Antidepressants: Everything You Need to Know

Antidepressants

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. Click To Tweet

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.

14 Comments »

  1. Curious as to why Citalopram is not listed or referred to.
    I found this medication to be extremely effective.

    Comment by Rick — October 17, 2022 @ 3:28 AM

  2. I was diagnosed with Anxiety Disorder years ago and have been struggling on and off since.
    I’ve had day where I can’t function , been hospitalized in the past and days of just gloom and doom where I will just sleep. I can go months without out it but when it hits it’s really bad. The fall seems to trigger it and I’m in a bad state again and need help. I saw my doctor and she put me on a new med after being on Prozac for years which I knew wasn’t working anymore. Where are you located? I need to do something. I can’t live the rest of my life like this!! Thank you.

    Comment by Debbie — October 17, 2022 @ 4:36 AM

  3. What about fluoride in antidepressants? I only recently learned that these antidepressants contain fluoride, which I find concerning. I’ve tried stopping them, with no success. I’ve cleaned up my diet, walk and move more, try to get adequate sleep…nothing else helps.

    Comment by Malena — October 17, 2022 @ 4:56 AM

  4. Although I appreciate the article for its educational basis… I am surprised coming from your website. You have seen the damage of drugs on the brain and know better than others the actual damage prescription drugs do to a brain. It is a slippery slope to head down that road for not falling off the cliff to a lifetime of drugs. My mother died with parts of her brain atrophied and holes like a lobotomy from a lifetime of prescription drugs… that for the most part were experimental. I guess I had a higher bar for your standards for providing greater information for alternatives without damaging the brain.

    Comment by Michelle D Richeson — October 17, 2022 @ 8:37 AM

  5. This article, which reflects your general stance and message on antidepressants, is dismissive and irresponsible. I have dealt with major depressive disorder for more than 40 years – and I know many people who are surviving the same. It certainly isn't a small percentage of the general population; please revisit the data. You intimate that in most cases, antidepressants are not needed and that "simple" lifestyle changes can fix the problem. It's unconscionable. Of course lifestyle and perspective changes are essential components of thriving in life; this is true for anyone facing imbalances within their daily living choices. What you may be describing are not cases of diagnosed depression, but rather, acute cases of trauma or tragedy through which people need support. Logic easily suggests that scans for them wouldn't show conclusive evidence correlated with diagnosed depression! I aver that in most cases of long-term depression diagnoses, an antidepressant is key to unlocking the door that blocks a person with mdd from making sustainable progress. If your business is all about brain scans that conclusively show changes connected to depression, it is unethical of your company to imply that it isn't a medical condition, one that requires medication. The tone of your article and stance provide fodder for the continual stigma associated with people admitting to their depression diagnoses and the devastating impact on their lives. Shame on you for making money off of people's pain.

    Comment by Susan — October 17, 2022 @ 8:43 AM

  6. You should discuss the absolute horrific withdrawals and lack of care and proper tapering off these drugs. I see this as one of the most pressing issues, especially for people that have been on for numerous years. Protracted acute withdrawal syndrome (PAWS) is equivalent to heroine and alcohol detox causing akathisia, seizure like uncontrollable body movements, severe insomnia, dramatic weight loss, panic attacks, crying spells, severe brain fog and more. This needs to be a top priority of psychiatrists, as no one knew how to handle other than putting you back on the med. Finally being off and healed has shown me how detrimental the withdrawals are and it was NOT original symptoms returning. Please do more work around helping people taper safely and providing informed consent for those looking to go on these.

    Comment by Andrea — October 17, 2022 @ 9:15 AM

  7. What about the tricyclic antidepressants? These are still prescribed for people who do not respond to the above mentioned categories. And they can be very effective for treating MDD. Yes, there are some unpleasant side effects. But the benefits greatly outweigh the risks. I wish you would write about this class of antidepressants. Dated, perhaps. But still effective!

    Comment by Stephanie — October 17, 2022 @ 11:07 AM

  8. What can you tell me about Mirtazapine. Is it good for anxiety and depression?

    Comment by Kathy Belair — October 17, 2022 @ 11:53 AM

  9. Thank you for his info. I take Lexapro. Prescription is for up to 2 times daily. I am down to 1/2 at supper time.

    Comment by M. Fredell — October 17, 2022 @ 4:43 PM

  10. I don't see mentioned the side effect (for men) of inhibited urine flow/prostate? I would happily take zoloft (and have to positive effect mentally) were it not for that side effect- seems to actually squeeze the urethra. I know prostate is a 65+ issue but zoloft definitely made it worse- wellbutrin 300mg seems tolerable but still painful urination; would like to go higher for otherwise beneficial effects (focus, energy), but cannot abide the bathroom problem getting worse.

    Comment by David Clear — October 17, 2022 @ 6:57 PM

  11. How do you prevent "Serotonin Syndrome" that causes STROKE.

    Comment by jeff otte — October 18, 2022 @ 2:32 AM

  12. What is your take on micro dosing mushrooms when all else fails?

    Comment by Lana — October 19, 2022 @ 10:29 AM

  13. I have failed 9 different antidepressant medications. In utter desperation, I turned to ketamine infusions and they saved my life and put me on a better path. Every single antidepressant I was on caused weight gain, sweating, sleeplessness, anxiousness, and all sorts of other unpleasant side effects. None of them worked. With SSRIs and SNRIs we are using archaic technology and it is high time for a revolution for mental health. I understand, and mostly agree with, your stance on turning away from chemicals and medications. However, in addition to lifestyle changes (which I have made), there needs to be greater support for the millions of us suffering with mental health issues. Not all of us can afford CBT or EMDR, at copays of $25 – $50/session. Ketamine cost me thousands, but I was absolutely suicidal, and the inpatient mental "healthcare" system is horrifically broken – attempting to use that avenue merely further traumatized me.
    Mental healthcare in this country, and probably worldwide, needs an enormous upheaval.
    I would love to try your clinic, and the brain SPECT scanning, but at a cost of several thousand dollars, once again, only the rich can afford to be cared for.
    This has to change – for too long now, suicide has been the third leading cause of death in the US. Healthcare leaders/practitioners/physicians should be horrifically ashamed of that statistic!

    Comment by Kat — October 20, 2022 @ 8:14 AM

  14. We went to the Amen clinic in Dallas summer before last. We got Spect scans for both our adoptive kids, and we got supplements recommended. You have no one in Wyoming who could help us after that. Let me know when you do.

    Comment by Terry Wills-Cathcart — October 27, 2022 @ 11:39 AM

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