How Antidepressants Work

Currently, depression is considered as one of the public health problems of the most concern because of its impact on the daily, social, occupational and quality of life of patients. . Antidepressants are the mainstay of treatment for this condition. You must have wondered how these drugs work? The following article will help us understand this problem.

In fact, even experts aren't entirely sure how antidepressants work. Besides, there's also a lot we don't know about how the brain works.
The most important thing you need to know when living with treatment-resistant depression is that antidepressants are considered the most effective method. To help you better understand medications to make the right choice, here are the facts about antidepressants.
If you have researched depression information through newspapers and magazines, or on the Web - you may find depression explained simply as a "chemical imbalance" or a "serotonin deficiency". However, the reality of depression is not so simple. Experts still don't know exactly what causes depression or how depression affects the brain. And experts don't know exactly how antidepressants improve symptoms.
That suggests many researchers believe the benefits of antidepressants stem from how they affect certain brain circuits and the chemicals (called neurotransmitters) that transmit signals from neuron to neuron in the brain. These include serotonin, dopamine, and norepinephrine. In different ways, different types of antidepressants affect the way these neurotransmitters work. Below is a list of the main types of antidepressants.

Some of the most commonly prescribed antidepressants are called reuptake inhibitors. What is reabsorption? It is the process by which neurotransmitters are naturally reabsorbed back into nerve cells in the brain after they are released to send messages between neurons. A reuptake inhibitor prevents this from happening. Instead of being reabsorbed, the neurotransmitter stays - at least temporarily - in the space between nerves, called a synapse.
The effect this drug has is that keeping levels of neurotransmitters higher can improve communication between nerve cells - and that can strengthen circuits in the brain that regulate mood.
Different types of reuptake inhibitors target different neurotransmitters. These include the following 3:
Selective serotonin reuptake inhibitors (SSRIs) are some of the most commonly prescribed antidepressants available. This list of drugs includes citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), prozac, and sertraline (Zoloft). Another drug such as olanzapine (Symbyax) is approved by the FDA specifically for treatment-resistant depression. It is a combination of the SSRI antidepressant fluoxetine (Prozac) and another medicine used to treat bipolar disorder and schizophrenia called olanzapine (Zyprexa). The drugs Aripiprazole (Abilify), quetiapine (Seroquel), and brexpiprazole (Rexulti) have been approved by the FDA as an adjunct to antidepressants. In addition, doctors often use a combination of other drugs to treat treatment-resistant depression. In addition, the drugs vilazodone (Viibryd) and vortioxetine (Trintellix- commonly known as Brintellix) are among the newest antidepressants that affect serotonin. Both drugs affect serotonin transporters (such as SSRIs) but also affect other serotonin receptors to relieve major depression. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are among the newer classes of antidepressants. As the name implies, they block the reuptake of both serotonin and norepinephrine. These medications include duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine ER (khedezla), levomilnacipran (Fetzima), and desvenlafaxine (Pristiq). Norepinephrine and dopamine reuptake inhibitors (NDRIs) are another class of reuptake inhibitors, but they are represented by only one drug: bupropion (Wellbutrin). It affects the reuptake of norepinephrine and dopamine.

Tetracyclics are also a component of antidepressants with drugs such as asamoxapine (ASENDIN), maprotiline (Ludiomil), and mirtazapine (Remeron). Despite affecting neurotransmitters, Remeron does not prevent reuptake in the same way. Instead, it seems to prevent neurotransmitters from binding to specific receptors on nerves. Because norepinephrine and serotonin do not bind to receptors, they are found to accumulate in the areas between nerve cells. As a result, the level of neurotransmitters increases. Serotonin antagonists and reuptake inhibitors (SARIs) work in two ways as follows. They prevent the reuptake of serotonin. Besides, they also prevent serotonin particles released in the synapse from binding to certain unwanted receptors and redirect them to other receptors which can help the nerve cells in the mood circuit to work. better. Examples include drugs such as nefazodone (Serzone) and trazodone.

These drugs were among the first drugs used to treat depression. Although they are effective, they can also have serious side effects and are especially dangerous when people take too much of them. Today, many doctors only switch to these drugs when the newer and better-tolerated medications don't work. Tricyclics and MAOIs may not be the best approach for someone newly diagnosed. But they can sometimes be very helpful for people with treatment-resistant depression or some other form of depression (such as depression with anxiety). Tricyclics antidepressants (TCAs) include amitriptyline (Elavil), desipramine (Nopramin), imipramine (Tofranil), and nortriptyline (Pamelor). Just like reuptake inhibitors, Tricyclics antidepressants help block the reuptake of serotonin, and once these chemicals are released into the synapse, epinephrine returns to nerve cells. Because of potential side effects, your doctor may periodically check your blood pressure readings. In addition, in some cases, your doctor may order an electrocardiogram or recommend a blood draw to monitor the level of Tricyclics in your body. These drugs may not be safe for people with certain heart rhythm problems. Monoamine oxidase inhibitors (MAOIs) include selegiline (Emsam), isocarboxazid (Marphan), phenelzine (Nardil), and tranylcypromine (Parnate). Compared to other antidepressants, these work slightly differently. Monoamine oxidase is a natural enzyme that helps break down serotonin, epinephrine, and dopamine. MAOIs block the action of this enzyme. As a result, levels of those neurotransmitters can increase. The downside is that MAOIs also block the body's ability to break down other drugs metabolized by this enzyme (such as Sudafed or stimulants) - which increase the risk of high blood pressure - as well as an amino acid called tyrosine. , found in certain foods such as aged meats and cheeses. MAOIs also should not be combined with other medications that can increase serotonin (such as certain migraine medications or other antidepressants), as that can cause an excessive buildup of serotonin (such as serotonin). called "serotonin syndrome") can be life-threatening.Nutraceuticals include l-methylfolate (Deplin).This is a highly prescribed form of folate, also known as one of the essential B vitamins, vitamin B9. Depression is often associated with low folate levels in the body, which affects the neurotransmitter that controls mood, and l-methylfolate has been shown to be effective in stimulating production of the neurotransmitter. nerve transmission.

Treatment for depression doesn't always work for people. Up to two-thirds of depressed people are resistant to the first antidepressant they take. And nearly a third did not respond to a variety of treatments.
You will feel hopeless when you have treatment-resistant depression. Your condition has not improved despite treatment for a long time, up to years. However, do not rush to give up, wait patiently even though treatment for depression may not be effective.
Currently, experts have not identified a specific reason for treatment-resistant depression. For most people, this can be a combination of many different factors. Among those factors, there are factors that are not in your control, such as genetics, and there are also factors that you can control. Therefore, to find the treatment that is right for you, continue patiently with your doctor.
Remember that much of what we think about antidepressants is still speculation. We don't really know whether low levels of serotonin or other neurotransmitters in the body cause depression, or whether increasing levels of these substances solves the problem. We don't have enough information and background to understand all about the brain, so it is difficult to conclude what is "balanced" or "unbalanced." It is possible that antidepressants have other as yet unknown effects and their benefits are not related to neurotransmitter levels as much as they might be to other effects, such as regulation of genes that control neurotransmitters. control nerve cell growth and function.
This can seem overwhelming, especially if you're relying on antidepressants to help you feel better. But remember: while experts can't say for sure how they work, it's up to the patient to know if they're working. Studies have shown that antidepressants can help many people feel better, and that's what really matters for patients.
When taking antidepressants to treat depression, you must be patient. Some people start taking an antidepressant and expect it to work right away. But that's not how antidepressants work. We still don't know the exact cause, but to get the full effect of the drug, you may have to wait a few weeks or months. When you're taking an antidepressant, it's important to adjust your expectations and try to be persistent.

Reference source: webmd.com