As Sir Francis Bacon once said Knowledge is power being nausea

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					Antidepressants—A Better Understanding Before You Talk With Your Doctor
A. Denae Brake, Pharm.D.
Clinical Pharmacist
Catalyst Rx

Sir Francis Bacon once said, “Knowledge is power”. But being depressed can make you feel like your power has been taken away
from you. Taking antidepressants can help improve your mood and the other physical and mental symptoms of depression, but th ey
can also be associated with side effects. Understanding how antidepressants work, what they treat and some of the associated side
effects can give you the power to make wise decisions when talking to your provider about being treated for depression.

Antidepressants were first developed in the 1950s. There are now over 30 different kinds from five major classes. The classes are:
       MAOIs (Monoamine oxidase inhibitors)
       SSRIs (Selective Serotonin Reuptake Inhibitors)
       SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)

Antidepressants generally work by increasing neurotransmitter activity in the brain. Neurotransmitters are chemical messengers that
help nerve cells communicate with one another. Antidepressants increase the number of neurotransmitters by stimulating their
production or by blocking them from going back into storage after they have been secreted. Neurotransmitters are involved in
controlling many aspects of our well being, such as our mood, sleep, eating, pain and thinking. The neurotransmitters believed to be
responsible for balancing our physical and mental health are serotonin, norepinephrine and dopamine.

As with other drugs, antidepressants may be used to treat other conditions. For example, antidepressants may be used to treat:

       ADHD (Attention-deficit hyperactivity disorder)
       OCD (Obsessive compulsive disorder)
       Moderate to severe depressive disorder
       Eating disorders
       Chronic pain
       PTSD (Post-traumatic stress disorder)
       Severe anxiety and panic disorder
       Smoking Cessation
     If you and your doctor decide that you should start an antidepressant, please rest assured that they are not addictive. Some drugs, like
     tranquilizers, certain sleep aids, alcohol and nicotine can be habit forming. Antidepressants are not. There is some controversy
     because many people who stop these medications suddenly experience symptoms, such as stomach upset, headache, dizziness,
     anxiety, agitation or irritability. But these symptoms are due to your body’s response to the sudden withdrawal of the medication. It is
     very important to taper off antidepressants when discontinuing their use in order to minimize these effects. You should only stop an
     antidepressant on your doctor’s advice, and you should follow his/her directions regarding the gradual reduction of the dosag e over a
     period of at least several weeks.

     As with many medications, certain side effects have been associated with the use of antidepressants. The table below lists some of the
     most common side effects associated with each of the families of antidepressants. Not all possible side effects are listed, and not every
     patient experience side effects to the same degree. Please be sure to speak with your doctor and/or your pharmacist if you have any
     questions about any side effects that you may be experiencing, or if you have any other questions about your medications.

     You may also want to ask your doctor if there is an alternative, other than medications, that may be appropriate for you to treat your
     symptoms of depression, stress and/or anxiety. Some alternatives are counseling and/or finding someone to talk to, regular exercise,
     avoiding alcohol or street drugs, eating healthy foods such as fruits, vegetables and whole grains, getting plenty of sleep, taking time
     to relax and participating in activities you enjoy. If you and your provider find that a medication is the best choice for you, take the
     time to talk with him/her about the pros and cons of each medication. When the right medication is taken at the right dose,
     antidepressants can be very effective in the treatment of depression.

 Class            Drug                     Use/Comments                         How they work                       Possible Side Effects
Tricyclics   Amitriptyline       These agents were developed for           Increase levels of serotonin     Major side effects include: dry mouth ,
             (Elavil®)           depression, but are also used for         and norepinephrine but also      blurred vision, constipation difficulty
             amoxapine           chronic pain, migraines, as               creates less serotonin           with urination.
             clomipramine        hypnotics, ADHD, some anxiety             receptors for the
             (Anafranil®)        disorders.                                neurotransmitters to work.       Other side effects include: arrhythmias,
             desipramine                                                                                    rash, anxiety agitation, movement
             (Norpramin®)                                                                                   disorders, nausea, decreased libido,
             doxepin                                                                                        sexual dysfunction, and sweating.
             (Sinequan®,         Doxepin is also used for itching
             Zonalon®)                                                                                      Not recommended for people with heart
             imipramine                                                                                     disease or uncontrolled blood pressure.
             Maprotiline                                                                                    Increased risk of toxicity with some of
             Nortriptyline                                                                                  these agents combined with grapefruit.
 Class         Drug                  Use/Comments                      How they work                      Possible Side Effects

SSRIs    Citalopram        Depression                             These medications block the      Somnolence, insomnia, nausea, dry
         (Celexa®)                                                reuptake of serotonin back       mouth, sweating, weight gain
         Escitalopram      Depression, Generalized Anxiety        into storage, so there is more   Headache, somnolence, insomnia,
         (Lexapro®)        Disorder                               available in the brain.          nausea,
         Fluoxetine        Depression, panic disorder, OCD,                                        Nausea, weight gain
         (Prozac®)         Generalized Anxiety Disorder, PTSD,
                           PMS, Bulimia
         fluvoxamine       Depression                                                              Nausea, weight gain
         Paroxetine        Depression, panic disorder, OCD,                                        Drowsiness, Nausea, weight gain
         (Paxil®)          Social Anxiety Disorder, Generalized
                           Anxiety Disorder, PTSD
         Sertraline        Depression, panic disorder, OCD,                                        Nausea, weight gain, diahrrea
         (Zoloft®)         Social Anxiety Disorder, PTSD

                           Depresssion, pain                      Inhibitors of serotonin and
                                                                  norepinephrine reuptake and
 SNRIs   Duloxetine                                               weak inhibitors of dopamine      Similar side effects as SSRIs
         (Cymbalta)                                               reuptake.
         Venlafaxine       Depression, anxiety disorder, social                                    Similar side effects as SSRIs. Not
         (Effexor)         anxiety disorder, panic disorder                                        recommended for people with heart
                                                                                                   disease or uncontrolled blood pressure.
 MAOIs   Isocarboxazid     Depression                             Monoamine oxidase is an          Dry mouth, constipation, blurred vision,
         (Marplan)                                                enzyme system, which is          & urinary retention; drowsiness, low
         Phenelzine                                               responsible for the              blood pressure, weight gain. Diet must
         (Nardil)                                                 metabolism of chemicals in       be low in tyramine—wines, cheeses.
         Tranylcypromine                                          the body; norepinephrine,        Absolutely can not use with other
         (Parnate)                                                epinephrine, dopamine,           antidepressants.
                                                                  serotonin. Monoamine
Class         Drug               Use/Comments                 How they work                      Possible Side Effects
                                                         oxidase inhibitors (MAOIs)
                                                         inhibit this enzyme system,
                                                         causing an increase in the
                                                         concentration of these
                                                         endogenous chemicals

Others   Bupropion      Depression, Smoking Cessation,   Works completely different       Agitation; Contraindicated with
         (Wellbutrin)                                    than other antidepressants its   seizures, bulimia, and anorexia
                                                         actions are thought to be
                                                         noradrenergic and/or

         Trazodone      Depression, Insomnia             It is thought to selectively     Nightmares, Somnolence, dry mouth,
         (Desyrel)                                       inhibits serotonin uptake by     blurred vision, dizziness, confusion
                                                         the brain
         Mirtazapine    Depression                       It works at receptors in the     Sedation, Weight gain, increased
         (Remeron,                                       central nervous system to        cholesterol, constipation, dry mouth,
         SolTab)                                         release more norepinephrine      increased appetite, weakness, muscle
                                                         and serotonin.                   aches


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