Brain Sci­ence

A Brief Primer on An­tide­pres­sants

The McGill Daily - - News - Nabeela Jivraj The Mcgill Daily

It’s no se­cret: in the age of big phar­ma­ceu­ti­cals, bio­chem­i­cal ap­proaches to men­tal health man­age­ment are more com­mon and read­ily ac­ces­si­ble than talk ther­a­pies for many peo­ple. For a va­ri­ety of men­tal health con­cerns, rapid ad­vances in neu­ro­science have al­lowed for low-main­te­nance and ef­fec­tive symp­tom man­age­ment. As uni­ver­sity stu­dents, many of us can at­test to long wait times to see men­tal health pro­fes­sion­als as much as we can at­test to leav­ing our first vis­its with pre­scrip­tions in hand. The most com­monly used pre­scrip­tion med­i­ca­tions for young peo­ple in Canada aged 15-24 (apart from fe­male hor­monal con­tra­cep­tives) are an­tide­pres­sants; they are now of­ten one of the first lines of treat­ment in the man­age­ment of symp­toms of anx­i­ety and de­pres­sion. Cana­dian cen­sus data in­di­cated that be­tween 2007- 2011, 2.2 per cent of males and 12.3 per cent of fe­males aged 15-24 used pre­scrip­tion an­tide­pres­sants (Statscan, 2015). Be­tween 2010-2013 alone, stud­ies in­di­cated ado­les­cent an­tide­pres­sant use in­creased an ad­di­tional 63 per cent. Within a mul­ti­fac­eted ap­proach to health, th­ese med­i­ca­tions are viewed as ef­fec­tive in the ma­jor­ity of the pop­u­la­tion.

De­spite how preva­lent the use of medication is, it can still be dif­fi­cult to dis­cuss their use and their side ef­fects. Start­ing or stop­ping med­i­ca­tions can be over­whelm­ing, so The Mcgill Daily Sci+tech presents a brief primer on what you need to know about an­tide­pres­sants to bet­ter sup­port your­self and those clos­est to you.

THE BA­SICS

In a sep­a­rate class from an­tipsy­chotics, ben­zo­di­azepines, and mood sta­bi­liz­ers, most an­tide­pres­sants work by pre­vent­ing the chem­i­cal break­down of key neu­ro­trans­mit­ters, the mol­e­cules re­spon­si­ble for com­mu­ni­ca­tion in the brain. Neu­ro­trans­mit­ters are be­lieved to be re­spon­si­ble for changes in mood and be­hav­ior. By in­creas­ing lev­els of sero­tonin, nor­ep­i­neph­rine, and dopamine, th­ese chem­i­cals act to treat im­bal­ances in th­ese neu­ro­trans­mit­ters. Neu­ro­trans­mit­ters are en­doge­nous chem­i­cal mes­sen­gers, which means they are syn­the­sized in the brain it­self. You couldn’t sim­ply “take more sero­tonin” if you needed to – the body must break down chem­i­cals be­fore they can pass through the blood­brain bar­rier, a very sen­si­tive fil­ter. Though the mech­a­nism of ac­tion for many of th­ese chem­i­cals is not fully known, it is known that all neu­ro­trans­mit­ters ac­ti­vate some tar­get cell to pro­duce a re­sponse be­fore be­ing re­ab­sorbed by the body. Most an­tide­pres­sants in­crease the du­ra­tion of im­por­tant neu­ro­trans­mit­ters by de­lay­ing this process of re­ab­sorp­tion.

Key Neu­ro­trans­mit­ters: ACETYLCHOLINE- re­spon­si­ble for mus­cle move­ment, con­sid­ered to play a role in me­mory, mood, and learn­ing. SERO­TONIN- has a func­tion in sleep, me­mory, ap­petite, and mood. DOPAMINE- plays a role in at­ten­tion, me­mory, re­ward, sleep, cog­ni­tion, and move­ment. NOR­EP­I­NEPH­RINE- works to reg­u­late or­gan func­tion, blood pres­sure, and heart rate.

The chart above out­lines the most com­monly pre­scribed an­tide­pres­sants, in de­creas­ing or­der of preva­lence, and the as­so­ci­ated side ef­fects for each.

It is im­por­tant to note that cer­tain med­i­ca­tions can in­crease sui­ci­dal thoughts or ideation. Though not com­mon, in some in­di­vid­u­als, in­creases in en­ergy caused by medication can pro­vide im­pe­tus to act on th­ese thoughts, or cause in­creased anx­i­ety. It is im­por­tant to be hon­est with your health­care provider if this is the case, so they can work with you to create a treat­ment plan that’s bet­ter for you. It’s equally im­por­tant to make sure you know what sup­port sys­tems are avail­able to you be­fore start­ing any medication, and that you’re able to com­mu­ni­cate with th­ese peo­ple should you need to.

START­ING & STOP­PING

Typ­i­cally, when start­ing a new medication, the first week is re­served to as­sess whether you ex­pe­ri­ence any side ef­fects from the medication. Fol­low­ing this week, you will likely be pre­scribed a full dosage for an ex­tended pe­riod to gauge whether the medication is ef­fec­tive in symp­tom man­age­ment for you. This might mean chang­ing med­i­ca­tions or dosages. Usu­ally, peo­ple tak­ing pre­scrip­tion an­tide­pres­sants take them for at least six months to a year to ef­fec­tively man­age symp­toms. Peo­ple who ex­pe­ri­ence de­pres­sion may need to take them for longer.

If the medication’s symp­tom man­age­ment is ef­fec­tive, you may de­cide you want to re­duce your dose of a medication or stop al­to­gether. Changes in dosages can greatly al­ter mood or cause mood episodes, so con­sider all the other facets of your men­tal health and the sup­port avail­able to you be­fore you change your dose. Speak to your health­care provider for their opin­ion, and if you don’t agree, con­sider seek­ing a sec­ond opin­ion.

If you and your health­care provider de­cide it is best to stop tak­ing a cer­tain an­tide­pres­sant, it’s im­por­tant to re­mem­ber that though they are not ad­dic­tive, they do cause with­drawal symp­toms. Like any other drug, your body ad­justs to the pres­ence of the chem­i­cals and has to read­just if you stop tak­ing the drug. Symp­toms of with­drawal can in­clude chills, nau­sea, vom­it­ing, di­ar­rhea, dizzi­ness, and headache.

It is eas­i­est for your body to slowly de­crease its dose in­take rather than stop­ping sud­denly. It is typ­i­cally rec­om­mended to re­duce dosages 10 per­cent at a time – it may take sev­eral months to fully cut down a dose. If you start to feel un­well while chang­ing your dose, speak to a pro­fes­sional who will be able to as­sist you in de­ter­min­ing whether you are ex­pe­ri­enc­ing with­drawal ef­fects or re­turn­ing symp­toms.

The high fre­quency of pre­scrip­tion for an­tide­pres­sants can make it seem as though they are the only vi­able ther­apy. Though med­i­ca­tions are an ef­fec­tive method for many peo­ple, they may not be right for you. Other ther­a­pies, such as psy­chother­apy and cog­ni­tive be­hav­ioral ther­apy ( CBT), are also ef­fec­tive ways to man­age symp­toms of anx­i­ety and de­pres­sion. Though it may seem that talk ther­a­pies and med­i­ca­tions are “ei­ther/or,” a holis­tic plan might use both. Talk to a pro­fes­sional to get more in­for­ma­tion and find an ap­proach to your health that works best for you, and don’t feel pres­sured to stick with one type of ther­apy if it isn’t work­ing for you.

con­tent warn­ing: men­tal ill­ness

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