There are several types of drugs available to treat depression, with the main types being TCAs, SSRIs, and SNRIs. — TNS
Depressive disorder, commonly known as depression, is a widespread mental health condition.
According to the World Health Organization (WHO), it affects approximately 280 million people worldwide.
While depression can impact anyone, individuals who have experienced abuse, significant loss or other stressful events are at a higher risk.
Additionally, women are more likely to develop depression than men.
In Malaysia, there is a rising trend in the number of depression cases.
The 2023 National Health and Morbidity Survey (NHMS) reported that 4.6% of adults experienced depressive symptoms, an increase from 2.3% in the 2019 NHMS.
The prevalence of depression among children aged five to 15 years has also shown a worrying increase, with the percentage rising from 7.9% in 2019 to 16.5% in 2023.
The rising rates of depression in Malaysia underscore the urgent need for early intervention, which includes screening and timely treatment.
Addressing mental health issues early can prevent more severe outcomes.
For example, ensuring that patients adhere to prescribed treatments is crucial, not only for better disease control, but also to improve their quality of life.
Risk factors and symptoms
Various factors can contribute to depression.
One of the causes is a chemical imbalance in the brain, particularly involving the neurotransmitters serotonin, noradrenaline (norepinephrine) and dopamine.
Additionally, depression can arise from a complex interplay of social, psychological and biological factors.
These include a family history of depression, environmental influences and chronic medical conditions.
Individuals who have experienced significant life challenges, such as unemployment, loss of a loved one or trauma, are at higher risk of developing depression.
A depressive episode differs from normal mood fluctuations.
Depression is characterised by a prolonged low mood that significantly impacts a person’s daily life, including their ability to manage social, environmental and occupational tasks.
Key symptoms of depression include:
- Persistent low mood
- Loss of interest or pleasure in activities
- Difficulty concentrating
- Sleep disturbances
- Loss of appetite
- Fatigue or low energy
- Excessive guilt or feelings of low self-worth
- Functional impairment that affects their ability to study or work, and
- Suicidal thoughts.
Common antidepressants
Depression is a treatable condition, and pharmacotherapy is the primary method of treatment for moderate to severe cases.
The doctor will evaluate the patient and recommend an appropriate antidepressant.
The selection of medicines will be influenced by several factors, including its effectiveness and tolerability, the patient’s profile and co-morbidities (other medical conditions), any concurrent medicines and potential drug interactions, as well as cost, availability and the patient’s preferences.
Several types of antidepressants are available in Malaysia.
The medicines help to regulate neurotransmitters such as serotonin, noradrenaline and dopamine, which play key roles in brain functions related to mood and behaviour.
The main classes of antidepressants include:
Examples of TCAs include clomipramine and amitriptyline.
They work by inhibiting the reuptake of noradrenaline and serotonin in the brain, causing an increase in the level of these neurotransmitters and prolonging their effects on the brain and body.
However, TCAs can also influence other chemicals in the body, which may result in unpleasant side effects.
These side effects can be dose-dependent, with higher doses often leading to more adverse effects.
The most common side effect associated with TCAs is drowsiness; therefore, patients are advised to take this medication at bedtime to minimise the side effects.
They should be more cautious when driving or engaging in activities that require concentration.
Other potential side effects may include blurred vision, constipation, dry mouth and urinary retention.
TCAs can also cause a drop in blood pressure when a person moves suddenly from sitting to standing (postural or orthostatic hypotension), which may result in lightheadedness.
SSRIs are generally better tolerated than most other types of antidepressants and are more frequently prescribed in Malaysia.
They primarily function by blocking the reuptake of serotonin.
By preventing this reuptake, more serotonin becomes available to facilitate communication between brain cells, allowing it to have a prolonged effect on the brain and body.
SSRIs are termed “selective” because they primarily target serotonin rather than other neurotransmitters.
Examples of SSRIs include escitalopram, sertraline, fluoxetine and fluvoxamine.
Possible side effects of SSRIs include stomach upsets, vomiting or diarrhoea, sweating, headaches, sleepiness or insomnia, and dry mouth.
Some of these side effects can be reduced by adjusting the timing of medicine intake.
For example, taking an SSRI with food or before bedtime may help prevent nausea.
If a patient experiences insomnia, it is advisable to take the SSRI in the morning, while those who feel drowsy after taking it are advised to take it at night.
Additionally, some SSRIs can lead to changes in appetite, resulting in either weight loss or weight gain.
Patients are strongly encouraged to monitor their food intake and maintain regular physical activity.
SNRIs function similarly to SSRIs, but have a significant effect on both serotonin and noradrenaline reuptake.
SNRIs are often preferred for treating more severe cases of depression.
Common examples include duloxetine, desvenlafaxine and venlafaxine.
The side effects of SNRIs are generally mild and often improve with time.
These can include nausea, vomiting, dry mouth, constipation, fatigue, drowsiness, dizziness and excessive sweating.
Patients should avoid stopping SNRIs abruptly without consulting a healthcare professional, as this may result in discontinuation syndrome.
This syndrome can cause flu-like symptoms, such as fatigue, chills and muscle aches, as well as other symptoms like dizziness, headache, diarrhoea, sleep disturbances and irritability.
Ensuring effectiveness
For depression treatment to be effective, antidepressants must be taken daily, following the prescribed dose and schedule.
This consistency is vital for achieving good treatment outcomes and assessing the response to the medicines.
Side effects are common when starting antidepressants, but they usually occur early in treatment and are usually temporary.
Patients should consult their doctor or pharmacist if they find the side effects difficult to tolerate.
Additionally, patients are strongly advised to inform healthcare professionals if they are taking any other medicines, health supplements or traditional products.
This information is important to avoid potential interactions that could reduce the effectiveness of the antidepressants.
Some antidepressants may not be suitable for pregnant or breastfeeding women, so these patients should inform the doctor of either condition to ensure their safety when taking these medicines.
Patients should not stop taking their medicines without first consulting their doctor, as discontinuing treatment may pose health risks.
Remember!
Depression is treatable, but effective management requires consistent adherence to prescribed antidepressants.
Taking them correctly helps minimise potential side effects, which can improve patient compliance with the treatment.
Patients should always consult their doctor or pharmacist if they encounter difficulties with their treatment.
Further enquiries regarding medicines can be submitted to the National Pharmacy Call Center (NPCC) through 1-800-88-6722 on Monday to Friday, from 8am to 5pm, except on public holidays.
Afra Nahdia Marizan Nor is a pharmacist at Hospital Sungai Buloh in Selangor. This article is courtesy of the Health Ministry’s Pharmacy Practice and Development Division. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
