Antidepressants:
in general
What are antidepressants?
The word "Antidepressant" is a trade name that applies to a wide range of chemically different classes of drugs that act in different ways on the body and brain. (Source: https://www.theinnercompass.org/learn-unlearn/intervention/antidepressants)
There are 6 families of antidepressants: tricyclic and heterocyclic (ATC) monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SSRIs), antidepressants of various classifications: bupropion (Remeron) and mirtazapine (Wellbutrin, Zyban) and vortioxetine (Trintellix), multimodal antidepressant. Consult the list of antidepressants by family. (Source AGIDD-SMQ)
For what types of problems are they generally prescribed?
Antidepressants are prescribed to treat people diagnosed with a wide variety of depressive, anxiety, obsessive-compulsive, eating, post-traumatic stress disorder, and attention, sleep disorders, and many other conditions. The United States Food and Drug Administration (FDA) has not approved most of these drugs for use in treating people diagnosed with most of these conditions, but some doctors and psychiatrists prescribe the drugs for these conditions "outside MA". (When a physician prescribes a drug for a use that has not been approved by the FDA and is not listed on the drug's official label, the physician is prescribing "off label".) (Source: https:// www.theinnercompass.org/learn-unlearn/intervention/antidepressants)
What are the effects, from a biological point of view, of these drugs?
The mechanism of action of antidepressants essentially consists in inhibiting the reuptake of norepinephrine, serotonin or even dopamine.
How soon should the effect start to be felt? How will I know?
It takes several weeks for antidepressants to produce their full effects. Improvements in sleep, appetite, and energy are often early warning signs that the drug is working. Mood improvement usually shows up later. (CAMH, Antidepressants, Online, accessed June 14, 2021, https://www.camh.ca/fr/info-sante/index-sur-la-sante-mentale-et-la-dependance/les-antidepresseurs )
Are these drugs addictive?
Antidepressants are habit-forming and cause withdrawal effects when withdrawn, more so when the withdrawal is abrupt. (CAMH, Antidepressants, Online, accessed June 14, 2021, https://www.camh.ca/fr/info-sante/index-sur-la-sante-mentale-et-la-dependance/les-antidepresseurs )
What are the withdrawal effects of antidepressants?
Withdrawal symptoms usually appear one to seven days after a discontinuation or a significant reduction in dose.
About 55% of people feel as if they are going through a period of excitement or depression which is accompanied by raw emotions, anxiety, disturbing dreams and lethargy (numbness of being) temporary. These effects disappear within a few days.
Selective serotonin reuptake inhibitors or SSRIs (Prozac, Luvox, Zoloft, Paxil and Celexa), serotonin and norepinephrine reuptake inhibitors or SNRIs (Effexor, Cymbalta and Pristiq) and bupropion share these symptoms of weaning.
Main psychological withdrawal symptoms:
Anxiety
Irritability
Restlessness
Insomnia
Nightmares or dreams of intense realism (vivid)
Very rarely:
Suicidal tendencies or tendencies to want to harm themselves which can appear suddenly at the time of increases or reductions. These symptoms are often preceded by a period of severe agitation (akathisia).
Mania or hypomania
Main physical withdrawal symptoms:
Flu-like effects:
Headaches (headaches)
sweating
Tired
General malaise
Muscle aches
Diarrhea
Dizziness, vertigo
Tremors
Numbness or tingling of the extremities
Electric shock sensations in the limbs
Blurry vision
Very rarely:
Concentration or memory problems
Movement disorders
Effexor and Paxil have shorter durations of action than other antidepressants. They can give withdrawal reactions that are more difficult to control from day one. It is therefore even more important to gradually reduce the dose.
(Source: AGIDD-SMQ RRASMQ, ERASME, My GAM personal guide, 2017, p.116-117)
Tricyclics and heterocyclics
For what problems are they prescribed?
Mental health problems
Depression
Prevention of recurrent depressive episodes
Anorexia, bulimia
Alcoholism, drug addiction
Obsessive compulsive disorders, phobias, post-traumatic stress disorder
Generalized anxiety, panic disorder
Aggressive behaviors
Attention Deficit Hyperactivity Disorder in Children (ADHD)
• Physical health issues
- Sleeping troubles
- Migraines, chronic neuropathic pain
- Fibromyalgia
• Children
- nuresis (urinary incontinence in children)
In what doses is this drug usually prescribed and what is its half-life?
(Appearance of a glossary box: Half-life: Time required for a substance to lose half of its initial pharmacological effect.)
What are the contraindications? Under what circumstances should I not take these medications?
Physical health issues
Some problems heart, liver, kidney, urinary retention
Closed-angle or narrow-angle glaucoma
Can make some breathing problems worse
People prone to seizures
mental health problem
- Bipolar affective illness (risk of triggering an episode of mania)
Seniors
Use half an adult dose
Confusion, disorientation and delirium when combined with other medications
Risk of falling due to hypotension
Pregnancy
- Some are safe, consult a doctor
Children
- Generally poorly tolerated
(Source AGIDD-SMQ)
What are common side effects?
They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.
Head
- Dry mouth
- Drowsiness, sedation (Eiavi/, Tofranil, Surmonti/)
- Sudden drop in blood pressure, dizziness and vertigo (Tofrani/); rarer with others
- Blurred vision
- Difficulty concentrating
- Agitation, anxiety
Weight
- Weight gain (Eiavi/, Anafranil, Tofranil)
Abdomen
- Constipation
- Nausea
Heart
- Increased or irregular heartbeat
Sexuality
- Various sexual disorders
Skin
- Marked sunburn
What are the less common side effects?
They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.
• Abdomen
- Difficulty urinating
- Disorders related to the liver
• Sleep
- Sleep disturbances, nightmares
• Skin
- Rashes
• Head
- Dry eyes
- Metallic taste in the mouth
- Speech difficulty
- Confusion
Seizures, very high risk (Ludiomil)
- Appearance of angle-closure glaucoma in predisposed subjects
• Members
- Lack of coordination, tremors
- Edema (swelling)
• Weight
- Loss of appetite
• Blood
- Decreased white blood cell count
• Psychological
- Triggering of an episode of mania or hypomania
• Others
- Discontinuation symptoms if treatment stopped abruptly (e.g. dizziness, sleep disturbances, agitation, anxiety, sensory disturbances)
What are drug interactions? In other words, what products could modify the effect of the drug?
Mental health problems
Anxiolytics (or tranquilizers) and hypnotics (or sleeping pills), antipsychotics (or neuroleptics) and antihistamines increase drowsiness and confusion
Antipsychotics (or neuroleptics) increase difficulty urinating, constipation, and a feeling of dryness in the mouth
The combination with another tricyclic antidepressant or MAOI should be avoided at all costs, as it may be fatal
Combination with an SSRI may increase the effects of the tricyclic
Physical health issues
- Meperidine (Demero/) can cause respiratory arrest
- Medication used to lower blood pressure: increased hypotensive effect
• Others
- Alcohol increases the sedative effect
- Narcotics (heroin, morphine, methadone) can cause
respiratory arrest
What are the risks associated with this medication (e.g. diabetes, effects on
kidneys, liver, heart, weight)?
Overdose Risks
Antidepressants tricyclics are responsible most deaths caused by drug overdose; fortunately, their use has greatly diminished.
Monoamine oxidase inhibitors (MAOIs)
For what problems are they prescribed?
• Mental health problems
- When other antidepressants have proven ineffective
or contraindicated
- Depression where anxiety dominates
(selective MAOI)
- Anxiety disorders
Non-selective MAOIs: atypical depression (symptoms more intense and aggressive)
What are the contraindications? Under what circumstances should I not take these medications?
Physical health issues
- Allergy or negative reaction
- Heart problems
- High blood pressure
- Epilepsy
- Parkinson disease
- Kidney or liver failure
- Diet containing tyramine for Nardil and Parnate
mental health problem
Space the intake of an SSRI or an SSRINa and an MAOI by at least 14 days
Seniors
- Marked side effects, should be used only as a last resort
Children
- Not indicated for children under 16 years of age
Pregnancy and breast feeding
- Congenital malformations;
abstain for breastfeeding
What are the side effects of Nardil and Parnate ?
They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.
• Head
- Headache
- dizziness
- Dry mouth
- Blurring of vision
- Restlessness, irritability
• Abdomen
- Nausea
- Constipation
• Weight
- Weight gain
• Heart
- Voltage drop
• Sleep
- Drowsiness
- Sleeping troubles
• Members
- Sweats
- Weakness
• Sexuality
- Sexual problems
• Others
- With certain foods that contain tyramine or certain medications such as decongestants: hypertensive crisis (nausea, vomiting, severe headache, palpitations, rapid heartbeat, fatal cerebral hemorrhage)
What are the risks of overdose for Nardil and Parnate?
Taking too high amounts of Nardil or Parnate can cause death.
Drugs interactions
• Food forbidden to consume with Nardil and Parnate because of the tyramine contained in certain meats, fish, vegetables, fruits, products derived from soy, alcoholic beverages. The tyramine acts in the human body as a vasoactive agent, allowing the modification of the caliber of vessels (vasoconstriction and vasodilation).
- Aged cheeses (cheddar, brick, mozzarella, parmesan, etc.)
- Liver, offal
- Beans
- Overripe fruits and vegetables
- Meat and yeast extracts
- Alcohol, red wine, aperitif and digestive liqueurs, beers
- Sausages (salami, pepperoni, mortadella, etc.)
- The sauerkraut
- Salted or smoked fish
- Glutamate sodium, soy sauce
(so, Chinese dishes)
- Figs, grapes
- Chocolate, liquorice
- The lawyers
- Sour cream, yogurts
- Coffee, colas
- Snails, caviar
- Canned or bagged soups
Medicines and drugs prohibited to consume with Nordi/ and Parnate
- Cocaine, opium and all other illicit and controlled drugs
- Stimulants such as amphetamines
(Rita/in, Cylert, etc.)
- Medications with or without a prescription for the flu, colds, sinusitis
as well as cough syrups and decongestants
- Antihistamines
Replace them with:
- Hypnotics (or sleeping pills)
over-the-counter (Nyto/.5/eep-Eze, etc.)
- Pain medication sold without a prescription (222, Tyleno/, etc.)
- Barbiturates
- Some painkillers narcotics
(Demerol)
- Certain antiparkinsonian drugs such as Levodopa
- Tricyclic antidepressants, SSRIs, NaSSRIs, real risk of serotonin syndrome
Serotonin syndrome: it's a medical emergency!
Toxic reaction produced by an excess of serotonin when taking or increasing the dose of the antidepressant; during an overdose or during an interaction with other drugs or substances.
More common with MAOIs, SSRIs and Effexor.
The symptoms are many:
- Hypervigilance
- Confusion
- Restlessness, rigidity and/or contraction of muscles
- Behavioral problems
- Fever
- High blood pressure, rapid heartbeat
- Sweats
- Can go as far as delirium
- Outbursts of violence
- Seizures
- suicide, homicide
- Coma
- Shock
- Death
What are the side effects of Manerix ?
They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.
• Head
- Dry mouth
Dizziness associated with a sudden drop in blood pressure when changing positions
- Headache
• Abdomen
- Nausea
Skin
- Skin problems
• Sleep
- Drowsiness
• Others
In other people, Manerix can have a stimulating effect such as: insomnia, anxiety, restlessness and feverishness, aggressive behavior {rare)
What are the drug interactions of Manerix? In other words, what products could modify the effect of the drug?
Mental health problems
• Avoid at all costs taking a
Selective MAOIs and non-selective MAOIs together: Nardilou Parnate with Manerix
- Confusion, disorientation
- Hyperactivity
- Chills, tremors, involuntary muscle contractions or lack of coordination
• Risky interaction: SSRIs, some tranquilizers (Buspar)
• Lithium and tricyclic antidepressants increase the effect of Manerix
• antiparkinsonians and Manerix can cause restlessness, disorientation, anxiety, memory lapses and hallucinations
Physical health issues
• May increase the analgesic effect of ibuprofen (Advil, Motrin, Actiprofen, etc.)
• Risky interaction: narcotics, certain migraine medications (mitrex)
Selective serotonin reuptake inhibitors (SSRIs)
For what problems are they prescribed?
Mental health problems
- Depression
- Prevention of recurrent depressive episodes
- Anorexia, bulimia
- Alcoholism, drug addiction
- Obsessive compulsive disorders, phobias, stress syndrome
Posttraumatic
- Generalized anxiety, panic disorder
- Aggressive behavior
- Depressive states related to menstruation
Physical health issues
- Migraines, chronic pain
- Premature ejaculation
- Chronic fatigue syndrome
In what doses is this drug usually prescribed and what is its half-life?
(Appearance of a glossary box: Half-life: Time required for a substance to lose half of its initial pharmacological effect.)
What are the contraindications? Under what circumstances should I not take these medications?
Physical health issues
- Allergy or bad reaction to SSRIs
- Concomitant intake41 of St. John's wort
- Diseases related to the liver, kidneys and heart
Weight below normal
Mental health problems
- Concomitant intake of pimozide (Orap}
- Manic Episode
Seniors
- Risk of drug interactions
Pregnancy and breast feeding
- Taken during the first trimester, increased risks
congenital malformations, particularly of a cardiovascular nature
Not recommended during breastfeeding
What are the side effects?
They depend on the dosage and duration of treatment, the individual's metabolism and the context in which he lives.
• Head
- Nausea and headaches
- Restlessness
- Dizziness
- Dry mouth
- Seizures
• Sleep
- Drowsiness
- Unusual dreams, nightmares
- Insomnia
• Members
- Tremors
• Sexuality
- Sexual disorders in men
• Abdomen
- Vomiting, abdominal pain
- Constipation, diarrhea
- Digestion problems
• Weight
- Weight gain or loss
• Blood
- Raised cholesterol levels
- Abnormal bleeding
• Psychological
- Possible behavior modification, suicidal ideation and self-harm
- Mania and hypomania (rare)
- Irritability, anxiety, nervousness
• Others
- Tired
- Symptoms of discontinuation if treatment stopped abruptly (e.g. dizziness, sleep disturbances, agitation, anxiety, disturbances sensory)
What are drug interactions? In other words, what products could modify the effect of the drug?
Mental health problems
Methylphenidate (Ritalin), antihistamines, chloral hydrate and cimetidine (Tagamet) increase the effect of SSRIs
Never combine with an MAOI antidepressant and at least 14 days apart from taking an SSRI or an SSRI Na and an MAOI
Carbamazepine (Tegretol) and barbiturates reduce the effect of SSRIs
Paroxetine (Paxil) and fluoxetine (Prozac) can reduce the effect of tamoxifen (hormone therapy to treat breast cancer)
Paroxetine (Paxil) and fluoxetine (Prozac) increase the effects of some antipsychotics
and all tricyclic antidepressants
Health problem physical
Ritonavir and fosamprenavir (antiretrovirals that work by preventing the multiplication of HIV} can reduce the effect of paroxetine (Paxil)
Other
• Alcohol not recommended
Selective serotonin and norepinephrine reuptake inhibitors (NaSSRIs)
What problems are Effexor XR and Pristiq prescribed for ?
Mental health problems
Depression
Anxiety disorders
Physical health issues
Fibromyalgia
Premenstrual dysphoria: symptoms resembling premenstrual syndrome usually preceding menstruation, but to a much greater degree {loss of interest in activities of daily living, impaired sleep, feeling out of control, lack of energy, physical symptoms , changes in eating habits and concentration disorders, irritability, depressed mood, emotional instability, anxiety and tension).
In what doses is this drug usually prescribed and what is its half-life?
(Appearance of a glossary box: Half-life: Time required for a substance to lose half of its initial pharmacological effect.)
What are the contraindications of Effexor XR and Pristiq? Under what circumstances should I not take these medications?
Mental health problems
Taken together: MAOIs and similar antidepressants
History of manic episodes
Physical health issues
people with allergies
Blood and kidney diseases
History of seizures
Untreated angle-closure glaucoma
Children
Not indicated for children under 18 years of age
What are the side effects of Effexor XR and Pristiq?
They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.
Abdomen
Nausea
Vomiting
Constipation
Weight
Loss of appetite
Head
Dizziness
Dry mouth
Sleep
Insomnia
Drowsiness
Members
- Sweat
- Chills
- Tremors
Sexuality
- Ejaculation, orgasm and impotence problems in men
Psychological
- Nervousness, anxiety
- Activation of mania
- Increased risk of behavioral changes, suicidal ideation and self-harm
Heart
- Increased blood pressure and heartbeat
Blood
- Abnormal bleeding
Others
- Tired
- Symptoms Related to Sudden Discontinuation of Treatment
For what problems is Cymbalta prescribed?
mental health problem
- Depression
Physical health issues
Diabetic neuropathic pain
Fibromyalgia
What are the contraindications of Cymbalta? Under what circumstances should I not take these medications?
Physical health issues
people with allergies
History of seizures
Liver and kidney diseases
Untreated angle-closure glaucoma
Concomitant intake of thioridazine, ciprofloxacin
and certain other antibiotics
People who are fructose intolerant or have a hereditary problem of glucose-galactose malabsorption
Mental health problems
Taken together: MAOIs and similar antidepressants
History of seizures and manic episodes
Other
Substantial alcohol consumption: can cause significant liver damage
Children
Not indicated in children under 18
What are the side effects of Cymbalta?
They depend on the dosage and the duration of the treatment, the metabolism of the individual and the context in which he lives.
Abdomen
- Nausea
Head
- Dizziness
Sleep
- Drowsiness
Members
- Sweat
Psychological
- Activation of mania
- Increased risk of behavioral changes, suicidal ideation and self-harm
Heart
- Increased blood pressure and heartbeat
Sexuality
Abnormal orgasm, loss of libido and erectile dysfunction in men
Other
Symptoms Related to Sudden Discontinuation of Treatment
Various classifications
For what problems are they prescribed?
Directions
• Mental health problems
- Symptoms of depression
- Stimulating adjuvant1 (combined with other antidepressants)
- Attention Deficit Hyperactivity Disorder
• Physical health issues
- Nicotine addiction
- Sexual problems
In what doses is this drug usually prescribed and what is its half-life?
(Appearance of a glossary box: Half-life: Time required for a substance to lose half of its initial pharmacological effect.)
What are the risks associated with overdose?
• Rarely fatal
• Difficulty breathing
• Lack of coordination
• Seizures
• Heart problems
• Hallucinations
• Loss of consciousness
What are the contraindications? Under what circumstances should I not take these medications?
• Physical health issues
- People with allergies
- History of seizures
- Kidney or liver problems: reduced doses and close monitoring. If severe kidney or liver problems: refrain
• Mental health problems
- Anorexia and bulimia
- Severe insomnia
- History of mania episodes
• Seniors
- Reduced doses
• Children and teenagers
- Use with caution as may trigger suicidal ideation; efficacy and safety have not been demonstrated
• Pregnancy and breast feeding
- Safe during pregnancy and breastfeeding
What are the drug and other substance interactions
Mental health problems
Raises levels of tricyclic antidepressants
Higher dose of Wellbutrin when prescribed with Tegretol
Increases the effect of Haldol
With MAOI antidepressants, can be fatal. Stop taking MAOIs for at least 2 weeks
With antidepressants, lithium and some antipsychotics (or neuroleptics), may increase risk of seizures
physical health problem
Close monitoring if prescribed with warfarin (Coumadin) as it may cause blood problems
Others
With alcohol, valerian, St. John's wort, kava kava (pear tree), increased central nervous system depressant effects
Wellbutrin, Zyban and Champix can accentuate the effects of alcohol
What are common side effects?
They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.
• Head
- Headache
- Dizziness
- Dizziness
- Dry mouth
- Restlessness
- Tinnitus
- Confusion
• Abdomen
- Nausea
- Abdominal pain
- Constipation
• Weight
- Loss of appetite
- Weightloss
• Sleep
- Insomnia
• Members
- Tremors
What are the less common side effects?
• Head
- Epileptic seizures
• Psychological
- State of mania or hypomania
- Suicidal thoughts in children and adolescents
- Anxiety
• Members 1
- Muscle aches
• Heart
- High blood pressure (may be serious)
- Allergic reactions
• Abdomen
- Diarrhea
Various classifications
For what problems are they prescribed?
In what doses is this drug usually prescribed and what is its half-life?
(Appearance of a glossary box: Half-life: Time required for a substance to lose half of its initial pharmacological effect.)