A is for Antidepressants

I am participating in the Blogging from A to Z Challenge (April 2014). For more information, click the link. Just to summarize, there are 26 letters in the alphabet and 26 days in April excluding Sundays. Each day gets a different letter (in alphabetical order) and you have to write about something that starts with that letter. Today is April 1st, so today’s letter is A. Since a lot of my posts are about my experiences with mental health, I’m going to stick to that theme.

A is for Antidepressants

Usually I post a doodle with my posts. Antidepressants were kind of boring to draw, so we’ll go with another “A”, Alice in Wonderland.

wonderland

When I was prescribed antidepressant medication for the first time, I didn’t know much about depression, never mind the medications and what was right for me. I just went with whatever the doctor said because doctor knows best, right? Wrong! The doctor knows the medications, their interactions and the general biology of how they work, but only you know you best. To find the right antidepressant for you, you have to work together with your doctor. Here is what I wish I knew at the beginning of my antidepressant experience.

1. Do your research. Know the different types of medications, what they do and the associated side effects. Here is a cheat sheet for you:

  • Selective Serotonin Re-uptake Inhibitors (SSRIs). These hit in the market in the 80s and are the most widely used class of antidepressants today. They are typically used to treat anxiety and depression. SSRIs increase the activity of the neurotransmitter serotonin the brain. Serotonin has been linked to feelings of well-being and happiness. The function of serotonin is inhibitory, it tends to decrease, appetite, sexual behaviour, aggression and pain perception.
  • Serotonin and Norepinephrine Re-uptake Inhibitors (SNRIs). This is a newer class of anti-depressants, most often used for depression and mood disorders. They are less often used to treat anxiety and relieve symptoms of menopause. They work similarly to SSRIs in that they increase neurotransmitter activity in the brain, but they act on norepinephrine in addition to serotonin. Norepinephrine is associated with concentration and alertness.
  • Tricyclic Antidepressants (TCAs). These were one of the earlier classes of antidepressants, developed in the 1950s. They have basically been replaced by the above two categories because those have more favourable side effects. There are different types of TCAs, some act on serotonin or on norepinephrine, or both.
  • Monoamine Oxidase Inhibitors (MAOIs). These were the first antidepressants developed. They work well, but are not often prescribed because of the adverse reactions they have with certain food and medications.
  • Atypical Antidepressants. These are all different and don’t fit into any of the previous categories. These are a few examples.
    Bupropion (Wellbutrin, Aplenzin) – Welbutrin acts on norepinephrin and dopamine. Dopamine is a neurotransmitter associated with the brain’s reward center. Side effects are usually mild.
    Mirtazapine (Remeron) – This one interacts with norepinephrine and serotonin. It is mostly used for depression and mood disorders, but is also used as an appetite stimulant. It is recommended to be taken at night.
    Trazodone (Desyrel) – This one interacts with serotonin. It is used for depression but also has anti-anxiety and sleep-inducing properties. It needs to be taken with food to decrease stomach side effects.
    Vortioxetine (Brintellix) – This one was approved only last year! It works on various neurotransmitters including serotonin, glutamate, GABA and histamine. The side effects are supposed to be minimal and it is supposed to help with the cognitive symptoms caused by depression.

2. Know your symptoms. Do you have trouble sleeping? Are you chronically low on energy? Do you have anxiety as well? If you aren’t sure about the answers to some of these questions, ask someone you see on a daily basis. They might have picked up on something you’re missing. Knowing the answers to these questions could help you and your doctor narrow down your options. You want to find a medication that will alleviate your symptoms and not exacerbate them.

3. Know your family history. If someone in your family is successful on an antidepressant, it is likely you will be too. Of course, the closer the relative, the better the chance you have. I tried three different medications before I found out my aunt had depression and was on Prozac (fluoxetine). Now I’m on it and my body tolerates it quite well. Something like this is often a good starting point.

4. Give the medication a chance to work (or not). Don’t worry if it doesn’t work right away. To notice a difference, it takes time for there to be a high enough concentration of the drug in your body. You may notice some changes right away too. They could be good or bad. This does not reflect how you will feel over the long term. Give these effects a chance to settle into something stable.

5. Watch for side effects. Some medications come with nasty side effects. These could outweigh the benefit the drug might give you. I have heard Remeron and Paxil are notorious for weight gain. Since I have body image issues, I’m not going near those. I’ve also had an interesting experience with Effexor (venlafaxin). It worked really well, but if my timing was off, I’d start to get crazy mood swing and brain zaps. It’s like the shock you sometimes get when you close a car door in the heat, except in your head. It’s not fun. Although Effexor helped me a great deal, it wasn’t worth the side effects.

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