A person who is going to take a prescribed medication for depression, should know the main advantages and disadvantages of different drugs in order to fully understand what to expect. Basically, there are 3 large groups of antidepressants that are most of all prescribed in the United States:
- Tricyclic antidepressants (Amitriptyline, Amoxapine);
- SSRIs (selective serotonin reuptake inhibitors) include such brand titles as Prozac, Zoloft, Paxil, Lexapro, Celexa, etc.;
- MAOI (monoamine oxidase inhibitors) with such FDA-confirmed meds as Marplan, Nardil, Emsam.
Tricyclic antidepressants: pros and cons
This is the oldest group of antidepressants, which have been used since the middle of the last century. However, although this group of antidepressants is outdated, it has some advantages:
- A large evidence base. Over the long years of existence, tricyclic antidepressants have been investigated a lot;
- There are the injection forms. You can use these antidepressants in circumstances where the patient is aggressive and refuses to take pills. In addition, the injection form of the drug acts quickly, so, if necessary, it can be used in case of the suicidal threat;
- Low cost. These drugs are used by people with a low budget;
- Stimulate the appetite. Tricyclic antidepressants are indicated to patients who, due to depression, refuse to eat and lose weight drastically;
- Provides the analgesic activity. This can be useful for the patients who suffer from chronic pain syndrome.
Disadvantages of tricyclic antidepressants:
- Cross-resistance. If one of the tricyclic antidepressants did not work, there is no sense in using another one;
- A narrow therapeutic range. You can’t significantly increase the dose, because such decision is usually followed by side effects;
- Many side effects. Tricyclic antidepressants may disrupt the heart rhythm, increase the risk of seizures if a person suffers from epilepsy. If taken in large doses, they can significantly reduce blood pressure, cause sustained constipation and urinary retention;
- Poor drug tolerance. Tricyclic antidepressants can’t be recommended for the treatment of chronic depressions. In addition, this group of drugs has a huge number of contraindications, which limits their use as well;
- Can’t be used during pregnancy and lactation. Tricyclic antidepressants may penetrate the placenta and spoil the breast milk;
- Strong soothing effect. The patient taking these drugs becomes inhibited after taking the pill and the efficacy rate is sharply reduced. Such patients during the period of treatment can’t perform normal work that requires increased concentration, drive a car and control any vehicles.
SSRIs: advantages and disadvantages
Selective serotonin reuptake inhibitors are the most commonly used group of antidepressants of mild-to-moderate severity. Advantages of this pharmacological group:
- High compliance with other pills. SSRIs are well tolerated, have a low risk of side effects. They should be taken only 1-2 times a day and are easily dosed (do not require a gradual increase of the daily dose);
- Reduce appetite in patients with obesity, metabolic syndrome, diabetes mellitus – all those who can’t gain weight;
- High security profile. The SSRIs have a very few contraindications, they can be used by elderly and weakened patients. In addition, the high safety makes it possible to increase dosage in the case of being resistant to other antidepressants;
- There is no evident hypnotic and sedative effect. A person gets rid of depression and does not become inhibited to these pills, does not lose his ability to work with vehicles;
- Overdose is almost impossible. A person who is prone to suicide will not be able to take SSRIs to end his life even after taking the whole bottle.
Disadvantages of SSRIs:
- Slow development of the therapeutic effect. The maximum therapeutic effect is achieved only after 3-4 weeks of regular intake. SSRIs can’t be used as an emergency medicine for severe depression;
- Weaker clinical effect. The drug can not eliminate all symptoms of depression, they are almost useless for chronic depression;
- Strong adverse effects. Initially, SSRI treatment can increase insomnia and anxiety;
- Poor sexual function. These drugs for depression reduce sexual desire, pleasant sensations during sex, can make orgasm impossible and cause the problems with ejaculation for men;
- Can badly interact with many drugs. A person who is being treated for other non-depressive illnesses should consult a physician before starting an SSRI course. Otherwise, he may suffer from side effects caused by the drug interactions.
MAOIs: pluses and minuses
Monoamine oxidase inhibitors are another group of antidepressants. Advantages of MAOI:
- Can be used by elderly patients. These drugs are not harmful, but on the contrary, are useful for the heart. MAO inhibitors do not have cholinolytic activity and lack many side effects characteristic for the other groups of popular antidepressants;
- Effective for treating panic attacks and social phobia. These drugs are preferred from depression in cases where a person isolates himself from communicating with other people and is extremely negative about interlocutors who impose a contact;
- Stimulation instead of sedation. While other drugs for depression have a more or less pronounced calming effect, MAO inhibitors act as stimulants. Therefore, they are effective for treating depression, accompanied by asthenia.
- Good tolerability. The safety profile is higher than that of SSRIs, and even more so than in tricyclic antidepressants.
- High efficiency for treating atypical depression. This mental disorder is characterized by unusual clinical manifestations: increased appetite instead of reducing it, weight gain instead of weight loss, drowsiness instead of insomnia.
The MAO inhibitor group is very heterogeneous. These pills can be selective and non-selective, reversible and irreversible.
MAOIs have a number of cons:
- Negative effects on liver function;
- Incompatibility with many drugs;
- Incompatibility with many foods (ice cream, some types of wines, caviar, smoked products, cheese);
- Incompatibility with alcohol and caffeine.
Be sure to consult with your doctor before using any antidepressants. Such wise decision will prevent the appearance of side effects and possible negative drug interactions.
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