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Antidepressants are medications designed to alleviate symptoms of depression, a prevalent mental health condition that affects millions of people worldwide.

With numerous antidepressants available, each with its unique mechanisms of action, understanding the different types is crucial for both patients and healthcare providers.

In this post, we will explore and discuss some of the commonly prescribed classes of antidepressants, their modes of action, and potential side effects.

1. Selective Serotonin Re-uptake Inhibitors (SSRIs): SSRIs are the most commonly prescribed class of antidepressants due to their relatively favourable side effect profile and efficacy. These medications work by inhibiting the re-uptake of serotonin, a neurotransmitter associated with mood regulation. Popular SSRIs include fluoxetine, sertraline, and citalopram. Common side effects may include nausea, headache, and sexual dysfunction.
   
2. Serotonin-Norepinephrine Re-uptake Inhibitors (SNRIs): SNRIs are another class of antidepressants that work by blocking the re-uptake of both serotonin and norepinephrine, thereby increasing the levels of these neurotransmitters in the brain. Examples of SNRIs include venlafaxine and duloxetine. Side effects may include increased blood pressure, insomnia, and gastrointestinal disturbances.
   
3. Tricyclic Antidepressants (TCAs): Although less commonly prescribed today, TCAs were among the first-generation antidepressants. They inhibit the re-uptake of norepinephrine and serotonin, similar to SNRIs. TCAs include medications like amitriptyline and imipramine. TCAs have a higher risk of side effects, including sedation, dry mouth, constipation, and potential cardiac effects. They are usually reserved for cases where other treatments have been ineffective.
   
4. Monoamine Oxidase Inhibitors (MAOIs): MAOIs are another older class of antidepressants. They work by inhibiting the enzyme monoamine oxidase, which breaks down serotonin, norepinephrine, and dopamine. This inhibition leads to increased levels of these neurotransmitters in the brain. MAOIs are generally used as a last resort due to their potential interactions with certain foods and medications, which can cause a severe hypertensive crisis. Examples of MAOIs include phenelzine and tranylcypromine.
   
5. Atypical Antidepressants: This category encompasses a diverse group of medications with various mechanisms of action. Examples include bupropion, which primarily affects dopamine and norepinephrine, and mirtazapine, which enhances serotonin and norepinephrine release. These medications are often chosen based on individual patient needs and symptoms. Side effects can vary, but common ones include sedation, weight gain, and dry mouth.
   

The availability of different classes of antidepressants provides healthcare providers with a range of options to address the diverse needs of patients with depression. Selecting the appropriate antidepressant depends on factors such as symptom severity, patient history, and potential side effects.

It is crucial for patients to work closely with their healthcare providers to find the most suitable medication and dosage. Additionally, periodic monitoring and open communication are vital to ensure optimal treatment outcomes and manage any adverse effects.

I’ve recently been thinking a lot about a friend and comments she made to me over dinner a few weeks ago. As a counsellor I’m used to friends sharing their thoughts and fears with me, it comes with the label of the job I do but every so often it throws up things that make me think that bit harder.

She had her first child a year ago, is now coming to the end of her maternity leave and the thought of returning to work fills her with dread. She’s loved being at home with her son for the past year and after being so happy she is scared stiff of what the next stage in her life will bring.

The more we discussed it the more she started to say that she’s never really enjoyed her job, like many people it was never her dream to work in the industry she found herself in, it just happened and 15 years later she’s still with the same employer. The more she talked the more it became apparent to me that her problems are much deeper than a fear of returning to work. She had got used to the comfort of the same job, the safety having been there for so long brings and the fact that she is familiar with the surroundings and her colleagues.

As we continued to talk (well she talked and I listened!) she eventually admitted that what she is really scared of is failing. She found a job that she is good at, one that she can do without having to worry about failing at because both she and her bosses know she is very capable. The idea of doing something different, taking a risk at something she may not be very good at seems abhorrent to her. In fact it turns out this fear of failure pervades every part of her life, she won’t take risks, won’t try something new and just continually does the same thing again and again safe in the knowledge she will succeed every time.

Human nature is to do the things that we do well more often than the things we don’t. If you are good at maths at school you are more likely to be a mathematician, if science was the subject you get A’s in then I bet I can guess which subject you studied at college.  Society loves success and pushes us to strive for it, tells us that if we are good at something that’s the path we should take.

How many kids though loved a subject that they didn’t excel in and so dropped it at an early age for one they had a better chance of success in? I for one loved tennis, I dreamed of being a professional player but the truth of the matter was that I wasn’t very good at it, I persevered for a while (thoroughly enjoying it the whole time) but when it became obvious I would never be very good at it I gave it up and took up running, a sport I thoroughly disliked but one I excelled at nonetheless.

What if we do this every time though?

What if we carry on in the career we dislike, study the subjects we have no passion for and partake in a sport we hate every minute of all because they are the things we are good at and are least likely to result in failure? Boredom that’s what, a sense of being unfulfilled and the looming day when we ask ourselves “what is the point”. The danger of course being that when we reach that day avoiding failure has become so ingrained in our psyche that we couldn’t take a risk to change things even if we wanted to.

Why do we do this? Do we not only truly learn when we fail? Certainly failing at things taught me a lot more than succeeding ever did. It is only when facing up to failure that we question what we did wrong and how we could have done things differently. It is the time when we learn the most about ourselves and our ability to get back up and try again.

So how do we avoid the next generation, our children, being so risk averse, so scared of failing that they won’t consider taking a risk to achieve happiness? The answer is surprisingly simple but by the same token not necessarily easy to do. Children model their parent’s behaviour, they learn through repetition so all they need to see is their parents being willing to take risks, not afraid to fail, not afraid to try and try again until they eventually succeed. Through this simple act they will intuitively start to understand that failure is a beginning not an end and only then will they will stop being scared of it.

Losing is not the end, failure is not the worst thing that can happen, it’s simply a step along the path to learning a genuine way to deal with life’s problems.

Thomas Edison so famously said “Many of life’s failures are people who did not realise how close they were to success when they gave up”.

Take a risk, accept failure is a part of life, take a chance things may work out and you may be surprised by quite how much you can achieve.