How do antidepressants work in the body?
Antidepressants act on neurotransmitters, substances present in the brain with the function of helping communication between neurons. They are popularly called “messengers”.
Many of them are mood regulators and other functions, such as sleep, libido, appetite, etc.
In depressive states, it is common for patients to have some neurotransmitter deficiency in certain areas of the brain. One of them is serotonin . Other neurotransmitters in imbalance in depression are norepinephrine and dopamine .
Thus, antidepressants act by increasing the availability of these neurotransmitters in the synaptic cleft, a space between neurons through which neurotransmitters travel.
When the neurotransmitter is released by a neuron, it can have two destinations:
- It is picked up by the receptors of the other neuron, after crossing the entire synaptic cleft;
- It is recaptured by the neuron that emitted it and then destroyed by an enzyme.
It is precisely in this reuptake system that most antidepressants act, seeking to reduce the amount of neurotransmitters recaptured and destroyed.
Types of antidepressants
Not all antidepressants are the same and work well for everyone. On the contrary, it is common to make several changes to the medication until the antidepressant can be found to which the patient best adapts.
The types of antidepressants on the market are:
Tricyclic antidepressants (ADT)
These were the first antidepressants to be discovered, back in the 1950s. Their name derives from the presence of 3 carbon rings in the composition. They work by increasing the brain’s availability of serotonin, norepinephrine and, to a lesser extent, dopamine.
Monoamine oxidase inhibitors (MAOIs)
Remember that after reuptake, the neurotransmitter is destroyed by an enzyme? Well, MAOIs act precisely by inhibiting this enzyme: monoaminoxidase. In this way, the recaptured neurotransmitters are released again in the synaptic cleft, improving their availability.
This enzyme acts on serotonin, norepinephrine and dopamine, making it an antidepressant that acts on several neurotransmitters. Its effects can be both reversible and irreversible.
The problem is that MAOIs also interact with tyramine, a substance common in various types of cheese, meat and alcoholic beverages. This interaction results in hypertension crises and, therefore, the use of this type of antidepressant is quite limited nowadays.
Selective serotonin reuptake inhibitors (SSRIs)
Currently, most of the antidepressants used are SSRIs. The name is very self-explanatory: they work by inhibiting the reuptake of serotonin. Thus, this neurotransmitter is “loose” in the synaptic cleft and, over time, is picked up by receptors on the other neuron.
The great advantage of SSRIs is that they act only on serotonin, without compromising the availability of other neurotransmitters.
Selective noradrenaline reuptake inhibitors (ISRN)
Like SSRIs, ISRNs also inhibit the reuptake of a specific neurotransmitter. In this case, noradrenaline. They are very useful in cases where the patient does not respond to selective serotonin reuptake inhibitors.
Selective dopamine reuptake inhibitors (ISRD)
A third type of selective reuptake inhibitor acts on dopamine, another neurotransmitter. It is more indicated in cases of patients suffering from serotonergic side effects, that is, related to the increased availability of serotonin, such as delayed ejaculation.
Selective serotonin and norepinephrine reuptake inhibitors (ISRSN)
SSRIs act by inhibiting the reuptake of both serotonin and norepinephrine, but have no effect on dopamine. Therefore, it acts in a similar way to tricyclic antidepressants, but does not have so many side effects.
Tetracyclic antidepressants are considered an evolution of tricyclics, while they have fewer side effects and also act on several neurotransmitters. They are used as a third alternative, when the patient does not respond to treatments with SSRI and ISRN.
This type acts by inhibiting both the uptake and uptake of several neurotransmitters, but keeps some specific receptors open so that they can pick up the free neurotransmitters in the synaptic cleft.
It has an analgesic and sedative effect, and can also potentiate the undesirable effects of alcohol, which makes the consumption of alcoholic beverages even more dangerous.
There are also other antidepressants that work with specific mechanisms, different from all those mentioned above. Among the drugs available on the market, these active ingredients are usually the only representatives of their classes. Among them, we can highlight:
- Valdoxan (Agomelatine);
- Donaren (Trazodone);
- Vortioxetine (Brintellix).
Names of antidepressants
Some trade names of antidepressants are:
- Amitriptyline (ADT): Tryptanol , Amytril , Neurotrypt;
- Clomipramine (ADT): Anafranil , Clo ;
- Desipramine (ADT): Norpramin;
- Doxepin (ADT): Sinequan, Zonalon;
- Phenelzine (MAOI): Nardil;
- Fluoxetine (SSRI): Prozac ;
- Fluvoxamine (SSRI): Luvox ;
- Imipramine (ADT): Tofranil , Imipra ;
- Isocarboxazide (IMAO): Marplan;
- Nortriptyline (ADT): Pamelor ;
- Paroxetine (SSRI): Pondera , Aropax ;
- Sertraline (SSRI): Zoloft ;
- Tranylcypromine (MAOI): Parnate ;
- Venlafaxine (ISRSN): Efexor XR , Alenthus XR , Venlift OD, Efexor XR, Venlaxin ;
- Desvenlafaxine (ISRSN): Zodel , Andes , Deller , Desve , Elifore , Imense , Pristiq , Indefa ;
- Escitalopram : Eficentus , Decipax , Escilex , Espran , Lexapro , Mind , Exodus ;
- Trazodone : Donaren , Donaren Retard , Loredon ;
- Agomelatine : Valdoxan ;
- Vortioxetine : Brintellix .
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Indications: when should you take antidepressants?
Despite the name, antidepressants are not only indicated for cases of depression. In fact, these drugs are used to treat other mental disorders and even to help with neurological diseases, such as Parkinson’s disease.
Antidepressants are commonly indicated under the following conditions:
Depressive disorders can be characterized as affective disorders and, for the most part, characterized by deep and prolonged sadness, discouragement to perform activities of interest, stress, apathy, among others.
They include major depression, dysthymia, atypical depression, among others.
Other affective disorders
Among the main affective disorders, we can mention bipolar disorder . Patients with bipolar disorder can use antidepressants to deal with depressive episodes. However, these drugs must be administered together with mood stabilizers, otherwise the patient may experience episodes of mania.
Several anxiety disorders, such as obsessive-compulsive disorder, social phobia, post-traumatic stress disorder and panic syndrome, can be treated with antidepressants.
Personality disorders can be defined as a group of psychiatric disorders in which the patient has atypical emotional and behavioral traits, which are often inflexible and poorly adjusted.
In cases of personality disorder, the use of medications may be necessary to relieve depressive symptoms arising from the disorder.
Borderline personality disorder, histrionic personality disorder and dependent personality disorder can be included in this group.
Antidepressants have some effect in controlling disorders such as binge eating and bulimia nervosa.
Smoking, alcoholism and drug addiction
In studies carried out with several volunteers, it was found that certain antidepressants help to overcome some addictions, such as smoking, alcoholism and other substance abuse.
It is not known exactly why antidepressants work in these cases, but it is known that bupropion and nortriptyline have been shown to be effective in smoking cessation even in those who did not have a history of depression.
Although the most frequently prescribed drugs for insomnia are benzodiazepines (substances that act in anxiety), antidepressants can sometimes help in insomnia attacks in some patients.
Chronic neurological pain
Noradrenergic antidepressants (which increase the availability of norepinephrine) help in the treatment of chronic neurological pain, such as fibromyalgia.
Antidepressants and Parkinson’s Disease
A large number of patients suffering from Parkinson’s disease also have to deal with depression. There are also studies that say that the risk of developing this disease is related to the use of antidepressants.
However, this relationship is not of cause and effect, that is, patients who end up developing Parkinson’s did not necessarily do so because of the use of antidepressants.
New research also shows that it is possible to use certain antidepressants – such as SSRIs, for example – without worsening the symptoms of the disease.
Side effects of antidepressants
Perhaps the biggest problem related to the use of antidepressants is the dreaded side effects, which, let’s face it, are not few.
Therefore, it is important that the patient is aware of what can happen to his body when using antidepressants, but he must also know when he can no longer support such adverse effects.
If you have any side effects that really get in the way of your life, it’s time to talk to the psychiatrist to ask what can be done. Remember your rights: you can and should refuse treatment if you don’t agree with it, but don’t forget, too, that in these cases you are at your own risk.
The most common side effects of antidepressants are:
More frequent in people who use tricyclic antidepressants (ADT), the intensity of these symptoms usually decreases over time or as the dose decreases. These effects are:
- Dry mouth;
- Blurred vision;
- Constipation (constipation);
- Urinary retention;
- Increased heart rate;
- Tremors and involuntary movements.
Changes in libido
As several drugs act on the serotonin that regulates, among others, sexual function, it may be that the sexual life changes with the use of antidepressants.
During treatment, libido may increase, due to the improvement of depressive symptoms, or decrease, as a side effect of the medication, and it is possible to lead to a reduction in sexual desire in men and women.
Abrupt withdrawal syndrome
Antidepressants can lead to an abrupt withdrawal syndrome. This usually happens when the patient suddenly stops using medications.
Therefore, it is extremely important to consult a psychiatrist if the patient is interested in stopping or decreasing the dose of the medication. Thus, the interruption of use can be made gradually, which avoids the withdrawal syndrome.
Otherwise, the symptoms of this syndrome are:
- Dizziness and dizziness;
- Motor uncoordination;
- Fatigue and “softness”, symptoms similar to the onset of the flu;
- Sensory disorders, such as paresthesia (numbness);
- Sleep disorders, such as insomnia, drowsiness or nightmares;
These symptoms usually appear between 1 and 10 days after you stop taking the medicine. In the case of fluoxetine, the syndrome can take up to 2 weeks to start happening.
In contrast, with tricyclic antidepressants, the syndrome can begin as early as the first 48 hours after stopping use, leading to cholinergic hyperactivity due to a rebound effect (when the body tries to compensate for what has been avoided for a long time, as in the case , cholinergic activity).
Symptoms include panic attacks, cardiac arrhythmias and delirium (mental confusion).
Read more: What are the symptoms of Paresthesia?
In the case of tricyclic antidepressants, the interaction of medications with certain types of food can trigger hypertensive crises in patients.
If it is necessary to use this type of antidepressant, you should avoid foods rich in tyramine. These foods include:
- Ripened or aged cheeses;
- Sausages or smoked meats – including fish;
- More than a bottle of beer, draft beer or wine, even if without alcohol;
- Yeast, broad bean and banana peel candy.
Serotonin syndrome is a set of symptoms that occur when there is too much serotonin in the synaptic cleft.
This usually happens if the patient is taking simultaneous administration of antidepressants (especially SSRIs) and medicinal herbs for depression, such as St. John’s wort (Hypericum).
Its symptoms include:
- Hyperreflexia (very sensitive reflexes);
- Muscle stiffness;
- Alteration of consciousness;
- Agitation and hyperactivity;
- Abdominal cramps;
- Hypertension or hypotension;
- Pupil dilation;
- With the.
Mania and hypomania
In the case of bipolar patients with a misdiagnosis of depression, antidepressants can lead to an episode of mania or hypomania. In such cases, the psychiatrist must readjust the medication and include a mood stabilizer to prevent manic episodes.
Symptoms of manic episodes include euphoria, agitation, accelerated thoughts, less need for rest, among others.
Especially at the beginning of treatment, antidepressants end up increasing the suicidal tendency. This can happen for several reasons, including:
- The patient’s brain is trying to adapt to chemical changes and this can result in unusual behaviors and thoughts;
- At first, the antidepressant has an effect and gives energy to the patient, making him able to get out of the limiting depression. However, the effect hasn’t peaked yet, and the patient still has symptoms of depression, including suicidal ideation. As a result, the patient’s chances of trying something self-destructive increase.
In these cases, the accompaniment of a psychologist at the beginning of the treatment is essential so that the patient does not try anything that puts his life at risk.
How to take?
Only a psychiatrist will be able to tell you what type and dose of antidepressant is right for you. However, it is worth remembering that starting and ending treatment with antidepressants is always something gradual, to avoid problems such as withdrawal syndrome.
It is likely that the psychiatrist will prescribe a reduced dose in the first days and will gradually increase over the weeks of using the medication. The same will be done when it is time to stop: the professional should gradually reduce the dose.
To give a better example, let’s look at the story of Luís (fictitious name):
Recently, Luís realized that he had depressive symptoms and decided to seek help. At the psychiatrist, he talked about his symptoms and about his life, so the professional could be sure that it is a depression and not something else.
When prescribing the medication, the psychiatrist told Luís to take 10mg of a certain antidepressant during the first week and, in the second week, increase it to 20mg. He also asked Luís to write down any side effects he might notice during the use of the medication.
Finally, the psychiatrist asked Luís to do psychological counseling and bring his complaints to the psychologist, a professional trained to assist patients during the treatment journey.
After 2 years of taking antidepressants and being followed up, Luís and the psychiatrist decided it was time to stop. However, it is not enough to just stop taking the pills, as this could trigger an withdrawal syndrome.
So, the psychiatrist asked Luís to continue taking 20mg for a week, then spend 2 weeks taking a 10mg dose and then two more weeks taking a 5mg dose a day, and then stop completely.
How long should you take antidepressants?
It is difficult to estimate how long someone will take an antidepressant, as it all depends on the disorder that affects the individual, the way his body reacts to medication, among other factors. However, treatment with antidepressants will rarely last less than 6 months .
In cases of endogenous depression, that is, a type of depression in which the problem is a congenital neurochemical imbalance, the patient may need the medication for the rest of his life.
In cases of major depression, which lasts a few months, the patient may spend a year or two taking the medication and then simply no longer need it.
It is also worth remembering that depressive episodes may end up coming back, which means that the patient may need treatment with antidepressants more than once during his life.
Like any medication, there are some contraindications to the use of antidepressants. Are they:
Pregnancy and lactation
Some medications can pass from the mother’s bloodstream to the baby, or they can also be expelled through milk. Therefore, the use of certain antidepressants may not be recommended during these periods.
Concomitant use of alcohol
If you need to use antidepressants, alcohol consumption is not indicated. This is because both alcohol and antidepressants are drugs that depress the central nervous system, that is, they make the central nervous system less active.
With this, the effects of alcohol can be enhanced and the patient can fall into a coma more easily than if he were not using these drugs.
Interestingly, antidepressants are used to assist in the treatment of alcoholism. Because it is also a depressant drug for the central nervous system, its use can prevent alcohol withdrawal.
How to improve the effect of the antidepressant?
It doesn’t matter if you take the best and most potent antidepressant on the market, the drug alone won’t be able to do much for you. The truth is that it is only able to regulate the flow of neurotransmitters in the brain, relieving the symptoms of depression, but it will not cure the problem on its own.
Depression is a multifactorial disorder whose causes include an imbalance in neurotransmitters, environmental factors, traumatic experiences and, sometimes, even heredity. The drug works on only one of these causes, while the rest must be worked on in other ways.
So, what can you do to help the drug fight depression and its symptoms? Well, there are several:
One of the most popular “alternatives” is psychotherapy (or psychological counseling). It is not really an alternative because psychotherapy is usually one of the main methods of treating depressive cases, and it may or may not accompany the use of antidepressants.
Psychologists are trained and highly qualified professionals to deal with psychic pain. They can help you find bad habits that go unnoticed, help you change those habits, and even identify the problems that led you to a depressive crisis in the first place.
There are many existing approaches that can assist the depressive patient, each in their own way. In Brazil, the most popular approaches are cognitive-behavioral therapy (CBT), psychoanalytic psychotherapy and gestalt therapy.
However, there are several other interesting approaches that can be used, such as body psychology, person-centered therapy, systemic psychology, etc. It is up to the patient to find a psychologist and an approach with which they feel comfortable.
Food and exercise
Did you know that food directly influences the production of neurotransmitters? Recently, it has even been discovered that part of serotonin is produced in the large intestine!
Therefore, eating healthily is a big step towards boosting the action of the antidepressant. Some of the foods that facilitate the production of serotonin are:
- Bitter chocolate.
Another activity that helps in the improvement of depressive symptoms is the regular practice of physical exercises. Although there is no clear explanation as to why this happens, it is known that, in general, exercising helps to improve anyone’s mood – even those who do not have depression .
Vitamin D can also help fight depressive symptoms, according to a study presented at The Endocrine Society’s 94th Annual Meeting in Houston (United States).
According to that study, vitamin supplementation improved depressive symptoms in several women who suffered from insufficiency of this nutrient.
It is worth remembering that vitamin D is synthesized by the skin during sun exposure and is not found in a significant amount in food. Therefore, when it is not possible to sunbathe, supplementation of this vitamin is recommended.
Another point to be well observed is the fact that this supplementation only helps in depression in cases where there is, in fact, some deficiency of this nutrient in the body. There is no evidence that, in people with normal levels of vitamin D, supplementation has an effect on depression.
Alternatives to antidepressants
Many people don’t like the idea of taking chemical drugs, and that is everyone’s right. There are some natural alternatives to antidepressant drugs that can serve this audience, but it is worth remembering that they are not as effective as drug treatment.
In addition, it is impossible to know for sure what the dose of the active substance with antidepressant effect contained in these natural alternatives.
This is because even plants of the same species may have been planted in soils with varying concentrations of nutrients and may have been exposed and varying degrees of sunshine, which may result in different levels of active substance in the composition of each individual plant.
So, before starting treatment with any of these remedies, talk to your psychiatrist! Only he will be able to tell if the use of these substances is safe for you.
It is worth remembering that, just because it is natural, it does not mean that it does not present risks. On the contrary, the concomitant use of medicinal herbs and medicines can cause dangerous interactions, such as serotonin syndrome.
Some alternatives to antidepressants are:
St. John’s wort / Hypericum ( Hypericum perforatum )
Well known for helping in milder depressive states, the hypericum works similarly to antidepressant medications. Its action improves the availability of serotonin in the synaptic cleft, but it is lighter than drug alternatives.
Hypericum can be consumed in the form of teas and capsules.
Rhodiola ( Rhodiola rosea )
Widely used in European countries, rhodiola is a hand on the wheel for people with mild depressive symptoms. It helps to improve concentration, brain performance and helps to combat slightly depressed thoughts and behaviors.
Use of antidepressants in Brazil
Those who think that the Brazilian people are happy by nature are mistaken: a report by the World Health Organization (WHO) revealed that Brazil is the most depressive country in Latin America. A fact that proves this is the increase in the use of antidepressants in the country: the growth was 74% between 2010 and 2016, according to SulAmérica.
Most users of these drugs are women and people over 50 years of age. Other psychiatric drugs also show an increase in sales, but antidepressants remain in first place among psychiatric drugs.
Clarify here the main doubts about antidepressants:
Antidepressant is fattening?
It depends. There are several reports of people who have gained weight after taking antidepressants, but this is not always the case.
Not infrequently, weight gain is related to patient improvement. Once the brain chemistry is balanced, the patient who previously had trouble feeding is now able to eat normally, or may even end up overdoing it. Weight gain occurs easily in situations like this, especially in the case of a sedentary lifestyle.
Although there are some mechanisms of action that increase the patient’s appetite, there is no evidence that only the antidepressant is able to increase weight.
As it is a multifactorial phenomenon, one must take into account the amount of calories consumed and spent during treatment, the speed and capacity of the metabolism and the amount of exercises practiced by the patient before it is possible to conclude that the person responsible for the increase in weight was medication.
It is also important that the patient seeks guidance from a nutritionist to prevent weight gain under any circumstances, whether using antidepressants or any other type of medication.
Are antidepressants always effective?
Not necessarily. Although they are highly effective in many cases, they will not always be the best medicine for a person with depressive symptoms.
As already said, each organism reacts in a different way and that is precisely why there are different types of antidepressants. Unfortunately, just one was not enough to cover all the people in the world who suffer from depression.
Nowadays, research continues to be done, as there are still many cases in which the patient simply does not respond to any type of antidepressant.
In these cases, however, treatment is mostly done through psychotherapy, in order to help the patient to deal better with his symptoms and learn new healthy behaviors, in addition to identifying what ails him and getting rid of it.
Are the side effects the same for everyone?
No . In reality, side effects can be completely different from one person to the next! This is because everything depends on the organism of each one, the way the medicine is metabolized in each body, the needs of the patient, among others.
Do antidepressants work as a placebo effect?
Definitely not! This myth comes from the idea that depression is just a “state of mind” that can be combated with positive thoughts, when, in fact, it is a serious mental disorder.
Just because the disease manifests itself in the mind, it does not mean that it is cured simply by thinking positive. Unfortunately, the hole is further down.
Yes, there are cases of people who have improved with placebo pills, but they are in the minority. This antidepressant effect usually occurs at the beginning of treatment, before the medication actually starts to take effect.
In cases where there is actually an abnormality in the production and availability of neurotransmitters, the placebo is not effective as a drug in fact.
That’s because the placebo effect disappears with the habit of taking the medication. The easiest way to explain this issue is through an example:
Maria feels depressed, goes to the psychiatrist, is diagnosed with a depressive disorder and starts taking the medication. In the first few weeks you feel an improvement. This initial improvement can be explained by the placebo effect.
As Maria is taking the medication and believes it will improve, she begins to feel signs of improvement even though the medication has not started to take effect yet.
If Maria was taking a medication that is in fact a placebo, after some time, when she has already made taking the medication a daily habit (when taking the pills is an automatic process), the placebo effect will disappear and the symptoms depression will come back, as she is no longer actively aware that she is taking a medication to improve her symptoms.
However, if Maria is actually taking a medication and not a placebo, the symptoms, if the medication works, will not come back even after Maria has already made taking the medication a daily habit.
Thus, it is clear that the antidepressant does not work like a placebo, since, unlike the placebo, once the ingestion of the medication becomes a habit, the symptoms do not appear again.
Do antidepressants damage the brain?
There is no evidence that antidepressants compromise the integrity of the brain, even in the long run. If the medication is taken correctly, the risks of having any sequelae from the use of the medications are practically nonexistent.
There are, however, some monoaminoxidase inhibitors whose effects are irreversible, that is, after taking the medication, the action of monoaminoxidase will no longer be the same.
However, this type of antidepressant is not widely used today. So, you will hardly have to worry about it.
Do antidepressants affect sex life?
Yes. As stated in the “Side effects” section, some of the neurotransmitters on which antidepressants act are responsible for regulating sexual function. Therefore, it is possible that your libido increases, due to the improvement of depressive symptoms, or decreases, as a side effect of the medication, and it is possible that there is a reduction in libido in men and women. Those who take antidepressants can drink alcohol ?
This issue is a little complicated, as it depends a lot on several factors, including the type of antidepressant, the dosage, among others. The general recommendation is that alcohol should not be ingested when being treated with antidepressants and other psychotropic medications.
Some psychiatrists allow the use of alcohol along with antidepressants, as long as they are in low doses. It is worth remembering, however, that there is no safe dose of consumption in conjunction with antidepressants.
There are several cases of famous artists who took the medicine and died shortly afterwards due to alcohol ingestion in a short period of time. It is a narrative that we have seen several times, and it is not something that should be repeated.
In cases where the psychiatrist lets the patient drink alcohol, the tip is to take the dose of the medication a long time before or after drinking. This without disrespecting the schedules of doses, of course.
If you use antidepressants and want to have a good weekend drink with friends, talk to your psychiatrist. Only he will be able to tell if there are major risks involved.