Ask your pharmacist antidepressants part 2

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie. This is the second of three articles on antidepressants in the Westmeath Examiner.

Side effects from antidepressants are relatively rare, however, like all medicines; antidepressants can have side-effects. Generally, the benefits of taking an antidepressant will out-way the risk of side effects for someone suffering from severe depression. 
 
Tricyclics are the older type antidepressants and are less often prescribed nowadays. However, they still have an important role, especially in situations where insomnia is a major symptom of the person’s symptoms. Tricyclics commonly cause dry mouth, a slight tremor, fast heartbeat, constipation, sleepiness, and weight gain. These effects are reduced if a low dose is given to start and the dose is then slowly increased.

Other side effects which are more common in older people include confusion, inability to pass urine, and faintness. They should be avoided with heart conditions as they can cause irregular heart beat. Tricyclic antidepressants are dangerous in overdose as they can cause heart problems. Examples of antidepressant brands which contain tricyclics include Prothiaden®, Gamanil® and Molipaxin®.

SSRIs can make you feel sick and more anxious initially; however these side effects often wear off after a few weeks. They can cause indigestion but this can be avoided by taking with food.

They rarely cause sexual problems such as loss of libido. There have been reports of episodes of aggression, although these are rare. Most people only get a small number of mild side-effects (if any). The side-effects usually wear off over a couple of weeks as the body gets used to the medication.

The more serious ones (problems with urinating, memory problems, falls, confusion) are uncommon in healthy, younger or middle-aged people. Examples of antidepressants which contain SSRIs are citalopram (Cipramil®), escitalopram (Lexapro®), fluoxetine (Prozac®), paroxetine (Seroxat®) and sertraline (Lustral®).

SNRIs:The side-effects are very similar to the SSRIs, although Venlafaxine should not be used with a serious heart problem. It can also increase blood pressure, so this should be monitored, especially initially. Examples of SNRI’s include duloxetine (Cymbalta®) and venlafaxine (Efexor XL®).

MAOIs:This type of antidepressant is rarely prescribed these days. This is because they can cause hypertensive response (dangerously high blood pressure) if foods containing a substance called tyramine are eaten with them. Foods containing tyramine include mature cheese, pickled herring, broad bean pods, yeast extracts including brands like Bovril®, Oxo® and marmite®. Manerix® is an example of a MAOI.

NASSAs:Mirtazapine (Zispin®, Mirap®) is the most common drug used in this group. The side-effects are very similar to SSRIs. It can make you feel drowsy, encourages weight gain, but it causes less sexual problems. Because it causes drowsiness, it often prescribed for people suffering from depression who find it difficult to sleep. It should be taken at night.

SSRIs in younger people. There is some evidence of slight increased suicidal thoughts (although not actual suicidal acts) and other side-effects in young people taking antidepressants. So, SSRI antidepressants are not licensed for use in people under 18. However, the National Institute for Clinical excellence in the UK has stated that Fluoxetine, an SSRI antidepressant, can be used in the under-18s.

Upcoming talk on depression and mental health
Whelehans Pharmacy have organised an expert panel to discuss depression and mental health later this month in Mullingar; some of the leading local experts on this subject will be talking.

Speakers will include Consultant Psychiatrist from St Lomans Mental Health Service, Dr Ciaran Corcoran; Specialist Psychiatric Nurse Colette Moriarty and Pharmacist Eamonn Brady.  This talk will be open to all and will be free of charge. The exact date and venue is to be confirmed soon so keep an eye on this column in the coming weeks for more details.

In order to avoid disappointment, you can put your name down on the waiting list for this event by calling Whelehans at 04493 34591.

To be continued next week