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The physician’s psychoactive medication resource guide
25% of your patients taking an antidepressant will have
weight gain and the weight gain is directly caused by the antidepressant.
What is an Antidepressant?
Depression is considered one of the most common psychological disorders that affect adults in the
United States. It is estimated that nearly 10% of American adults are affected with different types and
degrees of depression, including bipolar disorder and dysthymic disorder. An antidepressant is often
the initial treatment of choice when severe or moderate depression is diagnosed. It is meant to help
manage or reduce the symptoms of depression but is by no means a cure for the disorder.
An antidepressant is a type of drug that is used to deal with certain types of depressive disorders. It
is used to stabilize mood and ensure mental stability in patients who suffer from conditions such as
clinical depression, bipolar disorder, post-traumatic stress disorder, panic and anxiety attacks and
obsessive compulsive disorders.
The history of antidepressants:
Up until the early 1950s, opiates, amphetamine, and extracts from St. John's Wort- in spite of being
highly addictive- were commonly used to help treat symptoms of depression. Then in 1951, two
physicians from Staten Island began searching for an effective tuberculosis medication via anti-
tuberculosis agents isoniazid and iproniazid. The doctors found that their cure worked: their patients'
conditions in terms of their tuberculosis drastically improved. However, a secondary effect was
observed: curiously enough, patients were also reported as having a renewed vigor as well, hence
resulting in the world's official first- even if accidental- antidepressant.
There are several different classifications of antidepressants:
Selective Serotonin Reuptake Inhibitors (SSRIs): Examples are Prozac (fluoxetine), Celexa
(citalopram), and Paxil (paroxetine).
Serotonin and Norepinephrine Reuptake Inhibitors (SSNIs): Examples are Effexor
(venlafaxine) and Cymbalta (duloxetine).
Tricyclic antidepressants (TCAs): Examples are Elavil (amitriptyline), Tofranil (imipramine),
and Pamelor (nortriptyline).
Monoamine Oxidase Inhibitors (MAOIs): Examples are Nardil (phenelzine) and Parnate
There are other antidepressants that don't fall into any of these classifications and are considered
unique, such as:
Managing Side Effects
All antidepressants come with Medication Guides. These guides provide FDA-approved information
for patients, families, and caregivers that could help improve monitoring of a drug's effects.
Medication Guides are intended to be distributed at the pharmacy with each prescription or refill of a
Many people who take antidepressants have at least one side effect. Side effects can include:
Side effects are the most common reason people stop taking antidepressants. It's recommended that you don't stop taking your
antidepressants or reduce the dosage without talking to your doctor or mental health professional first.
Suicidal Thinking: In October 2004, FDA directed manufacturers to add a boxed warning to the labeling of all antidepressant medications to
alert the public about the increased risk of suicidal thinking or suicide attempts by children and adolescents taking antidepressants.
A boxed warning is the most serious type of warning used on prescription drug labeling. In May 2007, FDA directed that the warning should be
extended to include young adults up through age 24.
Birth Defects: In December 2005, FDA changed Paxil (paroxetine) from a pregnancy risk category of C to D. With a Category C drug, fetal
risk can't be ruled out. With a Category D drug, positive evidence of fetal risk exists. FDA chooses a medicine's letter category based on what
is known about the medicine when used in pregnant women and animals.
High Blood Pressure: It can be much more difficult for patients to take one of the MAOIs for depression because of the many dietary and
medicinal restrictions that must be followed. People taking MAOIs must avoid certain foods that contain high levels of the chemical tyramine,
which is found in many cheeses, wines and pickles, and some medications including decongestants. MAOIs interact with tyramine in such a
way that may cause a sharp increase in blood pressure, which could lead to a stroke or other complications.
An antidepressant typically causes withdrawal symptoms if the patient stops taking the medication abruptly. These symptoms can range from
the unpleasant to the downright troublesome. Some of these symptoms include nausea, vomiting, stomach cramps, involuntary muscle
fever, fatigue, irritability, anxiety, dizziness, nightmares, difficulty sleeping, depression and aggression. Mood swings caused by sudden
withdrawal from antidepressant use are usually more severe than the symptoms of the disorder itself.
When and if considering withdrawal from antidepressant use, always ask for professional advice. Typically, your doctor will recommend
gradual dosage reduction over a course of several weeks or months, depending on your case and the type of antidepressant involved. Any
changes to the dosage or medication should be closely made under your doctor's supervision.