Background

Depressive disorder is a complex heterogeneous disease that affects more than 280 million people worldwide.  The prevalence of depression is higher for women (4.1%) than for men (2.7%). People aged 50 years and more have a 1.5 times higher risk for developing depression than younger people. Symptoms of depressive disorder are persistent depressive mood, reduced ability to feel pleasure and rejoice, weight changing, disturbed sleep, loss of energy, low self-esteem, trouble with concentration, elevated emotional psychomotor activity in children and teenagers, psychomotor agitation or motor retardation, and self-injuring or suicidal ideation.   Depression can be distinguished as mild, chronic, moderate and severe depression.  Antidepressants are used in the treatment of depression

Objectives

To review current evidence regarding efficacy, adverse effects, and optimal selection of antidepressant drugs.

Methods

We searched Ovid Medline, Embase, Google scholar and the Cochrane Central Register of Controlled trials for English-language studies for articles published between January 1, 2000, and June 28, 2022, to identify  randomized clinical trials, systemic reviews and practice guidelines related to depression and antidepressants across the age groups

Results

Effectiveness

Antidepressants are effective against chronic, moderate and severe depression. They are not effective in mild depression.

The commonly used tricyclic antidepressants (SSRIs and SNRIs) are found to be equally effective.

In adults with moderate to severe depression, antidepressants such as TCAs, SSRIs or SNRIs can lower the risk of relapses, but can’t completely prevent them.  Prolong use of antidepressants, successfully prevented a relapse in an average of 27 out of 100 people.

Adverse Effects

Over half of all people who take antidepressants have side effects. These occur during the first few weeks of treatment and are less common later on.

The type and frequency of side effects, and how frequent they are, depends on the drug, the dose used, and whether they have just started taking it or have been taking it for some time.  SSRIs are more likely than tricyclic antidepressants to cause diarrhea, headaches, sleep problems and nausea.  Compared to SSRIs, tricyclic antidepressants are more likely to cause vision problems, constipation, dizziness, a dry mouth, trembling and difficulty urinating (peeing). The side effects of tricyclic antidepressants are often worse than those of SSRIs and SNRIs. More people tend to stop taking tricyclic antidepressants because of this: Studies found that about 15 out of 100 people who were taking tricyclic antidepressants  stopped taking these medications because of side effects, compared to around 10 out of 100 people who were taking SSRIs. There’s also a greater risk of severe side effects if an overdose of tricyclic antidepressants is taken.

Selection

Selection is based on severity of the symptoms. Patients with mild symptoms are not prescribed antidepressants.  Other factors include questions such as (a)  Are you going to psychotherapy or are you planning to (b) Have you taken antidepressants before and did they help? ©How bad do you think the potential side effects are compared to the possible benefits?

Conclusion

The most commonly used antidepressants are Tricyclic antidepressants (TCAs); Selective serotonin re-uptake inhibitors (SSRIs). Selective serotonin noradrenaline re-uptake inhibitors (SNRIs). The less commonly prescribed antidepressants, include Adrenergic alpha-2 receptor antagonists; Monoamine oxidase (MAO) inhibitors; Selective noradrenaline re-uptake inhibitors; Selective noradrenaline/dopamine re-uptake inhibitors; Melatonin receptor agonists and serotonin 5-HT2C receptor antagonists. There are also medications (like trazodone and lithium) that do not fall under any group, as well as herbal products such as St. John’s wort. Patients with mild depression are not treated with antidepressants.

Key words, Depression, Antidepressants – TCAs, SSRIs, SNRIs, MAOI