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Medication

Everything you wanted to know about sleeping pills, anti-depressants, psychiatric medication
Dr Uzma Ambareen answers every question you were too afraid to ask

Most people won't admit to taking a pill to sleep better or relieve anxiety and depression and many take them without a doctor's prescription. When we asked journalists if they had done this, a surprising number of hands would go up during workshops with psychologists at the IBA-CEJ's Wellbeing Centre over the last three years.

So we asked the Wellbeing Centre's clinical psychiatrist Dr Uzma Ambareen to answer all our questions on medication.

What is an antidepressant?

They are a group of drugs used to treat depression. They are used for treating other psychiatric disorders like panic disorder, generalized anxiety disorder, eating disorders and obsessive-compulsive disorder. Their exact mechanism of action is treating depression is still not known. They are known to target several brain chemicals (neurotransmitters) like serotonin, norepinephrine, and dopamine. Some antidepressants are not good for treating anxiety but some antidepressants work well.

How does an antidepressant work?

Interestingly, we still do not know how antidepressants exactly work to treat depression. There are some theories.

We know what happens to your brain but we don't know how that leads to an improvement in depression or anxiety. We do know that these medicines target different brain chemicals.

Often doctors say that there is a chemical imbalance. This is a very general term. This makes us think that if there is a chemical imbalance it can be fixed once you take X chemical.

But the truth is that it isn't that simple.

In order for any medicines to reach the brain its substances need to go through layers and layers. And until the molecules of these medicines are a certain size, they won't reach the brain.

Antidepressants target three neurotransmitters: serotonin, norepinephrine and dopamine.

All antidepressants take at least 3 weeks to start working, though sometimes, people report some improvement even earlier. A maximum effect can take up to 8 weeks.

After a significant improvement (70%-80%) has been achieved, the medication must be continued for at least 6 to 9 months, before being tapered off under a doctor's supervision.

What are the different types of antidepressants?

Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
Selective Serotonin Norepinephrine Inhibitors (SSNRIS)
Norepinephrine Dopamine Reuptake Inhibitors (NDRIs)
Tricyclics (TCAs)
Monoamine Oxidase Inhibitors (MAOIs)

What are some SSRIs?

Fluoxetine (Prozac, Depex, Depricap, Flux)
Paroxetine (Seroxat, Paraxyl, Paroxin)
Sertraline (Zoloft, Sert, Reline, Serlin)
Citalopram (Cipram, Citalo, Pramcit)
Escitalopram (Cipralex, Es-Pramcit, Citanew)
Fluvoxamine (Faverin, Voxamine)

These medicines don't have any effect on your kidneys, heart and other organs – so they are safe. You can take them with other medicines too. One of the most common complaints: acidity and nausea, excessive sweating

What are some Tricyclics?

Amitriptyline (Tryptanol, Amyline)
Imipramine (Tofranil, Imidol)
Dothiepin (Prothiaden)
Clomipramine (Clomfranil)
Nortriptyline (Sensival)
Miscellaneous antidepressants used in Pakistan
Duloxetine (Cymbalta, Dulan, Zenbar, Hapibar)
Venlafaxine (Effexor, Velax, Zaxine, Venice)
Desvenlafaxine (Denla)
Bupropion (Wellbutrin, Butrin, Zylexx, Deprion)
Mirtazapine (Remeron, Mirtazep, Ramargon)
Trazodone (Deprel)
The SSRIs have fewer side effects. They are safe and easy to prescribe.

To learn even more about medication, read the next article in this series here.

Always consult a doctor before taking any antidepressants or medication. Do not self-prescribe.

Talk to a mental health professional, a psychiatrist who can guide you.

Reliable websites to consult:
Mayo Clinic
Harvard Clinic

This article is based on an IBA-CEJ workshop on 'Depression, anxiety, medicine' held December 11, 2019 in Karachi at the IBA with Dr Uzma Ambareen.

Profile of clinical psychiatrist Dr Uzma Ambareen

Dr Uzma is one of Pakistan's best known clinical psychiatrists. She has been part of the IBA-CEJ Wellbeing Centre free counselling service since 2018.

She did her residency training in Psychiatry from Hahnema University and Brown University, US and her fellowship in Public Psychiatry from Columbia University, US. Dr Uzma has been the Medical Director of The Recovery House in Karachi since 2013 and runs her own practice.

Since her return to Pakistan in 1998, she has been associated with the Pakistan Association for Mental Health. She has served as Clinical Director at the Institute of Behavior Sciences and subsequently at the Free Mental Health Clinic.

Apart from Psychiatric Rehabilitation, her areas of interest include community psychiatry, public mental health awareness, individual psychotherapy and family therapy.