Antidepressants: Everything You Need to Know

Depression can be devastating, making you feel empty, hopeless, and helpless. At one point during the pandemic in 2020, over 30% of Americans reported experiencing depressive symptoms, according to a survey by Statista. Seeking treatment for major depressive disorder can be a frustrating process. In our society’s health care system, antidepressants are often the first line of defense. Over 13% of American adults were taking antidepressants before the pandemic, and that number is believed to have increased dramatically. But are they effective? And what types are there?

HOW EFFECTIVE ARE ANTIDEPRESSANTS?

Antidepressants may work for some people, but it can take a few weeks or a few months to see results, and they don’t work for everyone. Treatment-resistant depression is alarmingly common. In fact, one study states that “only one-third of patients with depression respond fully to treatment with antidepressant medication.” Other research suggests the symptom remission rate lies somewhere between 30%-50%, similar to the results from taking a placebo or from engaging in psychotherapy. That’s the sad truth about antidepressants. Antidepressants may work for some people with depression, but they don’t work for everyone.

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In part, this is because depression isn’t just one thing. The brain SPECT imaging work at Amen Clinics shows that there are 7 types of depression and anxiety. In addition, depression is a symptom that is associated with many causes, including head trauma, inflammation, infections (including COVID-19 and Lyme disease), neurohormonal imbalances, diabetes, obesity, sleep disorders, and exposure to toxins. No single medication can treat all 7 types of depression or all underlying causes. They all need targeted treatment plans. Are antidepressants right for you? It depends on your individual symptoms and on your brain. A growing body of research, including studies in The American Journal of Psychiatry and Nature Human Behaviour, suggests that brain scans can help predict how well a person will respond to depression treatment with antidepressants. Here’s what you need to know about commonly prescribed types of antidepressants.

ANTIDEPRESSANT TYPES: WHAT ARE SSRIs?

Selective serotonin reuptake inhibitors (SSRIs) are generally the first line of treatment for depression, making them the most commonly prescribed antidepressants in the U.S. SSRIs are believed to work by increasing the availability of serotonin in the brain. They don’t cause the brain to produce more serotonin, rather, they enhance the ability to use the neurotransmitter more effectively. Serotonin is a neurotransmitter that is involved in mood, sleep, and cognitive flexibility. It helps you be open and adaptable to change. Low levels of this feel-good neurotransmitter are involved in depression, anxiety, worry, poor memory, pain, aggression, suicidal behavior, poor self-esteem, being oppositional or argumentative, and being rigid or cognitively inflexible. Researchers have found that serotonin receptors are plentiful in a region of the brain called the anterior cingulate gyrus (ACG). Think of the ACG as a gear shifter that helps you go from thought to thought or from one action to another. Brain SPECT imaging shows that high activity in the ACG is associated with depression and low levels of serotonin in the brain. It’s as if the gear shifter gets stuck, so you get stuck on negative thoughts and behaviors. In a way, SSRIs act like grease for the brain’s gear shifter, the ACG. They can be beneficial for a specific type of depression that Amen Clinics refers to as “over-focused depression.” In this type of depression, the ACG works too hard and is associated with being over-focused, worried, rigid thinking, inflexibility, being argumentative and oppositional, and holding grudges. Serotonin can help calm overactivity in the brain. However, if you also have low activity in the prefrontal cortex, which is seen in people with impulsivity, poor judgment, and lack of motivation, this medication can make a person more disinhibited, impulsive, and unmotivated. There are several SSRIs on the market, including:

• Lexapro: This is the most commonly prescribed SSRI.
• Prozac: This was the first medication in the SSRI class to hit the market in the 1980s. Prozac tends to last in the body for a long time, and the side effects can linger for a long time. Typically, Lexapro is a better option than Prozac.
• Paxil
• Zoloft
• Celexa
• Luvox

ANTIDEPRESSANT TYPES: WHAT ARE SNRIs?

Serotonin-norepinephrine reuptake inhibitors (SNRIs) change brain chemistry by increasing the availability of both serotonin and norepinephrine in the brain. As described earlier, serotonin is involved in mood regulation, sleep, and flexible thinking. Norepinephrine is a neurotransmitter that plays a role in the body’s fight-or-flight response and increases alertness, attention, and arousal. SNRIs provide a dual action—calming worries and rigid thinking while also enhancing energy and mental clarity. They can be beneficial in people who feel sad, blue, or negative and who have low energy, poor memory, or brain fog. In a meta-analysis of head-to-head studies, SNRIs have been shown to be more effective than SSRIs. Some of the most commonly prescribed SNRIs include:

• Pristiq
• Effexor
• Cymbalta

ANTIDEPRESSANT TYPES: WHAT ARE NDRIs?

Norepinephrine-dopamine reuptake inhibitors (NDRIs) are antidepressants that increase the availability of norepinephrine and dopamine in the brain. As explained earlier, norepinephrine is associated with alertness and energy. Dopamine is a neurotransmitter that is involved with mood, motivation, and attention. In some people with depression, NDRIs can be beneficial by increasing energy, mood, and motivation. This type of antidepressant may also be recommended for people who have both depression and ADD/ADHD, since dopamine tends to be low in those with this condition. However, it is not recommended for everyone. In people who tend to be anxious, it can make them more anxious. In those who tend to be obsessive tendencies, it can make them more obsessive. The most common NDRI prescribed for depression is:

• Bupropion (Wellbutrin)

ANTIDEPRESSANT SIDE EFFECTS

All medications come with side effects. Some of the common side effects associated with antidepressants include:

• Weight changes
• Sexual problems
• Trouble sleeping
• Anxiety
• Dizziness
• Dry mouth
• Headache
• Gastrointestinal issues
• Restlessness
• Constipation
• Sweating
• Appetite changes
• Nausea
• Vomiting

At Amen Clinics, the side effects that patients complain about most are weight gain and sexual problems. In terms of weight, some antidepressants, such as SSRIs, may alter metabolism. And because they decrease function in the front part of the brain, which can diminish impulse control, leading to poor food choices. As for libido, SSRIs and SNRIs, but not NDRIs, are associated with erectile dysfunction, a lack of desire, and difficulty reaching orgasm—all of which can have detrimental effects on relationships and quality of life.

NATURAL STRATEGIES TO TREAT DEPRESSION

Antidepressants may be helpful for some people when targeted to their symptoms and brain, but they should never be the first or only thing you do for depression. There are many natural strategies for depression that can increase serotonin, balance dopamine, boost moods and motivation, improve energy, and enhance mental clarity. Adopting some simple lifestyle changes—including a brain healthy diet, physical exercise, and brain-directed nutraceuticals— can have a dramatic impact. Depression and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.