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Antidepressants

Antidepressants are a large class of medications used in psychiatry to treat Depressive Disorders. Many of the antidepressants are effective for treating various other conditions as well, such as Anxiety Disorders, impulsive behaviors associated with Borderline Personality Disorder, Intermittent Explosive Disorder and Dementia, Eating Disorders, Hypochondriasis, Body Dysmorphic Disorder, Trichotillomania, insomnia, chronic pain, and Fibromyalgia.

Safety Concerns regarding Antidepressants

Contrary to some popular rumors, antidepressants are not addictive, do not cause a dependency, and do not change one's personality. They also do not increase the risk of suicidal acts in adults, and if anything they likely reduce the chances of suicide [ref, ref].  

In children and adolescents, antidepressants do not increase the rate of suicide attempts, but there is evidence that some of the SSRI antidepressants may slightly increase the chances of children or adolescents having suicidal thoughts or engaging in self-harm behaviors [ref, ref; contradictory evidence: ref]. These tendencies include thoughts or acts of self-harm, but not actual suicide attempts. Venlafaxine seems to cause higher rates of these problems than most other antidepressants [ref].

For more in-depth information on the specific side-effects caused by each of the antidepressants, please refer to PsychVisit's individual articles on these various different medications.

Older Forms of Antidepressants

The earliest kinds of antidepressants to have been developed were the Tricyclics (TCA) and Monoamine Oxidase Inhibitors (MAOI). While these still remain effective options for various conditions, they tend to cause more side-effects, without being much more effective, than the newer forms of antidepressants. For this reason, they are no longer used very commonly. They are used mostly for treatment-resistant cases of Depression and in low doses for insomnia and chronic pain.

SSRIs and Novel Antidepressants

Newer forms of antidepressants that are more currently in use are the SSRIs as well as the other "novel antidepressants," which include Agomelatine, Bupropion, Duloxetine, Mianserin, Milnacipran, Mirtazapine, Reboxetine, Tianeptine, Venlafaxine and Desvenlafaxine.

Differences Among the Antidepressants

There is some evidence that among these newer forms of antidepressants, Escitalopram and Sertraline - both of which are SSRIs - stand out as being particularly effective and well-tolerated in the treatment of Depression [ref], and that Venlafaxine may also be somewhat more effective than various other antidepressants for treating this condition [ref]. Duloxetine and Milnacipran, too, may be counted among the more effective antidepressants [ref].

In terms of side-effects, certain antidepressants are known for having higher rates of causing various undesired effects [ref]:

  • Fluoxetine and Fluvoxamine may cause more nausea and stomach upset than other antidepressants.
  • Sertraline has higher rates of diarrhea.
  • Paroxetine tends to cause high rates of sweating, sedation, weight gain and sexual side-effects.
  • Mirtazapine can cause significant sedation and weight gain.
  • Escitalopram seems to have quite low rates of most side-effects.

However, it should be noted that the above points are based on large studies looking at statistical averages derived from hundreds and even thousands of participants. In real-life clinical practice, it is very difficult to predict how any given person will respond to a particular medication; two people may have completely different reactions to the same drug. Therefore, the above points can only be used as a very rough guide.