How do antidepressants actually work? Let's talk about this simply!

Has your doctor prescribed you medication for depression? Or does anyone you know use this medication? Although there are many stories in society about this medication, how many people really know how it affects the brain and what happens as a result? Many people are afraid of this medication, but the reason for that fear is ignorance. So, let's understand this simply and clearly today, as if we were talking to a friend.

What are these antidepressants?

Although these medications are called 'antidepressants', they are not only used to treat depression, a mental condition that causes feelings of intense anxiety and hopelessness. These medications were first introduced in the 1950s. Today, in addition to depression, these medications are also approved for conditions such as OCD (Obsessive-Compulsive Disorder), Social Phobia, Panic Disorder, GAD (Generalized Anxiety Disorder), and PTSD (Posttraumatic Stress Disorder).

In addition, doctors may sometimes prescribe this medication for conditions such as chronic pain, insomnia, and migraines. This is called 'off-label' use. This means that the medication has not yet been officially approved for that condition, but the doctor believes that the patient will benefit from it.

How does this medicine affect our brain?

Simply put, these medications work by changing the levels of certain chemicals in our brains. We call these chemicals neurotransmitters . These are the ones that control many things, such as our mood, emotions, sleep, and appetite.

Think of it this way. The nerve cells in our brain use these 'messengers' called neurotransmitters to communicate with each other. One nerve cell releases this messenger, passing the message on to the next cell. After the message is delivered, the messenger is quickly taken back into the original cell (this is called reuptake ).

What antidepressants mainly do is delay that reuptake process a little bit. Then that messenger (for example, serotonin) stays in the gap between the two nerve cells (the synapse) longer. Then it can work longer and improve our mood.

Commonly used types of reuptake inhibitors

The most commonly prescribed antidepressants currently belong to this group. These are divided into several main types.

1. SSRIs (Selective Serotonin Reuptake Inhibitors)

These are the first medications that doctors often prescribe. As the name suggests, these specifically target the neurotransmitter serotonin . Serotonin is important for things like our mood, behavior, and memory.

Once you start taking this medication, it can take several weeks, sometimes up to 2-3 months, to see full results. So it's important to be patient. Also, never stop taking this medication suddenly without your doctor's advice. Doing so can cause unpleasant symptoms (antidepressant discontinuation syndrome).

Serotonin Syndrome - Something to be concerned about!

Sometimes, when you take other medications that increase serotonin levels, such as SSRIs, the amount of serotonin in the brain can increase unnecessarily. This can be dangerous.

2. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

These are a slightly more advanced class of medications that came after the SSRIs. They affect both the neurotransmitters serotonin and norepinephrine . Norepinephrine is important for our attention and alertness. That's why these medications are sometimes used to treat chronic pain (e.g., diabetic neuropathy, fibromyalgia).

• Common examples: Duloxetine (Cymbalta), Venlafaxine (Effexor)
• Common side effects: nausea, dry mouth, fatigue, drowsiness, dizziness, sweating.

3. NDRIs (Norepinephrine and Dopamine Reuptake Inhibitors)

This medication increases levels of the neurotransmitters norepinephrine and dopamine . Dopamine is important for our happiness, motivation, and attention.

• Prime example: Bupropion (Wellbutrin). This is a medication that can also help you quit smoking.
• Special note: It has fewer sexual side effects than other antidepressants. However, it is not suitable for people who are at risk of developing seizures.

Other types, old but still important

Although these medications are not widely used now, they can be very useful for some people who do not respond to newer medications. However, they have many side effects.

Tricyclic and tetracyclic antidepressants (TCAs)

These are older medications that have been used since the 1950s. Although they are as effective as newer medications, they have more side effects. For example, they can cause drowsiness, dry mouth, weight gain, and changes in heart rate.

• Common examples: Amitriptyline, Nortriptyline, Clomipramine.

Monoamine oxidase inhibitors (MAOIs)

These are also very old and rarely used medications. When using these , you need to be very careful about what you eat. Because if you eat foods containing the amino acid 'Tyramine' (e.g., aged cheese, soy sauce, some meats, some fruits), your blood pressure can rise dangerously. Also, taking these with other antidepressants is very dangerous.

Nutraceuticals that can be taken to help with medication

These are not medicines, but dietary supplements or nutritional supplements that can help with certain medical conditions. They are not recommended for use alone for depression. However, they can be used in conjunction with mainstream treatment, as advised by your doctor.

• SAMe (S-adenosyl-methionine): A chemical produced by the body that helps make neurotransmitters.
• Omega-3 Fatty Acids: These, especially found in fish oil, may help reduce some inflammation in the brain.
• Vitamin D: Research shows that there is a link between a deficiency of this vitamin, which is obtained from sunlight, and depression.

But remember, it's not a good idea to take these at your own discretion. Talk to your doctor and use them only with his approval. Because sometimes these can interact with other medications you're taking.