By Antidepressants, like other psychotropic drugs, have been the target of much criticism, the most intense of which is their side effects. But what does science say about all this?
Humans are increasingly taking medication. And as the consumption of antidepressants increases, our mental health seems to become more fragile . In addition, the use of this type of drug has adverse effects that can go unnoticed.
Hypertensive crises, dry mouth, sedation or episodes of cardiac arrhythmia are just some of the side effects that result from taking psychotropic drugs . They also affect cognition, that is, the ‘way in which a person processes information from their environment and interprets it’.
“Mental well-being is about having the strategies to face challenges and manage stress effectively.”
-Marsha Linehan-
What is an antidepressant?
Antidepressants contain active ingredients that modulate the number of neurotransmitters involved in the synapse . We are talking about a kind of messengers that transfer information. There are different types of drugs depending on the neurotransmitters on which they intervene (Stahl, 2023); they are the following:
- Selective norepinephrine reuptake inhibitors (SNRIs): work exclusively on this neurotransmitter molecule; an example is reboxetine.
- Monoamine oxidase inhibitors: prescribed to control depressive and anxiety symptoms. Examples of this class include phenelzine, isocarboxazid, and selegiline.
- Dual antidepressants: These act selectively on two molecules (noradrenaline and serotonin ). The results they produce are therefore synergistic. Venlafaxine and duloxetine are part of this category.
- Dopamine and norepinephrine reuptake inhibitors (NDRIs): a good example of this pharmacological group is bupropion . Although it has antidepressant effects, its main use is in the treatment of tobacco addiction.
- Selective serotonin reuptake inhibitors ( SSRIs ) : by blocking the mechanism that reuptakes serotonin, the levels of the neurotransmitter increase in the intersynaptic space. This group includes escitalopram, paroxetine and sertraline .
- Heterocyclic antidepressants: these are psychotropic drugs known as the “first generation”. Their mechanism of action consists of inhibiting the reuptake of both noradrenaline and serotonin, although they may have effects on other substances. Examples of this group are amitriptyline and imipramine.
Adverse effects of antidepressant use
The concept of adverse effect refers to the “unintended adverse reactive effect of an antidepressant .” It varies depending on the time of consumption, as well as the prescribed dose. In this regard, a paper published in the Electronic Medical Journal indicates that 2.2 million people annually report an adverse consequence that could be classified as serious.
The range of reactions is multiple; below we mention some of them (Sthal, 2023):
- Insomnia .
- Constipation.
- Blurred vision.
- Headache.
- Sexual dysfunction.
- Dry mouth.
- Drowsiness and fatigue.
- Excessive sweating.
- Memory problems.
- Agitation and irritability.
- Withdrawal syndrome .
- Weight loss or gain.
- Concentration difficulties.
- Increased risk of suicidal thoughts.
The list goes on. However, it is important to note that the benefits of antidepressant intervention may outweigh the adverse effects . Therefore, if there is any doubt, the psychiatrist is the professional who best explains the intervention plan.
“Psychologists and psychiatrists have different but equally important roles in mental health care. Collaboration between the two can increase the likelihood of treatment success.”
-Norman Sartorius-
The antidepressant escitalopram under scrutiny
A recent study published in Neuropsychopharmacology analyses the effects of escitalopram. This antidepressant is a serotonin reuptake inhibitor , that is, it promotes the increase of this neurotransmitter in certain brain regions, producing antidepressant and anxiolytic effects.
Furthermore, prolonged and long-term use of escitalopram generates changes in the reinforcement mechanism (Langley et al., 2023). And it is through reinforcement that the person learns new behaviors or inhibits them. In this sense, persistent intake of escitalopram could increase the sensitivity of patients who consume it to positive reinforcement.
That is, chronic users of the psychotropic drug are more sensitive to rewards and less to punishments , The Journal of Neuroscience (Seymour et al., 2012) reports. In addition, patients frequently report the feeling of mental dullness (Marazziti et al., 2019), which together with the increased sensitivity to reinforcement or reward would be responsible for the clinical effects .
Although the adverse effects of antidepressants are many and varied, their use may be justified. Psychiatrists are the people empowered to decide. Difficulty concentrating, constipation or blurred vision are some negative sequelae . However, side effects with the potential to be beneficial, such as those of escitalopram, are also possible.