Types of medication

There are two main groups of antidepressants, the newer drugs (the dual action preparations and the SSRIs) and the old drugs (TCA and MAO-Inhibitors).

SSRI

The most widely used. Selective Serotonin Reuptake Inhibitors. These drugs boost the effect of the signalling substance serotonin in the brain, and they are effective in the treatment of depression.

List of SSRIs that are available in Singapore (alphabetical order):

• Citalopram
• Escitalopram
• Fluvoxamine
• Fluoxetine
• Paroxetine
• Sertraline

Dual action preparations

Dual action preparations boost the effect of the signalling substance serotonin and noradrenaline in the brain.

Currently there are two available drugs in Singapore:

• Venlafaxine
• Mirtazapine

The side-effects of SSRI and dual action preparations

These are the list of side-effects that may occurred if you are under the treatment with SSRIs or dual action preparations. The side-effects can vary from individual. So please consult your doctor. They might be:

• restlessness
• difficulty in sleeping
• dryness of the mouth
• nausea and vomiting
• headache
• constipation
• tendency to sweat
• sexual problems (lack of desire, delayed/absent ejaculation)
• weight increase
• high blood pressure (rarely a side-effect in high doses of Efexor)
• changes in the body's sodium balance

TCA

TCAs (tricyclic antidepressants) boost the signalling substances serotonin and noradrenaline in the brain and also block different receptors in the brain's nervous system. They have a slightly different effect than the SSRIs and also have a few more side-effects. This group comprises, amongst others:

• Nortriptyline
• Clomipramine
• Imipramine

Side-effects of TCA

The side-effects that might occur in the treatment with TCA are:

• dryness of the mouth
• constipation
• tendency to sweat
• problems focusing your sight at a short distance (especially in the young)
• dysuria (especially in elderly men with an enlarged prostate gland)
• dizziness (especially when getting up from a sitting or lying position)
• weight increase
• mild shaking of the hands
• effects on the heart beat (especially with too high doses)

Very old and frail people, people with history of heart problems should avoid TCA treatment.

MAO inhibitors

A type of preparation is the MAO inhibitors (monoaminoxidase inhibitors).

Isocarboxazid is an older preparation, which should only be used after advice has been sought from a psychiatrist, as very serious side-effects can occur during the treatment.

Moclobemide is another safer alternative.

Both are available in Singapore.