Antidepressants are used to treat endogenous depression.

Improvement in sleep is commonly the first benefit noticed by the patient.

They are also useful for treatment of phobias, anxiety, nocturnal eneuresis in children, fibromyalgia and some neuralgias. Now the antidepressant Bupropion is also used for the treatment of smoking addiction and possibly hyposexuality disorder of females. Cymbalta (DULOXETINE) is also used for peripheral neuropathy.

Since the effect of the treatment may take over two weeks to become obvious (except in Duloxetine - where benefit in 1 week), patients who have suicidal intention need to be admitted for further evaluation. In the US,  most patients with suicidal ideation are admitted and if necessary, are kept against their will. During such an admission, the patient is kept under close observation with an attendant present at ALL TIMES (called one to one nursing).

Anti depressants are of 4 main types: All of them are almost equally effective. Their most important difference is Side effect profile.

Tricyclics: Side effects include - Antimuscarinic (anticholinergic)- dry mouth, constipation,  higher risk of cardiac arrhythmias - especially with Amitryptiline. Members of this family include Amitryptiline/Nortryptiline/Trazodone and others

MAO inhibitors: I never use these but the things that one cannot eat with these are so important that you must know some important ones.  Not to eat cheese, fermented foods including Marmite/Bovril/Fermented Soya foods. Potential for interactions can remain 2 weeks after stopping MAOIs. Other antidepressants should not be started for 2 weeks after stopping MAOIs. Potential to cause severe blood pressure rise is the main problem.

If one is stopping MAOIs, they need to be withdrawn slowly.

SSRIs: Safest profile. Side effects include GI upset in the first week. This side effect settles down after the first week. Fluoxetine (Prozac) and Paroxetine (Paxil) are now generic. Citalopram, Escitalopram, Fluoxetine,Fluvoxamane, Paroxetine & Sertraline are the members of this family used in the US.

Others: Bupropion (Wellbutrin) - not to be used in patients who have seizures, Duloxetine, Venlafexine (Effexor), Mirtazapine (Remeron), Nefzodone (Serzone), Trazodone (Desyrel), St Johns wort.