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Antidepressants

Antidepressants are a type of medication that is primarily used in the treatment of depression, but also for treating OCD.

Depending on when they were first introduced, antidepressants are sometimes described as first, second, or third generation antidepressants.

The discovery of antidepressants could be described as a ‘lucky accident’. During the 1950s, while carrying out trials on a new medication for Tuberculosis, researchers noticed that the medication also had a mood improving effect. This initial discovery led to the creation of two classes of first generation antidepressants: Tricyclic antidepressants (TCAs), of which the most widely used type was called amitriptyline, and monoamine oxidase inhibitors (MAOIs), of which the two most widely used types were called moclobemide and phenelzine.

Both TCAs and MAOIs proved to be effective in treating depression, but they did cause a wide range of side effects, which were often unpleasant.

The second generation of antidepressants, which are collectively known as selective serotonin reuptake inhibitors (SSRIs), were introduced at the beginning of the 1980s. Fluoxetine is probably the best known SSRI (sold under the brand name Prozac).

SSRIs quickly became widely used because they were as effective as TCAs and MAOIs but caused far less troublesome side effects.

The third generation of antidepressants, which are collectively known as serotonin-norepinephrine reuptake inhibitors (SNRIs), were introduced during the 1990s. Examples of SNRIs include venlafaxine and mirtazapine.

SNRIs were the result of an attempt to create an antidepressant that was more clinically effective than SSRIs. However, the evidence that SNRIs are more effective at treating everyone with depression is uncertain. It seems that some people respond better to SSRIs while others respond better to SNRIs.

The biggest safety concern regarding first generation antidepressants is that they can have a potentially fatal effect if a person takes an overdose. This is an obvious concern when treating people who have an increased risk of committing suicide. The same is not true of SSRIs and SNRIs, although taking an overdose can still be dangerous. There have been reports of young people under 25 years of age experiencing suicidal thoughts when they first begin treatment with antidepressants (usually within the first two weeks of treatment). Because of this, it is recommended that young people are closely monitored when they first begin to take their medication. 

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