Antidepressants Series: Post 2 – Pharmacist’s Perspective

This blog post was written with the help of my brother, a practicing pharmacist in Ontario.  While it is meant to be interview-style, the responses are not direct quotations.  Thus, any factual errors that may have slipped through are the fault of my rewording.  If you need any clarifications, ask your local pharmacist.

How do antidepressants work?

Antidepressants work by adjusting the “balance” of neurotransmitters in the brain.  Neurotransmitters are the chemicals the brain uses to communicate.  Everyone has fluctuating levels of neurotransmitters and some people are genetically predisposed to lower (on average) levels of certain neurotransmitters.  The lower levels of neurotransmitters are linked to depression.

In particular, antidepressants function to increase the levels of serotonin, dopamine and/or norepinephrine in the brain.  Serotonin contributes to feelings of well-being and happiness, dopamine plays a role in reward-driven learning, and norepinephrine effects alertness, arousal and the reward system.  Neurotransmitters are constantly being turned over, and one method employed by antidepressants to increase their levels is to slow this turnover so they remain active for longer.

Are all antidepressants the same?

No.  The term antidepressants generally refers to several classes of drugs.  They can separated into two categories: old generation and new generation.  The old generation antidepressants are less selective in terms of which neurotransmitters they effect in comparison to new generation antidepressants.  However, they can be a good option for some people.  New generation antidepressants such as SSRIs (selective serotonin reuptake inhibitors) are most commonly prescribed as they have a favourable side-effect profile and low toxicity.

What are some side effects of antidepressants?

The side effects depend on the particular type of antidepressant used.  Some possible side effects are: decreased sexual function, dry mouth and drowsiness.  However, not everyone will experience these side effects as they are dose dependent.  Old generation antidepressants have more dangerous side effects associated with them.

Are antidepressants addictive?

An individual can become dependent on antidepressants, because the brain cells have altered their biochemistry and taking the chemical away all of a sudden can be problematic.  Withdrawal symptoms are possible if treatment is stopped abruptly.  However, there is an important distinction between “addiction” and “dependence”.  Addiction implies that an individual is behaving in a harmful way, despite negative consequences. It is possible that someone could become addicted to antidepressants, in the way that someone could become addicted to playing video games, but there is nothing inherently addictive about them.  Since they are more often beneficial than harmful, classifying them as addictive is incorrect.

Do you have any insight about where the stigma surrounding antidepressants comes from?  What can people do to help remove this stigma?

The focus should not be about reducing the stigma surrounding antidepressants, but rather the stigma surrounding mental health.  Antidepressants are an option of therapy for some people experiencing a number of psychological issues which can be effective, particularly when paired with psychotherapy.  While this is a question better addressed by say, a sociologist, something people can do to remove stigma surrounding mental health is to inform themselves.  Individuals should be more open-minded and take time to learn about mental health issues before judging.

More resources on antidepressants:

Pharmacist refilling prescription