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 benefits, so other forms of therapy (e.g. CBT) 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
  • How many people experience withdrawal effects and how best to withdraw from antidepressants
  • 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
  • Research aimed at developing more personalised treatment for depression is also underway

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: Jun 2019
Review due: Jun 2020

Our antidepressants Blogs

Maintenance or discontinuation of antidepressants for depression? Findings from the ANTLER trial

For every 6 people stopping their medication there was one additional relapse compared to those who maintained their antidepressant treatment, suggesting that stopping medication has an increased risk of relapse.

Raphael Rifkin-Zybutz and Sameer Jauhar summarise the recently published ANTLER trial, which explores whether antidepressant maintenance can reduce the risk of relapse in depression.

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Psychotherapy and antidepressant tapering can help people at risk of depression relapse, but more evidence needed before we can provide personalised treatment

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Jessica Scaife reviews a individual patient data meta-analysis exploring the continuation of antidepressants versus sequential psychological interventions to prevent relapse in depression.

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The benefits and harms of antidepressants for youth depression and anxiety #ActiveIngredientsMH

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Mark Horowitz and Joanna Moncrieff consider a new #ActiveIngredientsMH review published today in The Lancet Psychiatry, which looks at the knowns and unknowns of antidepressant treatment in young people with depression and anxiety: efficacy, predictors, and mechanisms of action.

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Expertise from outside the Academy: tapering off antidepressants

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Mark Horowitz considers a recent article written by Adele Framer, Founder of SurvivingAntidepressants.org, which describes how best to help people who are tapering off antidepressants.

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Turn on, or tune out? Is psilocybin assisted therapy close to becoming a first-line treatment for depression?

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James Rucker and Sameer Jauhar summarise a recent RCT on the effectiveness of psilocybin assisted therapy versus escitalopram assisted therapy for major depressive disorder.

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Antidepressant discontinuation and continuation: new Cochrane review finds miasma of confound

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Adele Framer, Founder of SurvivingAntidepressants.org, explores a recent Cochrane review on antidepressant discontinuation versus continuation for adults with depression or anxiety, which highlights huge uncertainty in the science about antidepressant withdrawal.

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Many men do seek help prior to suicide, but are services adequately designed to assess men’s needs?

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Cara Richardson summarises a qualitative photovoice study, which finds that some men who died by suicide did seek help before their death, but the help given was often ineffective.

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Living in anxious times? The rise of anxiety disorders in the UK

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Alice Grishkov and Derek Tracy explore a recent paper, which finds that generalised anxiety disorder is on the rise in the UK, especially in young women.

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Majority of people with ADHD in Ireland still thought to be untreated, despite increase in treatment rates

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In her debut blog, Poppy Ellis Logan summarises a longitudinal study which finds rates of ADHD prescription increased in Ireland between 2005 and 2015.

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Antidepressants and psychotherapy for adolescent depression: can they be compared? #ActiveIngredientsMH

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Catherine Harmer summarises a recent network meta-analysis relating to her own Wellcome Trust funded research into antidepressants for young people with anxiety or depression.

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