20 facts you need to know about antidepressants

Depression affects all of us at times in our lives, but as long as it's temporary, it won't require antidepressants. When this condition persists without improvement and is accompanied by symptoms associated with depression, it's important to consult a healthcare professional to determine if medication is necessary. Here's a 20-point overview of antidepressants.

There are different types of antidepressants.

Antidepressants are divided into several classes, the most commonly used being selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). SSRIs are the first choice for treating depression and anxiety disorders because they have fewer side effects than other classes. SNRIs, on the other hand, are thought to be more effective because they act on two neurotransmitters simultaneously. However, because they cause more side effects, they are used when SSRIs are insufficient to relieve symptoms.

How do antidepressants work?

People with depression appear to have an imbalance of certain neurotransmitters. These neurotransmitters, including serotonin and norepinephrine, are involved in regulating sleep as well as mood and emotions. Formulated to follow the same pathways, antidepressants are thought to help optimize or counteract their action, or even modify their quantity in certain areas of the brain to help restore chemical balance.

Finding the right antidepressant can take time

Finding the right treatment is a process of trial and error that often requires time and patience. The first antidepressant prescribed will generally be the one most people tolerate. However, it's important to remember that the medication's effects are not immediate, and each person will react differently.

How long does it take to see the effect of treatment?

It can take several weeks for antidepressants to begin working. It then remains to be seen whether the pros and cons are beneficial and to adjust the dosage based on the side effects experienced, which can significantly lengthen the trial period, as the medication may sometimes not be suitable.

How long should you take them?

There's no universal length of time you can take an antidepressant; it depends on each individual's condition. However, it can take several months to achieve conclusive results. Stopping too early also increases the risk of relapse, which could require a new, perhaps longer, course of treatment. In all cases, it's important to follow your doctor's recommendations.

Side effects that diminish

As with many other medications, antidepressants can be associated with side effects. The most common include headaches, dry mouth, nausea, drowsiness, agitation, sleep disturbances, and decreased libido. However, it's important to keep in mind that these side effects generally diminish over time and are milder with the most commonly prescribed products than with other classes of antidepressants.

Is there a risk of addiction?

Contrary to popular belief, antidepressants are not addictive. However, stopping their use can cause withdrawal symptoms, as the body becomes accustomed to them. Therefore, it's important to stop taking them gradually, as directed by your doctor.

Natural Antidepressants for Mild to Moderate Depression

St. John's Wort and saffron are said to be just as effective and generally have fewer side effects than synthetic antidepressants for treating mild to moderate depression. These adverse effects are most commonly observed with St. John's Wort (digestive disturbances, insomnia, photosensitivity), which can also interact with other medications (oral contraceptives, antiretrovirals, blood thinners, conventional antidepressants). As for saffron, it is not recommended for pregnant women, as it may cause uterine contractions. Beware of self-medication: even if it is natural, an antidepressant can cause more harm than good if not accompanied by proper monitoring.

Beware of Combining Antidepressants

Taking more than one SSRI drug at a time can be dangerous in some cases. Serotonin produces a vasoconstrictor effect, meaning that too high a concentration can significantly narrow blood vessels, increasing the risk of headaches or strokes. Some other classes of antidepressants have contraindications; combining them with SSRIs or SNRIs can also pose risks. Do you have any concerns about your medication? Don't hesitate to discuss it with your doctor or pharmacist.

Reduce risks upstream

Taking the time to talk with your doctor before starting antidepressant treatment allows you to get an idea of what to expect and reduce certain associated risks. Be sure to discuss your symptoms, personal and family history of mental illness, allergies, medications taken (including vitamins and natural products), and, in the case of women, indicate whether you are pregnant or breastfeeding.

Actively participate in your treatment

For antidepressant treatment to be effective, the best way is to be involved in the process. Keeping a journal of the positive and negative effects observed (mood, anxiety level, sleep, appetite, etc.) and reporting it to your doctor during follow-up appointments will allow them to determine if the chosen approach is the right one or if adjustments are needed.

Other Uses of Antidepressants

Because antidepressants help reduce certain symptoms, if their benefits outweigh their side effects, a healthcare professional may sometimes prescribe them for the treatment of conditions other than depression. These include anxiety disorders, irritable bowel syndrome, attention deficit hyperactivity disorder, bulimia, obsessive-compulsive disorder, and insomnia.

Beware of Drug Interactions

Antidepressants can interact with other medications or natural health products. And the fact that they are available over the counter doesn't make these combinations safer. For example, taking SSRIs with anti-inflammatory pain relievers like ibuprofen can increase the risk of internal bleeding.

Combining antidepressants with psychotherapy

Antidepressant treatment has limited effect. This is why it is strongly recommended to combine it with psychotherapy. Complementing medications, which act on a biological level, psychotherapy addresses the psychological dimension of depression. The best results are generally achieved when the two are combined.

A healthy mind...

In addition to helping maintain good health and redirecting thoughts away from illness, physical activity may also be beneficial in reducing symptoms associated with depression—in combination with antidepressants in more severe cases. This effect is thought to be due in particular to the release of endorphins and neurotransmitters in the brain, substances associated with well-being.

Substance Use and Caffeine

Alcohol, whose tolerance may be reduced by medication, is likely to amplify symptoms of depression or anxiety, and may also interact with antidepressants, including worsening some of their side effects. As for caffeine, since its stimulant action can further disrupt sleep already affected by depression or anxiety, it is best to avoid it.

Is there an upper age limit for taking antidepressants?

Due to the estimated increased suicide risk associated with them in children and adolescents, antidepressants should only be used if psychotherapy proves ineffective and should be closely monitored. As for older adults, they are more likely to experience side effects and drug interactions than other adults. Therefore, they will generally be prescribed lower doses, which will be increased very gradually.

Marked increase in antidepressant use in 2020

According to data collected by the Organization for Economic Co-operation and Development (OECD), the health crisis has had serious consequences on the mental health of the global population. The prevalence of depression and anxiety has more than doubled in several countries, and antidepressant prescriptions have seen a marked increase.

Safe for pregnant or breastfeeding women?

Since depression can impair a person's ability to care for their child, if the benefits of treatment outweigh the risks, a pregnant woman may be advised to continue it. As for newborns, while antidepressants can affect them when taken shortly before delivery, they are not thought to increase the risk of birth defects, and their effects disappear within three days to two weeks. Finally, since a very limited amount of antidepressants passes into breast milk, it is considered safe.

Who should not take antidepressants?

The use of antidepressants may require greater caution in certain people. This is particularly the case for those with epilepsy (increased risk of seizures), liver or kidney disease (which can affect their elimination), malnutrition with low protein, or a history of cardiovascular disease with heart rhythm disturbances. Hence the importance of consulting a healthcare professional before starting such treatment.