preparation for placement in the mental health sector

Antidepressant Medications

As an exercise physiology student in a mental health service, it can be helpful to have an understanding of the types of medications that maybe prescribed to the consumers you are working with, and to understand how this may impact your role.

 

Antidepressant medication is usually prescribed to help reduce the symptoms of depression in moderate to severe depression, and can be used in the treatment of some anxiety disorders (1). The length of time taken for an antidepressant to work varies from person to person, but usually an antidepressant effect occurs after approximately six weeks. For other people, it can take even longer to feel the effects of their medication, with the optimal effect usually occurring after six months of taking medication regularly (2).

Antidepressants were first developed in the 1950s. There are several different types of antidepressants used in Australia, as illustrated in the table below:

 

 

Categories of antipsychotic medication

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The most commonly prescribed antidepressants are Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are generally well tolerated by most people, and are generally non-sedating. SNRIs and RIMAs also tend to be better tolerated with fewer side effects than the older antidepressants, such as TCAs and MAOIs.

 

The information below about each class of antidepressant information is kindly provided by beyondblue (1).

 

Selective Serotonin Reuptake Inhibitors (SSRIs)

• the most commonly prescribed antidepressants in Australia

• often a doctors' first choice for most types of depression

• generally well tolerated by most people

• generally non-sedating.

 

Serotonin and Noradrenalin Reuptake Inhibitors (SNRIs)

• have fewer side effects compared to the older antidepressants

• are often prescribed for severe depression

• are safer if a person overdoses.

 

Reversible Inhibitors of MonoAmine oxidase (RIMAs)

• have fewer side effects

• are non-sedating

• may be less effective in treating more severe forms of depression than other antidepressants

• are helpful for people who are experiencing anxiety or sleeping difficulties.

 

TriCyclic Antidepressants (TCAs)

• effective, but have more harmful side effects than newer drugs (i.e. SSRIs)

• more likely to cause low blood pressure – so this should be monitored by a doctor.

 

Noradrenaline-Serotonin Specific Antidepressants (NaSSAs)

• relatively new antidepressants

• helpful when there are problems with anxiety or sleeping

• generally low in sexual side effects, but may cause weight gain.

 

Noradrenalin Reuptake Inhibitors (NARIs)

• designed to act selectively on one type of brain chemical – noradrenalin

• less likely to cause sleepiness or drowsiness than some other antidepressants

• more likely to:

  • make it difficult for people to sleep

  • cause increased sweating after the initial doses

  • cause sexual difficulties after the initial doses

  • cause difficulty urinating after the initial doses

  • cause increased heart rate after the initial doses.

 

Monoamine Oxidase Inhibitors (MAOIs)

• MAOIs are prescribed only under exceptional circumstances as they require a special diet and have adverse effects.

 

 

 

Are antidepressant medications addictive?

Antidepressant medications are not addictive medications, that is, an individual’s dose of medication will not need to continually increase in order to achieve the same effect. They do change the way people think and feel, so it is likely if someone ceases their medication against recommendations they may experience a relapse of symptoms (2).

 

 

What are the common side effects?

Antidepressant medication is generally effective, however, like with any medication, these drugs are not without side effects. The varying classes of antidepressant medication listed above each have a different side effect profile, but generally speaking, the most common side effects include those listed in the table below.

 

 

 

 

Common side effects of antipsychotic medication

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Specific antidepressant medications

There are lots of different medications that patients may be on. This list below includes some of the antipsychotics that your patients may be on. Click on the hyperlinks below for specific information about individual medications.

 

SSRIs

• Sertraline, such as Zoloft

• Citalopram, such as Celepram

• Escitalopram, such as Lexapro

• Fluoxetine, such as Prozac

SNRIs

• Duloxetine, such as Cymbalta

• Venlafaxine, such as Efexor

• Desvenlafaxine, such as Pristiq

RIMAs

• Moclobemide, such as Amira

TCAs

• Amitryptyline, such as Endep

• Nortriptyline, such as Allegron

NaSSAs

• Mianserin, such as Lumin

• Mirtazapine, such as Avanza

NARIs

• Reboxetine, such as Edronax

MAOIs

• Phenelzine, such as Nardil

• Tranylcypromine, such as Parnate

 

 

 

References:

 

1. beyondblue (2015) Treatments for depression                                                                                           Available from: https://www.beyondblue.org.au/the-facts/depression/treatments-for-depression/medical-treatments-for-depression (accessed on 23/11/2015)

2. Sane Austrlia (2015) Antidepressant medication                                                                                 Available from: https://www.sane.org/mental-health-and-illness/facts-and-guides/antidepressant-medication (accessed on 23/11/2015)

 

SSRIs

 

SNRIs

 

RIMAs

 

TCAs

 

NaSSAs

 

 

NARIs

 

MAOIs

 

 

 

Selective Serotonin Reuptake Inhibitors

 

Serotonin & Noradrenalin Reuptake Inhibitors

 

Reversible Inhibitors of MonoAmine oxidase

 

TriCyclic Antidepressants

 

Noradrenaline-Serotonin Specific Antidepressants

 

Noradrenalin Reuptake Inhibitors

 

Monoamine Oxidase Inhibitors

 

 

Sexual problems, agitation, nausea, dizziness, weight gain

 

Nausea, dizziness, weight gain , dry mouth, sleep problems

 

 

Sleep disturbances, dizziness, nausea, headache, dry mouth

 

Sexual problems, dizziness, weight gain, low blood pressure, constipation

 

 

Drowsiness, weight gain, headache, dry mouth, nausea

 

Difficulty sleeping, sexual problems, difficulty urinating, increased heart rate

 

Difficulty sleeping, sexual problems, dizziness, weight gain, somnolence, headaches, can’t eat food containing tyramine.

 

 

SSRIs

 

 

SNRIs

 

 

RIMAs

 

 

TCAs

 

 

NaSSAs

 

NARIs

 

 

MAOIs