done through a variety of ways:
- Sitting down with you in a psychotherapy setting and discussing your presenting concerns;
- Physical health exams – checking your vitals, bloodwork, echocardiogram, etc.;
This is done to obtain the best picture of your health as medications may cause side effects or worsen pre-existing conditions. Second, everyone reacts differently to antidepressants. The first type you try may not work. It often takes time and a bit of tweaking to find the exact “formula” personalized to you. Third, as just mentioned, is time. Antidepressants, unfortunately, do not begin working overnight or even within a couple of days of starting them. On average, it may take two months or more to start feeling the effects. Some classes of antidepressants are generally not felt in full until they’ve been taken for at least two years. In some cases, your psychiatrist may suggest adding other medications, such as mood stabilizers or atypical antipsychotics. The purpose of this is when combined with antidepressants, they augment the effects.
It is vital to keep follow-up appointments. They are essential for ensuring the medication is not disrupting your health or if changes to medication need to be made. Antidepressants are not to be viewed lightheartedly. They can help many people of all ages under appropriate supervision by an experienced, licensed psychiatrist. Nevertheless, antidepressants can be dangerous for people under 25 years old. Children, adolescents, and young adults who take antidepressants are at a higher risk of worsening depression symptoms or increased suicidal thoughts. If you or your child experience this, it should be reported to your psychiatrist immediately.
It is essential to take them as directed and be cautious of not missing doses or suddenly stopping them. Your psychiatrist informs you of serious side effects to be aware of and if there are other medications or foods, you should not consume for the risk of dangerous interactions.
Benefits of Antidepressants
Antidepressants, as well as other psychiatric medications, are not a cure. Their purpose is to treat symptoms, bringing relief, clarity, and stability to an individual. A reduction or elimination of symptoms from depression, anxiety, insomnia, or any other mental health condition, often helps people move forward in their treatment, where otherwise they felt “plateaued.”
Depression is the dominant illness treated by antidepressants but not the only one. Many other disorders, illnesses, or conditions that may be treated with antidepressants often coexist with depression, although this is not always the case. SSRIs and SNRIs have been shown to help some individuals with anxiety disorders. Individuals with PTSD may benefit from antidepressants, but solid evidence of efficacy is not well established. SSRIs are listed as a treatment; however, SNRIs are typically used as an off-label treatment.
Symptoms associated with adult obsessive-compulsive disorder (OCD) could be reduced with SSRIs. Antidepressants are recommended in addition to psychotherapy as a first-line treatment for people who have OCD with moderate to severe functional impairment; second-line treatment is an option for mild functional impairment.
Antidepressants have been found effective for some people in treating pain – physical and neuropathic, most commonly fibromyalgia and migraines. While antidepressants have versatile uses, it is not guaranteed to work for everyone who takes them.
There Is No Shame In Taking Antidepressants
The need for antidepressants, or any type of medication, is nothing to be ashamed of. Whether you need to take them for a short amount of time, or long-term, it is a form of caring for yourself and your health; it is self-love, kindness, and self-compassion. Antidepressants are a tool to help you achieve optimal health. The knowledgeable and empathetic therapists, counselors, and psychiatrists at Mindful Living Group are prepared to provide you guidance, support, and medical care.
Contact Mindful Living Group today with any questions or to schedule an appointment.