Antidepressants: Know What They’re Winding You Up With

April 16th, 2010. By Kristine B

C’mon. You know you’ve seen that Pristiq ad once or twice—the one with that little wind-up doll (yes, the one with the circa-1970’s get-up that would drive any of us into a state of mild depression)—and you’ve thought to yourself, “Gee, I’ve had days when I kind of felt that way”. Admit it folks, you’ve been there—maybe not in mauve polyester, but you’ve been there.

Now, you may or may not have taken that thought to the next level: the “I need help” level. Most of us don’t. But if you have, you’ve most likely “talked to your doctor” as only “he can determine whether [fill in anti-depressant drug name here] is right for you”.

And if you’ve left your doctor’s office with a little slip of paper to be dropped off at the pharmacy, you may have been prescribed an SSRI, SNRI, NDRI or MAOI. Perhaps you’re feeling high as a kite on the hopes that you’ll be giddier than a glee club as soon as you get that scrip filled. But, take pause. For while you fantasize about your future mental state, do you really know what you’ve just been given?

What follows is a mini primer to the world of anti-depressants—and, as this is a legal news site, the links provided will lead you to information on safety concerns and some of the resulting litigation that’s gone on.

There are actually many different types of antidepressants. Not just the brand names, but the actual types of drugs themselves that work on different chemicals in the brain. Generally, antidepressants aim to reverse depressive symptoms and stabilize mood by increasing the amounts of certain chemicals that are found in the brain. The type of antidepressant depends on the chemicals being affected. 

Depression 

Although there is no one answer to the question, “What causes depression?” scientists believe that chemicals in the brain play a role in some forms of depression. The brain has several hundred types of chemical messengers—also called neurotransmitters—that send messages between brain cells. Of these, three neurotransmitters specifically are targeted by the various antidepressants, to different degrees. 

Serotonin is thought to play a role in controlling anxiety, mood, sleep, sexuality and appetite. 

Norepinephrine is thought to play a role in sleep and alertness and is also thought to play a role in the fight or flight stress response. 

Dopamine is thought to be involved in motivation, reinforcement and addictive behaviors. Some experts also believe dopamine is linked to psychotic symptoms. 

SSRIs 

SSRIs are really called selective serotonin reuptake inhibitors. Essentially, that means that they prevent the reuptake of serotonin, resulting in more serotonin in the brain. SSRIs are used to treat depression and anxiety problems. 

Some studies have linked SSRIs to an increased risk of birth defects when expectant mothers take the SSRIs at certain times during pregnancy. 

SSRIs include Celexa, Lexapro, Paxil, Prozac and Zoloft. 

SNRIs 

SNRIs are serotonin-norepinephrine reuptake inhibitors. They are similar to SSRIs, but they also inhibit the reuptake of norepinephrine, resulting in higher levels of both serotonin and norepinephrine in the brain. SNRIs are used to treat depression, anxiety problems and chronic pain. 

SNRIs include Cymbalta, Effexor and Pristiq.

NDRIs 

NDRIs are norepinephrine and dopamine reuptake inhibitors. They are used to increase levels of norepinephrine and dopamine in the brain. NDRIs are often given because they can have an energizing effect. So, NDRIs are often given in combination with other antidepressants. Other uses for NDRIs include to treat attention-deficit/hyperactivity disorder and to aid in smoking cessation. 

NDRIs include Wellbutrin and Zyban. 

MAOIs 

MAOIs are monoamine oxidase inhibitors. Monoamine oxidase is an enzyme that breaks down serotonin, norepinephrine and dopamine. MAOIs are thought to work by reducing the activity of the enzyme MAO, which results in higher levels of serotonin, norepinephrine and dopamine in the brain. This, in turn, leads to an improved mood and lower panic. 

MAOIs are the first class of antidepressants but are not used as frequently any more because patients on MAOIs must also follow a special diet. 

MAOIs include Nardil and Parnate 

Tricyclics 

Tricyclic antidepressants are an older group of antidepressants and are not generally the first choice for treatment of depression because they tend to have more side effects than newer antidepressants. However, tricyclics are still used for severe depression when other drugs do not work. Tricyclics work by inhibiting the reabsorption of serotonin and norepinephrine by the brain cells. They also block the reabsorption of dopamine, although to a lesser extent than serotonin and norepinephrine. 

Tricyclics include Adapin, Anafranil, Elavil, Endep, Norapramin and Sinequan.

Tags: Antidepressant, Celexa, Cymbalta, Effexor, Lexapro, MAOI, NDRI, paxil, paxil-heart-defects-newborn, Pristiq, Prozac, SNRI, SSRI, Wellbutrin, Zoloft

This was posted on Friday, April 16th, 2010 at 3:34 pm and is filed under Drugs/Medical, Emerging Issues . Feel free to respond, or trackback. Read our comments policy.