Depression is a common mental disorder, with an estimated 300 million patients worldwide suffering from it.. According to the World Health Organization (WHO), this syndrome is the leading cause of disability worldwide and, in addition, some 800,000 people take their own lives each year as a result of depressive disorders, not receiving adequate medical care.
Depression goes far beyond sadness or apathy: there are underlying physiological mechanisms that explain it, at least in part. For example, low levels of circulating serotonin (a neurotransmitter) put a person at risk for depression, and certain neurotrophins (such as brain-derived neurotrophic factor, which promotes neuronal growth) decrease in expression in altered states of stress and anxiety, something that could be linked to the depressive state.
Even more shocking is to learn that brain-derived neurotrophic factor (BDNF) shows alarmingly low levels in the brains of people who have committed suicide, regardless of their psychiatric disorders. These data and much more evidence that, clearly, hormones, neurotransmitters, neurotrophins and other substances are linked to depressive states, far beyond a negative event in a person’s life.
As we talk about chemistry within our own body, we must accept that sometimes the treatment of altered states comes from the same premise: chemistry and pharmacology.. Based on this necessary idea, we will tell you about the 6 types of antidepressants and their uses.
How are antidepressants classified?
Today, some 15.5 million Americans have been taking antidepressants for more than 5 years, three times as many as in 2000. These data are often presented in the lay media as catastrophic, but nothing could be further from the truth: the problem is the social conflict that causes depression and anxiety, not the drugs that help to combat it..
Therefore, if you have gone to a psychiatrist and have been prescribed long-term treatment with antidepressants, do not be afraid: some may have certain side effects, but their use may be very necessary to enable patients to overcome an emotional state that could end in disaster without this chemical aid. To help you a little to alleviate the uncertainty, we tell you closely the 6 most common types of antidepressants. Let’s get to it.
1. Selective serotonin reuptake inhibitors (SSRIs)
As we have said before, low levels of circulating and brain serotonin are usually linked to depressive disorders.. Antidepressants of the selective serotonin reuptake inhibitor (SSRI) type block the uptake of this neurotransmitter by presynaptic neuronal bodies, allowing the extracellular increase of serotonin in the synaptic cleft.
Serotonin modulates many processes in the human mind, including mood, sexual desire, attention, feelings of reward and many other emotions. Therefore, drugs that increase its available concentration are used in disorders such as depression, generalized anxiety (chronic anxiety for more than 6 months), eating disorders, OCD and other events in people with psychological problems.
These drugs have been approved by the FDA (U.S. Food and Drug Administration), so there is no need to be wary of them, as long as a psychiatrist has prescribed them to the patient after a previous analysis. Some of the most common commercial names of SSRIs are Celexa, Lexapro, Prozac, Sertraline and Citalopram, among others.among others.
2. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
They are similar to SSRIs but, as their name suggests, they also inhibit the reuptake of the neurotransmitter norepinephrine, in conjunction with serotonin. Norepinephrine is an essential neurotransmitter that increases the rate of heart contractions, improves attention, increases blood pressure and blood sugar levels, which translates into increased “activity” of the body at the physiological level.
It is not surprising, therefore, that a lack of norepinephrine in the patient results in fatigue, apathy, inattention and difficulty in concentration, symptoms very common in ADHD.These symptoms are very common in depressive disorders. Venlafaxine and duloxetine are the most commonly marketed SNRIs for the treatment of depression.
3. Bupropion
This drug is in a completely different category from the ones described above. Bupropion is a psychostimulant, as it slightly inhibits the uptake of norepinephrine and dopamine, but has not been shown to be effective for more than 8 weeks of treatment. has not been shown to be effective for more than 8 weeks of treatment, while SSRIs and SNRIs are prescribed for months at a time.while SSRIs and SNRIs are prescribed for months or even years.
When drugs are used to treat depression, a very common side effect is a lack of sexual desire in the patient: this is not anecdotal, as it is estimated that 30 to 60% of patients taking the drugs described above suffer from sexual dysfunction. Bupropion is usually used in those who have experienced this effect due to the consumption of other antidepressants, as it seems to increase libido.
4. Tricyclic antidepressants
These drugs receive their name due to their chemical structure, since they present 3 rings in their composition, with chemical names as bombastic as the following: 3-(10,11-dihydro-5H-dibenzo[a,d]cyclohepteno-5-ylidene)-N, N-dimethyl-1-propanamine (formula that corresponds to amitriptyline).
Like the drugs mentioned above, they limit the reuptake of the neurotransmitters norepinephrine and serotonin, which allows an increase in their extracellular concentration at the level of the brain. In any case, the prescription of these drugs has decreased significantly since the popularization of SSRIs in the 1990s.since the 1990s.
This decrease in their consumption is due to the fact that they generally cause more side effects than the previously described antidepressants. Some of the discomforts derived in patients can be constipation, constant sleepiness, blurred vision, sporadic dizziness and other clinical events. For all these reasons and many others, they are not usually prescribed today.
5. Tetracyclic antidepressants
As their name suggests, these drugs are chemically composed of 4 rings instead of 3. The only examples we can cite in this category are maprotiline and mirtazapine.The other variants have either been withdrawn from the market or have not yet been marketed.
Unlike tricyclic antidepressants, these do not inhibit the reuptake of serotonin, but they do perform this work with norepinephrine. They also act in different physiological ways with respect to the other drugs mentioned above, but we will not dwell on their particularities as far as their mechanism of action is concerned.
6. Monoamine oxidase inhibitors (MAOIs)
In this last group we find some completely atypical drugs in the list, as they do not prevent the reuptake of neurotransmitters at the neuronal level. MAOIs inhibit the activity of monoamine oxidase enzymes, which catalyze the degradation of neurotransmitters at the neuronal level.which catalyze the degradation of neurotransmitters at the metabolic level.
Due to their properties, they have shown usefulness in treating disorders such as agoraphobia, social phobia, panic attacks and atypical depressions. MAOIs can have very serious adverse effects, so they are only used in clinical conditions where other antidepressants have not had an effect.
Without going any further, there are foods (such as very strong cheeses, cured meats, certain sauces, alcoholic beverages and others) that can interact negatively with these drugs, so patients must follow a strict diet. For all these reasons, are almost never the first choice when treating depression.
Summary
We would like to take advantage of these last lines to make a small reflection on the following sentence: antidepressants are not the enemy. It is common to see how many sources tinge these drugs with negativity and dependence with “alarming” statistics and figures, but we repeat that the problem lies in the reasons that cause depression at both individual and social level, not in the drugs designed to treat it.
“Being well” is often not achieved by trying or only with psychological help, so it is necessary to resort to chemical compounds that help to solve the physiological deficiencies derived from (or causing) certain emotional disorders. Sometimes there is no other, whether the patient likes it or not, as the concern for their health and the danger of neurological imbalance are far greater than any expected side effects of an SSRI or SNRI.
We therefore hope that the day will soon come when a patient can say “I take antidepressants” without a stony silence in the room. These are drugs that, like any other, are designed to treat a physiological imbalance in the patient and say absolutely nothing about the person beyond the existence of a problem, just like any other that is treated with antihistamines, non-steroidal anti-inflammatory drugs and a long etcetera. When society stops stigmatizing emotional maladjustments, we will be able to talk openly about them in family settings and save more lives.