antidepressants

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Introduction

Antidepressants are medications used in the treatment of depression, but many can also be used in conditions such as anxiety disorders and obsessive compulsive disorder. Most antidepressants are taken orally.

What we already know

Antidepressants can be divided into six groups, based on their mechanism of action:

  1. Selective Serotonin Reuptake Inhibitors (SSRIs)“ e.g. Citalopram, Sertraline
  2. Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs)“ e.g. Venlafaxine, Duloxetine
  3. Noradrenergic and Specific Serotonergic Antidepressants (NaSSAs) e.g. Mirtazapine
  4. Tricyclic Antidepressants (TCAs)“ e.g. Amitriptyline, Imipramine
  5. Monoamine Oxidase Inhibitors (MAO-Is) e.g. Phenelzine, Moclobemide
  6. Miscellaneous“ e.g. Bupropion, Trazodone, Reboxetine

Side effects depend on the mechanism of action and can vary from person to person.

NICE guidelines suggest use of antidepressants in moderate or severe cases of depression only. The risks of antidepressant medication use in mild depression outweigh the risks, so other forms of therapy are recommended in these cases.

Areas of uncertainty

  • The exact mechanisms of action – we are yet to find out exactly why and how many of the antidepressants work (there are inconsistencies in the monoamine theory of depression)
  • How to limit side effects associated with antidepressant use
  • Using antidepressants in special groups -“ limited data exists for which antidepressants (if any) are best to use in pregnant women, children and the elderly

What’s in the pipeline

  • Ketamine has been shown to have promising antidepressant effects, although further randomised placebo-controlled trials are needed (Coyle and Laws, 2015)
  • Research is ongoing into the biological causes of depression and it is hoped that when this is better understood, therapy can be targeted towards the exact cause
  • Further research is also being conducted into the long term effects of antidepressants

References

NICE guidelines CG90 (2009) ‘Depression in adults: The treatment and management of depression in adults’ [PDF]

Semple, D. and Smyth, R. (eds.) (2013) Oxford Handbook of Psychiatry. 3rd ed. Oxford: Oxford University Press. (Publisher)

Coyle, C. M. and Laws, K. R. (2015), ‘The use of ketamine as an antidepressant: a systematic review and meta-analysis.’ Hum. Psychopharmacol Clin Exp, doi: 10.1002/hup.2475 [Abstract]

Acknowledgement

Written by: Josephine Neale
Reviewed by: Helge Hasselmann
Last updated: Sep 2015
Review due: Sep 2016

Our antidepressants Blogs

Antidepressant withdrawal: reviewing the paper behind the headlines

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Joseph Hayes and Sameer Jauhar set the record straight on antidepressant withdrawal. They show how the recent review by Davies and Read is seriously flawed and does not accurately portray the data. They conclude that we urgently need clearer evidence on the incidence, severity and duration of any symptoms related to antidepressant withdrawal.

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Preventive cognitive therapy when continuing or tapering off antidepressants

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Linda Gask is encouraged by the findings of a new high quality RCT (the DRD study), which compares preventive cognitive therapy while tapering antidepressants versus maintenance antidepressant treatment versus their combination in the prevention of depressive relapse or recurrence.

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“Where I End And You Begin”: A personal commentary on Russo’s ‘Through the eyes of the observed’ #PsychDrugDebate

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Sarah Carr shares her own experiences of psychiatric medication and provides a critical reading of Jasna Russo’s new #PsychDrugDebate paper: ‘Through the eyes of the observed: re-directing the research on psychiatric drugs’.

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How should we redirect research on psychiatric drugs? #PsychDrugDebate

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Alison Faulkner dissects the new McPin Foundation Talking Point Paper by Jasna Russo entitled: Through the eyes of the observed: re-directing research on psychiatric drugs.

Follow #PsychDrugDebate today on Twitter for further discussion about this vital issue.

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Polypharmacy for major depression: is practice evidence-based?

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Jessica Bone reports on a recent cross-sectional study that looks at the clinical correlates of augmentation/combination treatment strategies in major depressive disorder.

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SSRIs and suicidality: effects of SSRIs on rating-scale-assessed suicidality in adults with depression

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Rina Dutta and Patrick McLaughlin summarise a new study looking at the effects of SSRIs (Selective Serotonin Reuptake Inhibitors) on rating-scale-assessed suicidality in adults with depression.

This study published in the British Journal of Psychiatry supports the conclusion that SSRIs remain a safe and effective treatment in depression for those aged 18 and over.

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Antidepressants can help adults with major depression

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André Tomlin reports on a new network meta-analysis that brings together the best available evidence comparing the efficacy and acceptability of 21 antidepressants for the acute treatment of adults with major depressive disorder.

This groundbreaking review of 522 trials is the largest ever meta-analysis in psychiatry, and finds that antidepressants are more effective than placebo for short-term treatment of acute depression in adults.

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What causes emotional blunting in people taking antidepressants? Results from a survey

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Linda Gask looks at a recent survey of people with depression that explores their experiences of emotional blunting. The research finds that nearly half of depressed patients on antidepressants report significant emotional blunting, but it’s impossible to say whether this is caused by their medication or the depression itself.

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Antidepressants for depression in schizophrenia: when good-enough evidence is good enough

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Carmine Pariante is positive about a recent systematic review and meta-analysis of antidepressants for the treatment of depression in schizophrenia.

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Medication for mental health: Oral health impacts

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This review of the side effects of medications prescribed for the management of mental health highlights their potential impact on oral health. The commonest problems being xerostomia.

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