Depression and anxiety are two of the most common mental health problems that affect millions of people around the world. Both of these disorders can have a significant negative impact on a person’s motivation, interest in daily activities, appetite, sleep patterns, and overall personality.
Anxiety and depression are not easy to treat or manage, but when they co-occur, they get even more resistant to treatment.
According to the National Comorbidity Survey, more than 50% of people with depression also get diagnosed with at least one anxiety disorder at some point in their life. This has a detrimental impact on their physical and mental health and worsens their prognosis.
Fortunately, there are many medications and therapies available for the treatment of both of these disorders, separately as well as combined.
Many new forms of antidepressants have been developed that target comorbid depression and anxiety, and not only improve the symptoms but also prevent relapse and remission.
Antidepressants are prescribed based on an individual’s specific needs and symptoms.
This article explains what antidepressants are, how they work, and what the best kind of antidepressants are.
What are Antidepressants?
As the name suggests, antidepressants are pharmacological drugs for the treatment and management of depressive symptoms and different anxiety disorders.
Even though antidepressants may not “cure” depression and anxiety completely, they still remain the most popular choice of psychologists and psychiatrists for the management of these disorders.
Different antidepressants may work for different people. Antidepressants must always be taken after consultation with a healthcare provider, who may prescribe you the best one according to your specific symptoms.
If one antidepressant doesn’t help your symptoms or causes harmful side effects, you may have to try a different one.
How Do Antidepressants Work?
All antidepressants work by increasing the availability of monoamine neurotransmitters in the brain. Neurotransmitters are chemical substances in the brain that perform different functions. Monoamine neurotransmitters, such as dopamine, serotonin, norepinephrine, etc. are responsible for the regulation of an individual’s mood and emotions.
Anxious and depressed individuals have low levels of monoamine neurotransmitters in their brains. Antidepressants increase the availability of these neurotransmitters by preventing their reuptake in the brain, improving the patient’s mood.
Best Antidepressant for Anxiety and Depression
Following are some of the best classes of antidepressants.
1.Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) prevent the reuptake of the neurotransmitter serotonin in the brain, increasing its availability. Higher levels of serotonin in the brain relieve the symptoms of anxiety and depression by regulating the individual’s emotions.
According to a study conducted in the United States, 70% of people with depression were treated with SSRIs between 1996 and 2015. This research, as well as numerous others, show that SSRIs are the most widely used medications for depression and anxiety.
SSRIs most commonly prescribed for anxiety and depression are as follows.
· Prozac (fluoxetine)
Research shows that 11% of individuals with depression and anxiety take Prozac for the management of their symptoms. It is regarded as the most common SSRI medication in the US.
It is approved by the FDA and is safe to use not only for adults but also for children and adolescents.
· Celexa (citalopram)
Celexa is another popular drug taken most commonly for depression and anxiety. It is highly effective but high doses of Celexa have been linked with heart rhythm problems.
Taken in recommended quantities, Celexa can significantly improve symptoms of depression and anxiety. Research shows that more than 10% of antidepressant users have Celexa as their first choice.
· Zoloft (sertraline)
Zoloft is the brand name of the generic antianxiety and antidepressant medicine known as sertraline. It is an FDA-approved medication for different anxiety and depressive disorders, manufactured and distributed by Pfizer.
A doctor’s prescription is required to get your hands on Zoloft.
It comes in the form of a tablet and is one of the most popular anxiety medications sold on the market. In the US, around 30 million prescriptions are written for Zoloft annually.
Zoloft is the first choice of psychiatrists for the treatment of anxiety and depressive disorders. Different anxiety disorders that Zoloft helps with include social anxiety disorder, obsessive-compulsive disorder (OCD), panic attacks, and panic disorder, etc.
· Lexapro (escitalopram)
Lexapro is another effective medication for relieving anxiety and depression symptoms. It is the only SSRI, apart from Prozac, that is approved by the FDA to be consumed by teenagers and adolescents.
· Paxil (paroxetine)
Paxil is another trusted antidepressant prescribed by doctors. However, it has been shown to cause some side effects, such as excessive sweating and sexual problems.
2.Serotonin-noradrenaline reuptake inhibitors
Serotonin-noradrenaline reuptake inhibitors are the second most prescribed class of antidepressants by doctors for the treatment of depression and anxiety.
These drugs prevent the reuptake of serotonin as well as noradrenaline, also known as norepinephrine, therefore, increasing their levels in the brain and improving the mood of the individual.
SNRIs take around 6-8 weeks to start showing effect. Some of the most commonly prescribed SNRIs include duloxetine, venlafaxine, desvenlafaxine, levmilnacipran, and milnacipran.
· Effexor (venlafaxine)
Venlafaxine, sold under the brand name Effexor, is considered one of the most effective SNRIs but it has been shown to increase the heart rate and blood pressure of the patient and induce nausea and vomiting.
· Cymbalta (duloxetine)
Cymbalta is another very effective medication for depression and anxiety but it is also associated with high blood pressure. One more serious side effect of duloxetine is that it may impact the liver of the patient, hence, it is not recommended for people with liver issues.
It may also cause sexual dysfunction, headaches, upset stomach, or nausea. People who drink alcohol frequently should also avoid this medication.
3.Tricyclic Antidepressants (TCAs)
Tricyclic antidepressants are one of the oldest classes of antidepressants that are still used when patients do not respond to SSRI and SNRI-based medications.
This class of antidepressants also works by blocking the reuptake of serotonin and norepinephrine in the brain. This increases the levels of these neurotransmitters in the brain, hence, improving the anxiety and depressive symptoms of the patient.
The most common TCAs are Pamelor (nortriptyline), Tofranil (imipramine), and Elavil (amitriptyline). The reason TCAs have been broadly replaced by newer medications (SSRIs and SNRIs) is that they cause some major side effects in patients, which include urinary retention, orthostatic hypotension (dropping of blood pressure when a person stands up), nausea, and blurred vision.
For this reason, they are only prescribed when the patient isn’t responding to other treatments.
4.Monoamine oxidase inhibitors (MAOIs)
Monoamine oxidase inhibitors are the oldest antidepressants for the treatment of anxiety and depression that were approved by the FDA. They work by increasing the level of dopamine in the central nervous system.
Some examples of MAOIs include Parnate (tranylcypromine), Nardil (phenelzine), and Marplan (isocarboxazid).
However, their use has decreased largely over the past few decades due to their numerous serious side effects. They have been replaced by SSRIs, SNRIs, and other medications with fewer side effects.
5.Norepinephrine and dopamine reuptake inhibitors (NDRIs)
NDRIs are commonly prescribed by doctors for the treatment of depression, anxiety, seasonal affective disorder, bipolar disorder, and attention deficit hyperactivity disorder (ADHD). Bupropion, sold under the brand name Wellbutrin, is the most popular NDRI.
However, it may cause some side effects due to interaction with certain types of foods such as alcohol, processed meats, some herbal supplements, and other medications.
The side effects may include tremors, insomnia, headaches, nausea, constipation, and dry mouth. They are only prescribed if other forms of antidepressants don’t seem to work or cause serious side effects.
Esketamine (Ketanest, Sparvato) is a ketamine nasal spray that was approved by the DFA in 2019. Esketamine is a non-competitive N-methyl-D-aspartate receptor antagonist, developed recently for the treatment of extreme cases of depression and anxiety.
This is especially used to reduce suicidal tendencies in people diagnosed with major depressive disorder.
It is not available for home use and is only available at the doctor’s clinic for immediate relief, especially in cases of potential self-harm. It provides almost immediate relief to the patient and has shown to be one of the most effective medications for the treatment of depression.
Its benefits are only short-term if taken in isolation. It is almost always taken along with some other antidepressant.
It is not considered the first option for the treatment of depression because it has the potential for abuse. It can be very harmful if it falls n the wrong hands, and may increase suicidal thoughts and behaviors instead of reducing them if it is not administered by a certified professional.
Effectiveness of Antidepressants
A longitudinal study conducted on the effectiveness of antidepressants revealed that 89% of people report improvements in their symptoms after using antidepressants, and 54% at least report that their quality of life was significantly improved due to them.
The most effective antidepressants that were reported in this study were Prozac, Celexa, Effexor, Paxil, and Pamelor.
Other treatments for depression
If you have tried antidepressants and decided they are not a good fit for you, you can try other alternatives for treating your depression or anxiety. You can try changing your lifestyle and diet, and give therapy a go. One of the most effective therapies for the treatment of anxiety and depression is cognitive behavior therapy (CBT).
CBT revolves around the central idea that our thoughts impact our emotions, and our emotions impact our behaviors. CBT practitioners treat depression and anxiety by targeting their root causes. CBT can also be received along with medications for depression and anxiety.
You can go for in-person or online CBT. There are many platforms, like BetterHelp, that have made it easier for people to obtain therapy online.
What is the recommended dose of antidepressants?
Antidepressants are slowly built into your routine, so the doctor will prescribe a smaller dose initially and will instruct you to keep increasing it gradually.
How long does it take to get better?
It takes around 2-4 weeks before you start noticing an improvement in your symptoms. People usually report significant improvement in their symptoms after 6 months, after which they may discontinue it. Some people with chronic depression may be required to take antidepressants for longer periods of time.
With antidepressants, it is very important that you be consistent with your treatment routine. Do not stop if you experience mild side effects at the beginning of the treatment as they usually wear off in a few days.
However, if you don’t feel better even after weeks of taking medication, talk to your doctor to try a different antidepressant.
Are antidepressants addictive?
Antidepressants are not addictive but they may still cause withdrawal effects, for example, dizziness, nausea, muscle aches, etc., if you stop taking them suddenly.
Since your body gets used to the presence of the antidepressants, you should not abruptly remove them from your routine.
What are the side effects of antidepressants?
Most people do not experience any side effects if they stick to their recommended doses of antidepressants. Mild side effects usually subside within a week as the body gets used to the medication. Following are some of the side effects that you should look out for:
· Constipation or diarrhea
· Weight gain
· Drowsiness, sleepiness or dizziness
· Mild chest tightness or pain
· Upset stomach
· Dry mouth
· Numbness of mouth or tongue (caused by the oral solution)
· Orthostatic hypotension
· High blood pressure
· Excessive sweating
Always check the information leaflet to know more about the potential side effects of the medication you are about to start. If you keep experiencing any of the above-mentioned side effects even after a week, you should contact your doctor immediately.
How can I manage the side effects of my antidepressant on my own?
As mentioned above, most side effects subside within a few days. However, here are a few ways in which you can minimize the side effects.
· Eat a high-fiber diet that is low in sugar and fats to prevent weight gain and constipation.
· Make it a habit to exercise regularly, even if it is for 15 minutes per day. This will not only help you with the side effects but will also help reduce depressive symptoms.
· To prevent dry mouth, try sugarless gum or candy. You should take at least 8 glasses of water daily to keep your body hydrated.
· Get up slowly from a lying or sitting position to prevent dizziness.
When it comes to taking antidepressants, there is a big chance that you will feel worse before you start to get better. Still, never hesitate to reach out to your doctor or healthcare provider when something in your body feels off.
What to do if I miss one dose of my antidepressant?
If you accidentally skip one dose of your antidepressant, you should take it as soon as you remember it, except when it is almost time for your next dosage. In this case, you should completely skip the missed dose, and just take the next one on time.
Never take a double dose the following day if you miss one, it would cause more harm than benefit to your body.
Try your best to be consistent with your antidepressant by building it up in your routine. Put up an alarm to ring at the same time each day or ask someone to remind you to take your medicine.
One effective way to remember is by combining it with an activity that you do daily, for example, having breakfast or going on a walk.
How to discontinue my antidepressant?
Antidepressants should be eliminated from your routine gradually, under the guidance of your doctor or psychiatrist. Even though antidepressants are not addictive, if you stop taking them abruptly and suddenly, it may cause some sort of withdrawal effects.
The amount and frequency of the dosage should be decreased gradually over a couple of weeks.