Trauma Survivors Network - provided by ATS

Antidepressants

Various types of antidepressant medications are available to treat depressive disorders. Presently, selective serotonin reuptake inhibitors (SSRIs), tricyclics, and monoamine oxidase inhibitors (MAOIs) are the most widely prescribed. The SSRI’s act on neurotransmitters such as dopamine or norepinephrine, and are prescribed more often because they tend to produce fewer side effects than the tricyclics. The psychiatrist may prescribe several medications or change the dosage before arriving at the single most effective one, or combination. The individual may notice subtle improvement immediately, but overt symptom reduction typically occurs after three to four weeks (or up to eight weeks).

Individuals may cease their medication before receiving the full benefits if initial improvements are not observed, or the negative side effects outweigh the benefits. While these are natural reactions, it is imperative the individual continue their medications until they have the chance to produce results. Likewise, medications should be continued for four to nine months after experiencing improvements, so gains can be maintained. For individuals with bipolar disorder or major depression, medications may need to be taken long-term. Ceasing medications without consulting a doctor or psychiatrist is risky, as most need to be steadily tapered to avoid negative consequences. A psychiatrist or doctor should work closely with the client to monitor progress or decline. While antidepressants are not habit-forming, dosages may need to be adjusted periodically.

While MAOIs are prescribed less frequently than SSRI’s, they represent the most effective treatment option for some. Individuals on MAOIs must avoid certain foods which contain high levels of tyramine, including many cheeses, wines, pickles, and even certain medications such as decongestants. These restrictions are in place because the interaction between MAOIs and tyramine can result in a hypertensive crisis, in which an acute increase in blood pressure can cause a stroke. There are no food restrictions for other types of antidepressants.

Individuals should consult their doctor before taking prescribed or over-the-counter medication, additional to their antidepressants, to monitor the interaction effects. Likewise, other prescribing health professionals should be told what antidepressants are being taken to pre-determine these effects. Some drugs, including alcohol (wine, beer, liquor) or street drugs, can reduce or prevent the beneficial effects of antidepressants. Some individuals who have not demonstrated a problem with alcohol use may be permitted to occasionally drink in moderation while on the newer antidepressants. As with any treatment, questions regarding prescribed antidepressants should be addressed with the individual’s doctor or psychiatrist.