Patients with Huntington’s disease often experience depression; in fact, it is the most common psychiatric disorder associated with this disease.

Depression may be evidenced as a sulky mood, tiredness, a loss of interest, poor appetite and weight loss. Such symptoms can be managed with a class of medications known as antidepressants.

How antidepressants work

Research studies have shown that Huntington’s patients appear to respond with stronger emotions — like anger and fear — to negative stimuli, relative to responses seen in those without this disease. Scientists suggest such emotional outbursts are due to the brain damage and shrinking of certain areas that occurs in this disease.

A Huntington’s diagnosis itself is also considered a major contributor to depression in these patients.

Neurotransmitters — chemical messengers in the brain such as serotonin, dopamine, and noradrenaline — influence mood and feelings. Neurotransmitters are known to be deficient in people with depression.

Antidepressants work to increase levels of serotonin, dopamine, or noradrenaline. Some classes of antidepressants may work on more than one type of neurotransmitter.

Types of antidepressants

Major types of antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants, all of which may be prescribed to treat depressive symptoms in people with Huntington’s disease.

SSRIs block serotonin reabsorption, making more serotonin available for neurons (nerve cells). Some examples of SSRIs are Zoloft (sertraline), Celexa (citalopram), Paxil (paroxetine), Lexapro (escitalopram), and Prozac (fluoxetine).

SNRIs work by blocking the recycling of norepinephrine in addition to serotonin. Examples of SNRIs include Effexor (venlafaxine) and Cymbalta (duloxetine).

Atypical antidepressants are medications that do not quite fit into the SSRI and SNRI families. One example is Welbutrin (bupropion), which stops the re-uptake of dopamine and norepinephrine. Another is Remeron (mirtazapine), which increases the concentration of serotonin and norepinephrine.

Side effects of antidepressants

Each class of antidepressants are linked to specific side effects. In general, taking either SNRIs or SSRIs are linked to problems that include sexual dysfunction, nausea, and changes in appetite in some users.

Common side effects of SSRIs are an upset stomach, diarrhea, insomnia, weight loss, and restlessness. But this class is known to cause the fewest side effects of all classes of antidepressants. SNRIs are linked to side effects that may include excessive sweating, headache, dizziness, dry mouth, and nausea.

A major side effect of Remeron is drowsiness, so this medication may be of help to those also experiencing insomnia — a common complaint in Huntington’s patients. Compared to SSRIs and SNRIs, Remeron does not cause as much sexual dysfunction but patients on this medication may gain weight despite a reduced appetite.

Common side effects of Wellbutrin can include dry mouth, anxiety, restlessness, irregular heartbeats, and trouble sleeping.

Taking antidepressants

Antidepressants usually have to be taken regularly for at least six to eight weeks before improvements in symptoms are noticeable, although some people may begin feeling better after two weeks.

Not all antidepressants work for everyone. Some patients may need to try different types before finding one that works and causes the least side effects for them. Once started, these medications need to be taken consistently for a period of nine months to a year.

Stopping an antidepressant abruptly or too early could cause a relapse of depressive symptoms.

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