Types Of Antidepressants: Characteristics And Effects
Mood disorders are, after anxiety disorders, the most prevalent in the population. Within these types of disorder, depression is the best known and most common. And to confront this type of psychopathology in the field of medicine, Different types of antidepressants have been developed which are psychotropic drugs relatively commonly used in the world of psychiatry.
In this article you will find a summary of the different varieties of antidepressants, as well as what these medications are for, and the precautions that must be taken when using them due to the risks associated with these substances.
The main objective of the different types of antidepressants is to treat depression It is a disorder that causes major problems in practically all areas of human life, affecting cognitive, emotional and interpersonal aspects. For this reason, its treatment is one of the great objectives of psychology and psychiatry, developing different types of treatments both psychologically (such as cognitive-behavioral treatment) and pharmacologically, in the form of antidepressants. In fact, the use of medications of this class is one of the main resources of psychiatry in helping depressed people; hence this group of drugs is called “antidepressants.”
Regarding the latter, Research throughout history has produced numerous types of antidepressants in order to produce an improvement in depressive symptoms, avoiding side effects as much as possible.
At a clinical level, depression is considered to be a condition in which a sad mood occurs (which can be seen as irritable in the case of childhood depression) together with the absence of motivation and the experience of pleasure, together with other symptoms such as problems sleep or weight.
Depressed people tend to present a high level of passivity at a vital level, feeling that they have little control over their lives and frequently appearing feelings of hopelessness. Those who suffer from depression therefore present a high level of negative affect, along with a low positive affect and, in general, usually present a low level of activation at both a mental and physiological level.
Thus, the different types of professionals who are in charge of working in order to improve the situation of these people must find methods and mechanisms that allow them to face these difficulties, having created from pharmacology the different types of antidepressants which are described below.
Main types of antidepressants
Different antidepressants have different mechanisms of action, but the main hypotheses and treatments explain depression from the degradation of monoamines and/or serotonin, so the antidepressants created mainly focus on preventing the degradation of these substances and maintaining them for longer. time in the synaptic space.
These are the first antidepressants discovered. Its action is based, as in the rest of the types of antidepressants, on prevent the degradation of monoamines, concentrating on a particular enzyme This enzyme is monoamine oxidase, which is emitted from the presynaptic neuron when it captures an excess of monoamines in the brain synapse in order to eliminate said excess. Thus, eliminating or blocking this enzyme prevents the degradation of monoamines in the synaptic space, resulting in greater availability of these neurotransmitters.
However This type of antidepressant presents a high health risk, since in interaction with substances containing thiamine (a substance that is easily found in a wide variety of foods) it can cause hypertensive crises, along with other unpleasant side effects. For this reason, they are mainly used in cases where other antidepressants have not shown any effect.
Types of MAOIs
Within MAOIs we can find two subtypes. The first subtype is irreversible monoamine oxidase inhibitors, whose main mechanism of action is the complete destruction of this enzyme, meaning that until it is regenerated again, its basic functionality is lost. This type of antidepressant is the one that presents the greatest risk, its interaction with other substances rich in thiamine being dangerous and the foods to be consumed must be carefully monitored to avoid serious health problems.
A second subgroup is reversible monoamine oxidase inhibitors or RIMAs, which are preferable to other types of MAOIs because they do not pose such a high risk nor do they tend to interact with diet. Its operation is based on temporarily inhibiting the function of the enzyme. Moclobemide is one of the substances that are part of this type of antidepressants.
2. Tricyclic and tetracyclic antidepressants
These drugs are, after MAOIs, the oldest and what for a long period of time were the most used antidepressants. Its mechanism of action is based on preventing the reuptake of serotonin and norepinephrine. However, its action is nonspecific, affecting other hormones such as acetylcholine, histamine and dopamine. Because of this, it can have serious side effects and even be addictive.
Overdosing on these types of substances is potentially fatal For these reasons and with the discovery of new substances, they are no longer used as much, but can continue to be found in clinical practice due to their greater effect in cases of severe depression.
3. Selective Serotonin Reuptake Inhibitors or SSRIs
Selective serotonin reuptake inhibitors are currently the type of antidepressant most used in clinical practice, being the treatment of choice in cases of depression, among other things because the side effects they produce are not as intense as those of other drugs. drugs used for the same purpose.
These are psychotropic drugs that act by specifically inhibiting the reabsorption of serotonin, not presenting effects on other neurotransmitters. Although they may produce some side effects, these are usually mild (nausea, vomiting or light sedation among others), they are one of the safest classes, being applied in patients who have not had previous contact with antidepressants.
In addition, the relationship between depression and anxiety and the specific mechanism of action of the SSRI means that it has also been used as the treatment of choice in some anxiety disorders.
4. Selective Serotonin and Norepinephrine Reuptake Inhibitors or SSRIs
This type of antidepressant, its best-known exponents being venlafaxine and duloxetine, acts on serotonin and noradrenaline as occurs with tricyclics The main difference with this other type of antidepressant is in its specificity, that is, while dual inhibitors of serotonin and norepinephrine have an effect only on these two neurotransmitters, tricyclics have an effect on other substances such as acetylcholine, which can produce side effects.
Since they work not only on serotonin but also on norepinephrine, these drugs show a relatively faster effect than other substances.
5. Selective Dopamine and Norepinephrine Reuptake Inhibitor: Bupropion
Although this substance is best known for being very useful in the detoxification of nicotine and other substances, Bupropion has been shown to have positive effects in cases of depression acting by inhibiting the transport of dopamine and norepinephrine.
Other classification: atypical and typical antidepressants
This other way of categorizing antidepressant psychotropic drugs draws a very general image of how they work, so in practice it is not very useful, although it helps to locate oneself without going into many details. On the one hand, the concept of typical antidepressants contains all those antidepressants that work in a similar way, normally by increasing the amount of norepinephrine and serotonin in the synaptic spaces in the neurons of the brain. On the other hand, atypical antidepressants are a second generation of antidepressants that encompasses medications with very different mechanics of chemical action among them, and act as a kind of “catch-all”.
Risks and side effects
Like all psychotropic drugs, the use of different types of antidepressants can entail various risks and side effects. It must be taken into account that between the first administration of an antidepressant and its therapeutic action, in general, between two and four weeks can pass because the neurons have to carry out a process of adaptation and modification of their receptors, especially in the related to serotonin.
However, the presence of side effects may occur before noticing its therapeutic effects, which is why treatment with antidepressants is usually discontinued and often abandoned. Some of the symptoms and risks of consuming the different types of antidepressants available are as follows.
Dependence
Some types of antidepressants can generate tolerance and dependence, an example of this being tricyclics. Likewise, abrupt cessation of consumption can generate withdrawal syndromes and rebound effects, making it necessary to schedule both its consumption and its cessation. That is why sometimes it is not recommended to make a sudden withdrawal of consumption, but rather a more gradual one that allows the body to adapt to the new situation.
Overdose
Taking an excessive amount of antidepressants can lead to poisoning and overdose, the latter could be lethal. Tricyclics are some of the drugs that have recorded cases of this phenomenon, a fact that must be evaluated when medicating patients with suicidal ideations.
This type of side effect is one of the biggest risks that MAOIs cause. It is due to the interaction of this substance with substances rich in proteins and thiamine, common elements in food. Thus Strict control of diet and blood tests are necessary to prevent problems
Sexual and genital symptoms
Taking some antidepressants sometimes produces a decrease in the libido of those who take them, decreasing desire or potentially causing situations such as anorgasmia or delayed ejaculation. This occurs because the hormonal imbalance produced by the consumption of these substances is very noticeable in sexual behavior, as it is very sensitive to these types of changes.
Drowsiness and sleep problems
Many types of antidepressants cause drowsiness and sedation as a secondary symptom. Others, such as MAOIs, They can suppress paradoxical or REM sleep also producing problems when consolidating new knowledge.
Manic symptoms
Some substances cause you to go from a depressed state to a manic state. An example of this is bupropion.
Other somatic and gastrointestinal symptoms
The presence of nausea and vomiting is common when taking these substances as well as headaches and tremors. In fact, these types of symptoms are the most common secondary symptoms during the consumption of antidepressants, being generally mild. Many of these alterations appear initially and disappear with the appearance of tolerance to the substance.
What are the safest types of antidepressants?
It is difficult to talk about the safest antidepressants in general, since this will depend on several factors, such as the individual’s general health, their gender, whether they are taking other medications, or the specific depressive symptoms they are suffering from.
For example, although in the case of pregnant women it is recommended not to use antidepressants in general, it is considered that in cases in which it is essential to resort to psychotropic drugs for depression, the least dangerous tend to be SSRIs such as escitalopram or fluoxetine. On the other hand, In addition to SSRIs in general, there are some atypical antidepressants that stand out for being safer than most, such as mirtazapine and agomelatine Of course, in all cases they should be used under strict medical supervision and without ignoring their instructions.
In any case, do not forget that no psychotropic drug is risk-free, and even the safest types of antidepressants can lead to the appearance of severe health complications, as occurs with many other medications in general; However, the chances of this happening are low enough that it is worth using them if the health professional who has studied your case considers it so. Furthermore, if your doctor does not prescribe one of the psychotropic drugs that we have seen in this list of products that are safer than the rest but rather another, don’t worry; It is still not dangerous enough to be marketed, and perhaps it has certain characteristics that make it inadvisable to start treatment with those medications that would have calmed you down more. As a patient, do not assume that you know better than the doctor what is best for you.
