antidepressants

shutterstock_129836540

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

Medication for mental health: Oral health impacts

shutterstock_146973512

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.

[read the full story...]

Off-label antidepressants: limited evidence to support their use

health-1628372_1280

John Baker reports on Canadian study looking at prescriptions of off-label antidepressants in primary care, which concludes that when antidepressants were used outside of their licence, there was usually not strong evidence supporting the respective indication.

[read the full story...]

Antidepressants for depression in Alzheimer’s Disease

mental-health-2211184_1280

The EQUATOR Publication School #EQPubSchool group summarise a systematic review and meta-analysis on the efficacy of antidepressants for depression in Alzheimer’s Disease, which finds no statistical difference between antidepressants and placebo.

[read the full story...]

Depression in later life: who benefits most from antidepressants plus exercise?

walk-1385880_1280

Linda Gask explores an RCT of physical exercise for depression in later life, which considers the best way to customise the intervention for primary care.

[read the full story...]

Antidepressants for bipolar depression: weighing up the benefits and harms

7347845622_508b764a51_k

Murtada Alsaif considers a recent systematic review on the safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabiliser or an atypical antipsychotic in acute bipolar depression.

[read the full story...]

One size does not fit all: divergent outcomes from CBT and antidepressants for depression

4417026016_b8ae7a8cec_b

Suzanne Dash explores a recent meta-analysis of CBT and antidepressants for depression, which looked at negative and positive responses to treatment and what predicted different outcomes.

[read the full story...]

In praise of little: sponsorship bias in depression research

2737146722_8681e3711e_o

Samei Huda welcomes a new meta-analysis of sponsorship bias in the comparative efficacy of psychotherapy and pharmacotherapy for adult depression.

[read the full story...]

Does taking antidepressants during pregnancy harm the child? Here are the facts

baby-boy-shoes-on-belly

Ian Jones summarises a number of studies that consider the benefits and harms of antidepressants during pregnancy, including a recent cohort study that found that exposure to antidepressants in the womb is associated with a modest increased risk of speech and language disorders.

[read the full story...]

Time to stop prescribing antidepressants to young people with depression?

photo-1456397807017-5a6b47d257f4

Andrew Shepherd considers the implications of a recent network meta-analysis of the efficacy and tolerability of antidepressants for children and adolescents with depression.

[read the full story...]

Specialist depression service may help people with persistent depression

photo-1461783436728-0a9217714694

Ben Hannigan reports on a recent RCT of the efficacy and cost-effectiveness of a specialist depression service versus usual specialist mental health care to manage persistent depression.

[read the full story...]