Antidepressant Medications: A Look into Their Nature and Beyond
In the ongoing quest to find effective treatments for depression, three new antidepressants have recently been approved or are on the market: Brexanolone, Esketamine, and Agomelatine.
Brexanolone, also known as Zulresso, is a unique antidepressant that works by activating gamma-aminobutyric acid (GABA) receptors and raising GABA levels in the brain. It is given as an intravenous (IV) infusion for a total of 60 hours (2.5 days) in a hospital setting. The most commonly reported side effects include dry mouth, flushing, loss of consciousness, and sleepiness.
Esketamine, derived from ketamine, a drug used for anesthesia, is another novel antidepressant. It works by blocking NMDA receptors, triggering the production of glutamate, and potentially helping to form new brain cell connections. Esketamine comes in a nasal spray and is used once or twice a week, along with another oral antidepressant. Like other antidepressants, esketamine may increase the risk of suicidal thoughts or behaviors in people ages 24 years and younger.
After taking esketamine, a healthcare professional will monitor the patient for at least 2 hours for an increase in blood pressure and signs of excessive sleepiness or dissociation. It is recommended that one avoids driving or operating machinery for 24 hours after taking esketamine. Esketamine is only administered in a healthcare facility setting due to the risk of dissociation and potential dependence.
Agomelatine, an antidepressant that blocks serotonin receptors and stimulates melatonin receptors to help with sleep, is approved for depression treatment in Europe and Australia but not yet in the United States. The lack of approval in the U.S. is due to negative results seen in late-stage trials and the possibility of liver damage.
Other commonly used antidepressants include selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and sertraline (Zoloft). SSRIs remain the most prescribed antidepressants, with fluoxetine (Prozac) being the first approved by the FDA to treat depression.
Noradrenergic and specific serotonergic antidepressants (NaSSAs) are often prescribed for depression, anxiety, and personality disorders, with mirtazapine (Remeron) being the most commonly used NaSSA.
Tricyclic antidepressants (TCAs) are less often prescribed for depression due to some unpleasant side effects but are still used for other conditions such as trouble sleeping and some types of chronic pain. Commonly used TCAs include amitriptyline (Elavil), doxepin (Sinequan), imipramine (Tofranil), and nortripyline (Pamelor).
Lastly, it's worth mentioning Esketamine, which was recently approved by the FDA to treat depression that hasn't improved with other medications. Other commonly used SNRIs include desvenlafaxine (Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor).
The newest antidepressant available in Germany is Zuranolone, recommended by the European Medicines Agency (EMA) for approval; it is the first oral medication specifically for postpartum depression, administered as capsules taken daily for 14 days, and expected to offer a fast-acting treatment option.
These new antidepressants offer hope for those struggling with depression, providing more treatment options and potentially more effective solutions. As always, it's crucial to discuss treatment options with a healthcare provider to determine the best course of action.
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