How doctors prescribe antidepressants

Finding the right anti-depressant medication requires a trial and error approach. Currently, there exists no test to accurately measure your symptoms. So your doctor doesn’t really know what to prescribe you. They select one from a list, prescribe it to you and monitor you over 4-12 weeks (this is how long it takes to see benefits and qualify a medication) to see if what they’ve chosen works. If not, they try another medication. This process continues until they find what works.

How doctors prescribe antidepressants:

There are approximately 22 antidepressant medications on the market that have been approved by the American Federal Drug Association (FDA). They fall under four categories, labeled for the brain chemical they target. (each variety is explained below)  In order to choose an appropriate medication for you, your doctor may consider these factors:

• Your situation. Each case of depression is different, which means so are the symptoms. Your doctor will like assess your situation and choose an antidepressant that is likely not amplify a negative issue you are dealing with. For example, if you are severely overweight or have an eating disorder a doctor will try and prescribe a medication that does not have a side effects of weight gain because that will only make your situation worse.
• Your lifestyle. Antidepressants have side effects that can unobstrusive but annoying (ie. dry mouth, low sex drive). A doctor may ask you some lifestyle questions to help him discover what a good medication would be. For example, if you are a man trying to have a baby with your wife, taking a low sex drive medication may not be helpful. 
• Your current physiology. Your doctor will evaluate your current physiology, this includes taking into account other health conditions you may have.  If you are pregnant or breast feeding, there are some antidepressants you should not take.
• Your genetics. If you have a family members that takes antidepressants your doctor may prescribe the same treatment. Often genes play a role in how a patient reacts to a medication. If it work for a family member with a similar genetic predisposition then it may be effective for you.
• Your finance capabilities. If you do not have medical coverage antidepressants can cost up to $350/month.  Some antidepressants are cheaper than others.
• Your other medications. Are you taking other supplements and/or medications? This will be considered as some medications work negatively together.

 

How do anti-depressants work?:

The basic premise of an antidepressant is that once you take it the drug passes through your body via your blood and into your brain.  There, it targets a specific brain chemical (or chemicals) that control your mood.

If you read the word “inhibitor reuptake” what that means is that the drugs stops a process where the chemical does not re-enter the brain cell, which it would normally do.  That means, less of the chemical remains in the nerve cell.

The brain chemicals that are targeted by these drugs are called: Dopamine, Serotonin, and Norepinephrine

Selective serotonin re-uptake inhibitors (SSRIs)

These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants.

Common SSRIs by drug name include: Prozac, Selfemra, Paxil, Pexeva, Zoloft, Celexa, Lexapro

Serotonin and norepinephrine re-uptake inhibitors (SNRIs)

Common SNRIs by drug name include: Cymbalta, Effexor XR, Pristiq, Khedezl, Fetzima

Norepinephrine and dopamine re-uptake inhibitors (NDRIs)

One of the few antidepressants not frequently associated with sexual side effects.

Common NDRIs by drug name include: Wellbutrin, Aplenzin, Forfivo XL.

Tricyclics

Not many doctors prescribe tricyclics these days, though they are still effective for many people. They are often used after other drugs haven’t work. They’ve been replaced because they tend to have more side effects.

Cyclic antidepressants block the absorption (reuptake) of the neurotransmitters serotonin (ser-o-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin), making more of these chemicals available in the brain. This seems to help brain cells send and receive messages, which in turn boosts mood.

Norpramin, Tofranil, Pamelor, Vivactil, Trimipramine, Surmontil

MAOIs Using an MAOI requires a strict diet because of dangerous food interactions. Selegiline (Emsam), a newer MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs

Atypical antidepressants

Oleptro, Remeron, Brintellix, Viibryd

 

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