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Antidepressant

Antidepressant
Drug class
Class identifiers
UseDepressive disorders, anxiety disorders, chronic pain, and addiction
ATC codeN06A
Mechanism of actionVaries
Chemical classVaries
Clinical data
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Consumer ReportsBest Buy Drugs
WebMDMedicineNet  RxList
External links
MeSHD000928
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In Wikidata
The skeletal structure of the SNRI venlafaxine, a typical example of an antidepressant.

Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction.[1]

Common side effects of antidepressants include dry mouth, weight gain, dizziness, headaches, akathisia,[2] sexual dysfunction,[3][4][5][6][7] and emotional blunting.[8][9][10] There is an increased risk of suicidal thinking and behavior when taken by children, adolescents, and young adults.[11] Discontinuation syndrome, which resembles recurrent depression in the case of the SSRI class, may occur after stopping the intake of any antidepressant, having effects which may be permanent and irreversible.[12][13]

Research regarding the effectiveness of antidepressants for depression in adults is controversial and has found both benefits[14] and drawbacks.[15] Meanwhile, evidence of benefit in children and adolescents is unclear,[16][17] even though antidepressant use has considerably increased in children and adolescents in the 2000s.[18] While a 2018 study found that the 21 most commonly prescribed antidepressant medications were slightly more effective than placebos for the short-term (acute) treatments of adults with major depressive disorder,[19][20] other research has found that the placebo effect may account for most or all of the drugs' observed efficacy.[21][22]

Research on the effectiveness of antidepressants is generally done on people who have severe symptoms,[23] a population that exhibits much weaker placebo responses,[24] meaning that the results may not be extrapolated to the general population that has not (or has not yet) been diagnosed with anxiety or depression.[20]

  1. ^ Jennings L (2018). "Antidepressants". In Grossberg GT, Kinsella LJ (eds.). Clinical Psychopharmacology for Neurologists. Springer. pp. 45–71. doi:10.1007/978-3-319-74604-3_4. ISBN 978-3-319-74602-9.
  2. ^ Ghaemi SN (2019). Clinical Psychopharmacology: Principles and Practice. New York: Oxford University Press. p. 90. ISBN 9780199995486.
  3. ^ Healy D, Le Noury J, Mangin D (May 2018). "Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases". The International Journal of Risk & Safety in Medicine. 29 (3–4): 125–134. doi:10.3233/JRS-180744. PMC 6004900. PMID 29733030.
  4. ^ Bahrick AS (2008). "Persistence of Sexual Dysfunction Side Effects after Discontinuation of Antidepressant Medications: Emerging Evidence". The Open Psychology Journal. 1: 42–50. doi:10.2174/1874350100801010042.
  5. ^ Taylor MJ, Rudkin L, Bullemor-Day P, Lubin J, Chukwujekwu C, Hawton K (May 2013). "Strategies for managing sexual dysfunction induced by antidepressant medication". The Cochrane Database of Systematic Reviews. 5 (5): CD003382. doi:10.1002/14651858.CD003382.pub3. PMID 23728643.
  6. ^ Kennedy SH, Rizvi S (April 2009). "Sexual dysfunction, depression, and the impact of antidepressants". Journal of Clinical Psychopharmacology. 29 (2): 157–164. doi:10.1097/jcp.0b013e31819c76e9. PMID 19512977. S2CID 739831.
  7. ^ Serotonin and noradrenaline reuptake inhibitors (SNRI); selective serotonin reuptake inhibitors (SSRI) – Persistent sexual dysfunction after drug withdrawal (EPITT no 19277), 11 June 20191, EMA/PRAC/265221/2019, Pharmacovigilance Risk Assessment Committee (PRAC)
  8. ^ Sansone RA, Sansone LA (October 2010). "SSRI-Induced Indifference". Psychiatry. 7 (10): 14–18. PMC 2989833. PMID 21103140.
  9. ^ "Is your antidepressant making life a little too blah?". Harvard Health Publishing. 8 November 2016. Retrieved 25 February 2021.
  10. ^ "Half of Patients on Antidepressants Experience Emotional Blunting". HCPLive. 19 June 2017. Retrieved 25 February 2021.
  11. ^ "Revisions to Product Labeling" (PDF). FDA. Archived (PDF) from the original on 9 October 2022. Retrieved 10 November 2018.
  12. ^ Wilson E, Lader M (December 2015). "A review of the management of antidepressant discontinuation symptoms". Therapeutic Advances in Psychopharmacology. 5 (6): 357–368. doi:10.1177/2045125315612334. PMC 4722507. PMID 26834969.
  13. ^ Gabriel M, Sharma V (May 2017). "Antidepressant discontinuation syndrome". CMAJ. 189 (21): E747. doi:10.1503/cmaj.160991. PMC 5449237. PMID 28554948.
  14. ^ Barth M, Kriston L, Klostermann S, Barbui C, Cipriani A, Linde K (February 2016). "Efficacy of selective serotonin reuptake inhibitors and adverse events: meta-regression and mediation analysis of placebo-controlled trials". The British Journal of Psychiatry. 208 (2): 114–119. doi:10.1192/bjp.bp.114.150136. PMID 26834168.
  15. ^ Jakobsen JC, Gluud C, Kirsch I (August 2020). "Should antidepressants be used for major depressive disorder?". BMJ Evidence-Based Medicine. 25 (4): 130. doi:10.1136/bmjebm-2019-111238. PMC 7418603. PMID 31554608.
  16. ^ Cipriani A, Zhou X, Del Giovane C, Hetrick SE, Qin B, Whittington C, Coghill D, Zhang Y, Hazell P, Leucht S, Cuijpers P, Pu J, Cohen D, Ravindran AV, Liu Y, Michael KD, Yang L, Liu L, Xie P (August 2016). "Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis". Lancet. 388 (10047): 881–890. doi:10.1016/S0140-6736(16)30385-3. hdl:11380/1279478. PMID 27289172. S2CID 19728203. When considering the risk-benefit profile of antidepressants in the acute treatment of major depressive disorder, these drugs do not seem to offer a clear advantage for children and adolescents. All antidepressants were more efficacious than a placebo in adults with major depressive disorder
  17. ^ Safer D, Zito J (2019). "Short- and Long-Term Antidepressant Clinical Trials for Major Depressive Disorder in Youth: Findings and Concerns". Frontiers in Psychiatry. 10: 705. doi:10.3389/fpsyt.2019.00705. PMC 6797591. PMID 31681028.
  18. ^ Hengartner MP (2020). "Editorial: Antidepressant Prescriptions in Children and Adolescents". Frontiers in Psychiatry. 11: 600283. doi:10.3389/fpsyt.2020.600283. PMC 7661954. PMID 33192742.
  19. ^ "The most effective antidepressants for adults revealed in major review". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 3 April 2018. doi:10.3310/signal-00580.
  20. ^ a b Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JP, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JP, Geddes JR (April 2018). "Comparative efficacy and acceptability of twenty-one antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis". Lancet. 391 (10128): 1357–1366. doi:10.1016/S0140-6736(17)32802-7. PMC 5889788. PMID 29477251.
  21. ^ Kirsch I (January 2014). "Antidepressants and the Placebo Effect". Zeitschrift für Psychologie. 222 (3): 128–134. doi:10.1027/2151-2604/a000176. PMC 4172306. PMID 25279271.
  22. ^ Turner EH, Rosenthal R (March 2008). "Efficacy of antidepressants". BMJ. 336 (7643): 516–517. doi:10.1136/bmj.39510.531597.80. PMC 2265347. PMID 18319297.
  23. ^ National Collaborating Centre for Mental Health (UK) (2010). Depression: The Treatment and Management of Depression in Adults. National Institute for Health and Clinical Excellence: Guidance (Updated ed.). British Psychological Society. ISBN 978-1-904671-85-5. PMID 22132433.[page needed]
  24. ^ Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT (February 2008). "Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration". PLOS Medicine. 5 (2): e45. doi:10.1371/journal.pmed.0050045. PMC 2253608. PMID 18303940.