SSRI, SSNRI, Tricyclic, and MAOI Antidepressants: What's the Difference?
Don’t take depression for granted or take it for granted, as its effects are very dangerous. Various studies have found a link between depression and chronic liver disease, obesity and heart failure. At worst, depression can trigger suicidal thoughts or attempts. Antidepressants are often the first choice of treatment prescribed by doctors for depression. What are the most commonly used antidepressants, and are there any side effects?
Types of antidepressants that are commonly prescribed by doctors
Antidepressants work by balancing chemicals in the brain called neurotransmitters, which affect your mood and emotions. This medication can help improve mood, help you sleep better, and increase appetite and concentration.
How depression medication works will depend on the type of medication. The following are the various types of antidepressant drugs that are most commonly used:
1.Selective Serotonin Re-uptake Inhibitors (SSRIs)
Serotonin is a neurotransmitter associated with feelings of health and happiness. In the brains of people who are depressed, serotonin production is low.
SSRIs are used to treat moderate to severe depression. SSRIs work to block serotonin from being reabsorbed by nerve cells (nerves usually recycle this neurotransmitter). This results in an increase in the concentration of serotonin, which can improve mood and re-generate interest to activities you used to enjoy.
SSRIs are the most commonly prescribed type of antidepressant because of their low risk of side effects. Examples of drugs of this type are escitalopram (Lexapro), fluoxetine (Lovan or Prozac), paroxetine (Aropax), sertraline (Zoloft), and citalopram (Cipramil).
Possible side effects of SSRIs include:
- Gastrointestinal disorders (influenced by the number of doses) such as nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation.
- Anorexia with weight loss, but there are also in some cases an increase in appetite resulting in weight gain
- Hypersensitivity reactions including itching, hives, anaphylaxis, myalgia
- Dry mouth
- Nervous
- Hallucinations
- Sleepy
- Seizures
- Impaired sexual function
- Interference with the bladder to pass urine or empty it
- Visual disturbances
- Bleeding disorders
- Hyponatremia
It should also be noted that SSRIs should not be used if the patient is entering the manic phase.
2.Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
SNRI blocks serotonin and norepinephrine from being reabsorbed by nerve cells. Norepinephrine is involved in the nervous system of the brain that triggers the response of feelings of attraction to external stimuli motivate them to do something. Therefore, SNRIs are believed to be more effective than SSRI-type drugs that focus solely on serotonin.
Antidepressants included in the SNRI group are venlafaxine (Effexor XR), desvenlafaxine (Pristiq), duloxetine (Cymbalta), and reboxetine (Edronax). The side effects of this type of medication include:
- Nausea and vomiting
- Dizziness; kliyengan head
- Difficulty sleeping (insomnia)
- Unusual dreams; nightmare
- Excessive sweating
- Constipation
- Shaky
- Feeling anxious
- Sexual problems
3. Tricyclics
Tricyclics work directly to inhibit a number of neurotransmitters, including serotonin, epinephrine, and norepinephrine, from being reabsorbed as well as binding to nerve cell receptors. Usually, this medication is prescribed for people who have previously been given SSRIs but no change in symptoms.
Antidepressant drugs included in this group are amitriptyline (Endep), clomipramine (Anafranil), dosulepin (Prothiaden or Dothep), doxepin (Deptran), imipramine (Tofranil), nortriptyline (Allegron).
The side effects caused by this type of drug are:
- Arrhythmia
- Heart block (especially with amitriptyline)
- Dry mouth
- Blurred vision
- Constipation
- Sweating
- Sleepy
- Urine retention
- Fast or irregular heartbeat
These side effects can be reduced if initially given in low doses, and then gradually increased. Gradual dosing is especially applied to elderly people who are depressed, as there is a risk that a drop in blood pressure may cause headaches and even fainting.
4.Monoamine Oxidase Inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) work to inhibit the monoamine oxidase enzyme which can destroy serotonin, epinephrine, and dopamine. These three neurotransmitters are responsible for generating feelings of happiness.
Examples of this type of drug are tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan). MAOIs are usually prescribed when other antidepressant drugs do not provide symptom improvement. MAOIs can cause interactions with some foods, such as cheese, pickles and grapes. Therefore, you must be careful with the foods you consume while using the drug.
This type of drug has very serious side effects. The side effects that occur are:
- Dizziness (head kliyengan, sensation of spinning room)
- Changes in blood pressure
- Feel sleepy
- Hard to sleep
- Dizzy
- Fluid build-up in the body (such as swelling of the feet and ankles)
- Blurred vision
- Gaining weight
5. Noradrenaline and specific serotonergic antidepressants (NASSAs)
NASSAs are antidepressants that work by increasing noradrenaline and serotonin levels. A drug that is included in this type is mirtazapine (Avanza). Serotonin and noradrenaline are neurotransmitters that regulate mood and emotions. Serotonin also helps regulate sleep cycles and appetite.
The side effects given from this drug are drowsiness, increased appetite, weight gain, dry mouth, constipation, flu symptoms, and dizziness.
Drug effects will be most effective when accompanied by psychotherapy and a healthy lifestyle
Antidepressants are often the first treatment option prescribed by health professionals for treating depression. However, the effectiveness of the drug does not happen overnight.
It usually takes at least three to four weeks before you notice a change in your mood. Sometimes it can take longer. Taking medication every day as directed by your doctor can help increase the effectiveness of the medication and speed healing.
In addition to prescription medications, your doctor may also refer you to psychotherapy such as cognitive behavioral therapy (CBT) and intrapersonal therapy as co-treatments for depression, especially in cases of moderate to severe depression.
Apart from medical treatment, many medical professionals also agree that a healthy diet and regular exercise are the best “alternative medicine” for people with depression. Apart from improving mood, regular exercise offers other health benefits, such as lowering blood pressure, protecting against heart disease and cancer, and increasing self-confidence.
One thing is certain: Depression is not a sign of a character flaw, weakness, or something that goes away instantly. Depression is a real mental disorder that requires painstaking and ongoing medical treatment to be cured.
If you, a relative, or family member shows signs of depression or other symptoms of mental illness, or exhibits a desire or behavior or is contemplating suicide, call the police emergency hotline immediately 110; Suicide Prevention hotline (021) 725 6526 / (021) 725 7826 / (021) 722 1810; or NGOs Don’t Suicide (021) 9696 9293
Hello Health Group does not provide medical advice, diagnosis or treatment.
POM RI. Without Year. 4.3.2 Selective Serotonin Re-uptake Inhibitor (SSRI) and the like [online] available at: http://pionas.pom.go.id/ioni/bab-4-sistem-saraf-pusat/43-depresi/432-selective-serotonin-re-uptake-inhibitor-ssri-dan (Accessed 15/11/2017)
Novick, Diego., Montgomery, William., Moneta, V., Peng, Xiaomei., Brugnoli, R., Haro, JM. 2015. Antidepressant medication treatment patterns in Asian patients with major depressive disorder. Patient Prefer Adherence. 9: 421-428 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362981/
MayoClinic. 2014. Antidepressants: Selecting One That’s Right for You. [online] available at: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273 (Accessed 15/11/2017)
Sydney & South Western Sydney LHD Mental Health Service. 2009. Depression. [online] available at: http://www.dhi.health.nsw.gov.au/ArticleDocuments/1729/Depression_Indonesian2013.pdf.aspx (Accessed 15/11/2017)
POM RI. Without Year. 4.3.1 Tricyclic Antidepressants and the like. [online] available at: http://pionas.pom.go.id/ioni/bab-4-sistem-saraf-pusat/43-depresi/431-antidepresan-trisiklik-dan-sejenis (Accessed 15/11/2017)
