All prescription drugs cause depression

Depression: Medication & Psychotherapy

Antidepressants are sometimes prescribed for other illnesses - for example anxiety disorders - and influence the brain metabolism. Antidepressants increase the availability of these mood-related transmitter substances and usually attack the following points:

  • Inhibition of the re-uptake of neurotransmitters in the memory of the nerve cells,
  • Inhibition of the breakdown of neurotransmitters,
  • increased release of neurotransmitters.

This increases the concentration of these messenger substances and the mood in depressed patients - but only after a longer period of treatment (often only after more than two weeks).

Groups of antidepressants

There are several groups of antidepressants:

  • Selective serotonin reuptake inhibitors (Selective Serotonin Reuptake Inhibitors, abbreviation SSRI): These prevent serotonin from being transported back into its stores. This means that more of it is available.
  • Selective Serotonin / Norepinephrine Reuptake Inhibitors (SSNRIs): block the return transport of serotonin and noradrenaline to the nerve cells (neurons) in a targeted manner.
  • Selective Norepinephrine Dopamine Reuptake Inhibitors (NDRI): These antidepressants specifically inhibit the transport of norepinephrine and dopamine back into the nerve cells (neurons).
  • Melatonin receptor agonists (MT1 / MT) and serotonin 5-HT2C receptor antagonists (agomelatine): Melatonin receptor agonists tend to promote sleep. Agomelatine also blocks serotonin 5-HT2C receptors and therefore has antidepressant effects.
  • Alpha2 receptor antagonists: These drugs block the noradrenaline receptors for noradrenaline on the nerve cells and at the same time cause an increase in the release of this messenger substance. They are used for depression, which is mainly characterized by "inner" restlessness or sleep disorders.
  • Non-selective monoamine reuptake inhibitors (NSMRI): These include the so-called tricyclic antidepressants. They are no longer among the drugs of first choice because there are other antidepressants that have a more targeted effect (e.g. selective serotonin reuptake inhibitors (SSRI). If you do not respond to selective drugs or if you have very severe depression, nonselective monoamine reuptake inhibitors are also used to the train.
  • Lithium ions: How exactly lithium works is still controversial to date. If it is administered as a long-term medication, it prevents depressive or manic attacks. However, it takes months to take effect. The level of lithium in the blood must be checked at regular intervals, as lithium is a toxic drug which, in very high doses, can cause serious side effects. Lithium is mainly used in bipolar disorders ("manic-depressive").

Proof of effectiveness

The effect of antidepressants in mild depressive illnesses has not yet been adequately supported by high evidence. The effectiveness has been better proven for moderate as well as severe depression. You can find more information at Gesundheitsinformation.de.

When can therapy adjustments be necessary?

If a patient does not respond to therapy with an antidepressant after four weeks, the reasons for this should be clarified or the therapy concept should be adapted. For example, the effect of an antidepressant can be increased by administering another drug that is not an antidepressant (augmentation). Or you switch from one antidepressant to another (switching). You can also try to take another antidepressant (combination). In addition, psychotherapy - if it has not already taken place - can be weighed up. During drug therapy, the doctor pays attention to possible interactions between the various drugs. These should therefore only be taken in the prescribed dose. Otherwise there is a risk of a so-called serotonin syndrome, for example. The medication is discontinued on recovery in gradually decreasing doses over a period of weeks. However, it may also be necessary to take additional medication to avoid relapses or recurrences.

NoteTaking antidepressants can initially increase the risk of suicide. Do not be afraid to seek help if you have thoughts of suicide and, as a relative, watch out for possible signs. You can find more information and emergency numbers on the public suicide prevention portal.