Antidepressants – Medication for Depression

Antidepressants are drugs that are used to treat depression or severe depression. Antidepressants fall under the group of psychotropic drugs (medication for psychological and/or psychiatric complaints) and can also be used to combat or reduce anxiety and panic attacks. Which classic and second generation antidepressants (the brand name and substance name) do you take and what are the side effects, side effects and withdrawal symptoms?

Psychotropic drugs – Antidepressants

Psychotropic drugs can be used to combat or prevent psychological and psychiatric complaints, but they do not eliminate the causes. Psychotropic drugs are often used in mental health care as part of a treatment method and can improve the quality of life of people with psychological complaints, combat a condition or sometimes prevent recurrence of complaints.

Effect of psychotropic drugs

The effect and effectiveness of psychotropic drugs can differ from patient to patient and from situation to situation. In addition, medications/psychotropic drugs always have side effects in addition to their intended effects. It is important to take time, patience and expert guidance to evaluate the dosage, effects, effectiveness and side effects of medications and to adjust their use where necessary. Psychotropic drugs can be divided into/aimed at:

Combating or preventing a depressed mood – Antidepressants.
Combating or preventing psychoses – Antipsychotics.
Combating mood swings – Mood stabilizers.
Fighting Anxiety – Sedatives and antidepressants.
Combating insomnia – Sleep aids.

Please note : This article is for information purposes only. For proper use, application, dosage or modification of antidepressants, it is necessary to consult with an expert physician.

Characteristics or symptoms of depression

What is a Depression

Depression is a condition in which there is (very) severe depression (see further under characteristics).

Characteristics – Symptoms Depression

Characteristics of depression can include:

A gloomy/depressed mood for a long period of time.
Loss of interest in others, in food or in sex.
Feeling worthless or guilty.
Indecision.
Attention and concentration problems.
Fatigue, feeling of exhaustion.
A hunted or inhibited feeling.
Sleep problems (falling asleep and staying asleep)
Suicidal thoughts.

Medication – Antidepressants

Antidepressants are medicines against depression, depressive symptoms or severe depression. Antidepressant medications can also be used to combat anxiety and panic attacks, phobias, and compulsive behavior.

Effects of Antidepressants – Evaluation Use

The effects of this medication may vary from person to person. What is effective for one person may not or hardly be effective for another. With antidepressants, it is often only after 2 to 4 weeks that it can be assessed whether the drug works sufficiently or effectively. If it is not sufficiently effective, the dosage will have to be changed or other medication will have to be prescribed. The use of antidepressants requires thorough and regular evaluation of the effects by an expert doctor or psychiatrist.

Types of antidepressants

Classic and Second generation. There are two types of antidepressants, namely: ‘classic’ and ‘second generation’ antidepressants. They differ in the degree of effect and in the side effects they can cause.

Substance name and brand name

The names of medicines can sometimes cause confusion, as they have both a substance name (generic name) and a brand name. When the patent on a medicine has expired, other manufacturers – apart from the inventor – may also produce the medicine in question. However, they are not allowed to use the brand name.

Substance name cheaper

Medicines provided under the substance name are generally cheaper, while the effectiveness is often the same as that under a brand name. In the overview below, both the substance name and the brand name are given. Brand names are also given of some often prescribed antidepressants abroad (which you can also find on the Internet).

Classic and second generation antidepressants – Brand name and substance name

Classic Antidepressants – TCA	Second generation Antidepressants – SSRI
Substance name	Brand name	Substance name	Brand name
amitriptyline	Sarotex, Tryptizole	citalopram	Cipramil
clomipramine	Anafranil	doxepin	Sinequan
dosulepine	Prothiads	fluoxetine	Prozac
doxepin	Sinequan	fluvoxamine	Fevarin
imipramine	Tofranil	mianserin	Tolvon
maprotiline	Ludiomil	mirtazapine	Remeron
nortriptyline	Nortriles	parexotine	Seroxat
trimipramine	Surmontil	sertraline	Zoloft
		trazodone	Trazolan
		venlafaxine	Effexor

Reversible Monoamine Oxidase Inhibitor – RIMA

In addition to antidepressants, the Reversible Monoamine Oxidase Inhibitor is used for depression, also called RIMA (Reversible Inhibitor of Monoamine Oxidase). Only one of these medications is available in the Netherlands: moclobemide (Aurorix).

MAOIs

For very severe depression where the above remedies do not help, classic MAOIs are sometimes used, such as tranylcypromine (Parnate, Tilcyprine) and in some cases also phenelzine (Nardil).

Foreign brand names of anti-depressants

Brand names abroad (on foreign websites or in English reference works) often have a different name than in the Netherlands, such as:

Citalopram (Cipramil) – Celexa.
Fluoxetine (Prozac) – Fontex, Fluctin .
Fluvoxamine (Fevarin) – Faverin, Luvox .
Mirtazapine (Remeron) – Zispin.
Paroxetine (Seroxat): Paxil, Aropax, Deroxat.
Sertraline (Zoloft): Lustral.

Antidepressants – Effect and duration of use

It is not known exactly how antidepressants work. Antidepressants do not work immediately. In general, it can take 2 to 4 weeks before an effect is noticeable. The antidepressants should also be taken regularly. Taking a tablet every now and then – only when it seems necessary – is of no use. If there is a chronic depression, a different indication will be required than if there is a reactive depression (depression as a result of a specific (traumatic) event.

Side effects of antidepressants

In many cases, the side effects of antidepressants start earlier than the drug takes effect, which can give the patient doubt about whether or not to continue with the medication. Sometimes immediately and sometimes when using it in the second week, one should be alert that the complaints and the depressive feeling may actually be intensified. In some cases there is the experience that people become more indifferent and suicidal thoughts can also more easily lead to actions. If the state of mind or mood has not improved after approximately 4 weeks, the dose of a number of drugs can be increased. If there is no effect after 6 to 8 weeks, there may be no point in continuing to use the drug in question and it is better to use another antidepressant.

People with depression will also have to weigh the pros and cons of using psychotropic drugs themselves. In addition to the doctor’s advice, contact with fellow sufferers can be of support . If in doubt, a second opinion can always be requested.

Effect/side effects and side effects of antidepressants

In addition to antidepressants, other drugs are sometimes used to prevent or counteract side effects, for example. The effect and side effects of the medicine are always described in detail in the package leaflet. The pharmacist is even obliged to provide you with a package leaflet for every medicine they give you. You can also (if you have lost the package leaflet, for example) consult the package leaflets of all medicines via the internet; including on the sites: www.repertorium.org or www.ziekenhuis.nl.

Classic – Second generation antidepressants

There are two groups of antidepressants, namely the classic and the newer so-called second generation antidepressants. Antidepressants can have a variety of side effects, which vary from person to person and situation. Some side effects occur in very few patients, others in many users. Always consult your doctor and never decide for yourself about changing or discontinuing the medication you are taking.
So there are two types of antidepressants:

Classical antidepressants (TCAs or tricyclic antidepressants)
Second generation antidepressants (mainly SSRIs or Selective Serotonin Reuptake Inhibitors)

Possible side effects of classic antidepressants (TCAs)

Drowsiness, dullness or lethargy.
Anticholinergic effects: dry mouth and/or eyes, difficulty urinating, blurred vision, memory loss
and concentration disorders and constipation (blockage of intestines)
Sexual problems, such as reduced sex drive (loss of libido) or erection problems.
Sudden dizziness and increased heart rate (this can be problematic in the elderly)
Weight gain due to increased appetite.
Decreased heart function due to disturbed heart rhythm.

Possible side effects of second generation antidepressants (SSRIs)

Nervousness, (severe) agitation.
Nausea, vomiting, diarrhea.
Headache.
Insomnia.
Sexual problems, such as loss of libido) or erection problems.
Bleeding disorders (bruising)
Reduction of appetite.
Sometimes weight loss after short use; after longer use or after stopping, sometimes weight gain.
Withdrawal symptoms when using short-acting drugs.

Effects on behavior

In addition to the above-mentioned physical side effects, antidepressants can also have (side) effects on behavior. Such as indifference or temporarily making important decisions (too) easily. In some cases, an increased risk of suicidal thoughts (suicide) may also arise.

Contraindications – Interaction/Interference with other medications/diseases

Always be alert when using! There may also be contraindications for medications. Certain medications cannot always be used and can even be dangerous in some cases. Consider, for example, use during pregnancy, at too young or too old an age, when interacting with other medication or interfering with other health problems. Although the description of the medicines is under the control of the prescribing doctor/expert and the pharmacist, it is important to remain alert – just to be on the safe side.

Discontinuing medication for depression – Antidepressants and withdrawal symptoms

Some people stop taking antidepressants without consulting their doctor. This can have very negative consequences. After stopping, depression can develop because the (underlying) depression has not yet gone away or because a new depression develops. In general, a doctor will recommend taking an anti-depressant for an average of 6 to 9 months.

Stopping prematurely

Although opinions about the percentages may differ, it appears that in 50% of patients who quit prematurely, there is a chance that the depression will return within a few months. In patients who stop after 6 or 9 months, depression appears to return in approximately 20% of patients.

Withdrawal symptoms from antidepressants

After abruptly stopping antidepressants – but sometimes also when gradually reducing them – the body may react with withdrawal symptoms (which are sometimes confused with a return of the underlying depression).

Withdrawal symptoms may be

Gastrointestinal complaints: abdominal pain, nausea, vomiting, diarrhea.
Flu-like symptoms: sweating, chills, muscle pain, weakened feeling.
Anxiety, nervousness, feeling of excitement and restlessness.
Sleep problems, nightmares.
Movement and balance disorders: dizziness, restlessness, stiffness, tremors.
Sensory disturbances: feeling of an electric shock, tingling.
Heart complaints (although rare): cardiac arrhythmias.

Antipsychotics – Medication against Psychoses
Emotions – what is the function of emotions