Mental health has taken a front seat as the world has grappled with a global pandemic. Rates of anxiety and depression have skyrocketed as we all try to cope with our lives being turned upside down with isolation, fear and loss. A recent study, published in JAMA, reports that rates of depression have tripled during the COVID-19 pandemic.
What are antidepressants and what are the different types?
Antidepressant medications are a powerful tool to help individuals during this difficult time. During the pandemic, several antidepressants were placed on the FDA's drug shortage list due to increased prescriptions and demand.
While antidepressants are effective at reducing the symptoms of depression and certain types of anxiety, they also have many side effects, some of which can be especially bothersome. There are many different types of antidepressants, with the most commonly prescribed classes being reuptake inhibitors.
SSRI: selective serotonin reuptake inhibitors
SSRIs are the most commonly prescribed type of antidepressants. These drugs are generally associated with a lower risk of side effects than other types of antidepressants, and they may also cause fewer problems when prescribed at high doses.
Popular SSRIs include:
- Prozac (fluoxetine)
- Paxil (paroxetine)
- Zoloft (sertraline)
- Celexa (citalopram)
- Lexapro (escitalopram)
- Luvox (fluvoxamine)
- Pexeva (paroxetine mesylate)
- Trintellix (vortioxetine)
SNRI: selective serotonin norepinephrine reuptake inhibitors
SNRIs are a new class of antidepressants that act on both serotonin and norepinephrine in the brain. They are a newer type of antidepressant and have grown in popularity in recent years.
Popular SNRIs include:
- Cymbalta (duloxetine)
- Effexor XR (venlafaxine)
- Pristiq (desvenlafaxine)
- Fetzima (levomilnacipran)
NDRI: norepinephrine-dopamine reuptake inhibitors
NDRIs are a newer class of antidepressants that act on norepinephrine and dopamine in the brain.
The only NDRI used to treat depression is:
- Wellbutrin (bupropion)
What side effects are commonly associated with antidepressants?
Each type of antidepressant has different side effects that are commonly associated with its specific drug class, and within each drug class, each medication has slightly different side effects. However, some side effects are common for all or most medications within a drug class.
Common side effects of SSRIs include:
- Feeling agitated, shaky, or anxious
- Loss of appetite and weight loss
- Blurred vision
- Excessive sweating
- Difficulty achieving orgasm during sex or masturbation
- Low sex drive
- Erectile dysfunction in men
- Feeling or being sick
- Diarrhea or constipation
- Dry mouth
- Difficulty falling asleep (insomnia)
Common side effects of SNRIs include:
- Excessive sweating
- Dry mouth
- Loss of appetite
- Changes in sexual desire
- Difficulty achieving orgasm
- Erectile dysfunction
How can side effects associated with antidepressants be minimized or avoided?
Although antidepressants come with a long list of side effects, many people rely on the medication to improve their depression or anxiety, which means that quitting the medication is not an option. Fortunately, it is possible to mitigate or avoid some common side effects associated with different types of antidepressants.
How to Cope
Nausea: Take your medication with food, eat small meals more frequently, and drink plenty of fluids.
Fatigue and drowsiness: Get in some form of physical activity, such as going for a brisk walk; take a nap during the day if needed; take your medication at bedtime
Insomnia: Take your medication in the morning; avoid caffeinated food and drinks; get regular exercise that ends several hours before bedtime
Constipation: Drink lots of water, eat foods with plenty of fiber, get regular exercise, and take a fiber supplement
Dry mouth: Drink plenty of water; breathe through your nose; avoid tobacco, alcohol, and caffeine; brush your teeth twice daily
Sexual side effects: Engage in sexual activity before taking your medication dose, communicate with your partner about sexual side effects and necessary changes in routine, consider adding a medication that can improve sexual side effects, such as Viagra
Increased appetite and weight gain: Reduce your intake of sugar, count your calories and track your food, get regular exercise, and fill up on fruits, vegetables, and other healthy snacks that are high in fiber
Dizziness: Get up slowly from a sitting or lying position; avoid using caffeine, alcohol, or tobacco; drink lots of water; take your antidepressant at bedtime; use handrails or other sturdy items for support. Also salt your food as reuptake inhibitors can lower sodium levels in the body.
Restlessness and anxiety: Get regular exercise, practice deep-breathing or mindfulness exercises, and practice meditation
In addition to these recommendations, it is important to note that certain classes of antidepressants such as SSRI’s cause Medication Induced Nutrient Depletions (MIND). When a medication causes a loss of nutrients in the body, it may lead to symptoms and common complaints that are associated with the class of medication.
One way to improve how you feel while using an antidepressant is meeting your unique nutrient needs. Reuptake inhibitors increase the need for vitamin C, B vitamins, mitochondrial antioxidants, iodine and nutrients needed to make the sleep well neurotransmitter, melatonin.
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