Comparison Between Mirtazapine And Escitalopram

Overview

Antidepressants are medicines used to treat low mood (depression) and ongoing worry or fear (anxiety). They come in several families that work in slightly different ways. This article compares two families that doctors are asked about most often. One is a group called 'SSRIs' (selective serotonin reuptake inhibitors). These raise the level of a mood chemical called serotonin in the brain. The other is a single medicine that works on serotonin and also on a second chemical called noradrenaline. It tends to be more calming, and doctors often choose it when sleep and appetite are the biggest problems. You will not see the medicine names in this article on purpose. Your doctor or pharmacist can tell you the exact medicine and dose that suits you.

Very common. Depression and anxiety are among the most frequent reasons people visit a doctor, and antidepressants are among the most widely prescribed medicines in the world. If you are offered one, you are in very ordinary company.

Anyone can need an antidepressant — no age, gender or background is immune. The choice is tailored to the person. Young people need closer checking in the first few weeks. Older adults may be more sensitive to drowsiness, dizziness, falls and low salt levels. Pregnancy, breastfeeding, other medicines you take and long-term health conditions all change the picture, so tell your doctor about all of them.

Symptoms

Common symptoms

• Low mood or sadness that lasts for weeks and does not lift on its own
• Losing interest or pleasure in things you normally enjoy
• Sleep problems — either trouble falling asleep, waking in the night, or sleeping far more than usual
• Appetite and weight changes, up or down
• Tiredness and low energy, even after rest
• Feeling restless, wound up, or slowed down and heavy
• Constant worry, tense muscles, a racing heart or a churning stomach
• Trouble concentrating or making decisions
• Feeling worthless, guilty or hopeless
• Irritability or a short fuse that is not like you

Symptoms in children

• Children and teenagers often show low mood as irritability rather than sadness
• Headaches or stomach aches with no clear physical cause
• Refusing or avoiding school, or pulling away from friends
• Falling grades or trouble concentrating
• Changes in sleep and appetite, or clinginess in younger children
• Note: antidepressants in young people are usually started and monitored by a specialist, with close follow-up and talking therapy alongside

Symptoms in older adults

• Low mood may show up as physical complaints, pain, or memory and concentration problems rather than sadness
• Weight loss and poor appetite, sometimes mistaken for other illness
• Withdrawal from hobbies, family and social contact
• Higher sensitivity to side effects such as drowsiness, dizziness and falls
• Confusion or unsteadiness, which can be a sign of low salt levels from some antidepressants
• Dry mouth, constipation and trouble passing urine are also more common

Causes

Main causes

• Depression and anxiety usually come from a mix of things rather than one single cause
• Changes in brain chemistry involving serotonin, noradrenaline and other signalling chemicals
• An inherited (genetic) tendency — depression often runs in families
• Stressful or traumatic life events, bereavement, money worries or relationship problems
• Long-term illness, chronic pain, thyroid problems or hormone changes
• Poor sleep, low physical activity and isolation
• Alcohol or drug use, which can both cause and worsen low mood
• Why the two medicine families differ: they act on different combinations of brain chemicals, which is why one may suit you better than the other

Risk factors

• A previous episode of depression or anxiety
• A family history of depression or anxiety
• Ongoing stress at work, at home or with money
• Long-term physical health conditions or chronic pain
• Being isolated or having little social support
• Recent childbirth, menopause or other hormonal change
• Heavy alcohol use
• Certain other medicines that can affect mood or interact with antidepressants
• Older age, which raises the chance of side effects and drug interactions

When to see a doctor

See a doctor urgently if:

• You have thoughts of harming yourself or ending your life — seek help immediately
• You feel unable to keep food or fluids down
• You have a severe or frightening side effect after starting or changing a medicine
• You notice sudden very high energy, racing thoughts or not needing sleep
• You have an unusual bleed, black stools, or a fever with stiff muscles and confusion

Book a routine appointment if:

• Low mood, worry or loss of interest has lasted more than two weeks or is affecting work, sleep or relationships
• You are thinking about starting an antidepressant and want to talk through the options
• You are already taking one and side effects are bothering you
• You want to stop your medicine — ask first so it can be reduced safely
• You are planning a pregnancy, are pregnant or are breastfeeding
• You are feeling better and want to review how long to keep taking your medicine
• You start any new medicine, supplement or herbal remedy, as some can interact

Diagnosis

There is no single test that finds depression or anxiety or tells you which antidepressant to take. Your doctor will talk with you about how you have been feeling, how long it has lasted, how it affects sleep, appetite, work and relationships, and whether you have had similar episodes before. They will review your other health conditions, all the medicines and supplements you take, and any allergies. From that picture they will discuss the options with you, including talking therapy, an antidepressant, or both. Choosing between the two medicine families is a matching process: your doctor weighs your main symptoms, the side effects you most want to avoid, and anything else you take or live with.

Tests that may be done

• A conversation and a short set of questions about mood, worry and daily life
• Blood tests to rule out other causes — thyroid function, a full blood count, vitamin B12 and folate, kidney and liver function
• A salt (sodium) level check, especially before starting in an older adult
• Blood pressure, pulse and weight
• An ECG (heart tracing) if you have heart problems or take medicines that affect the heart
• A pregnancy test if that is relevant to your treatment choices

What to expect at your appointment

Your first appointment is mostly a conversation, and it may take a while. You do not need to prepare anything special, but it helps to bring a list of everything you take, including vitamins and herbal products, and to note down your main symptoms and any questions. If a medicine is agreed, you will usually have a check-in after about one to two weeks, then regularly after that. Starting low and going slowly is normal, and reviews are a chance to adjust rather than a sign anything is wrong.

Treatment

Treatment for depression and anxiety is built around you, not just a prescription. Talking therapy, support with sleep, activity and alcohol, and practical help with stress all matter. Many people do best with a combination of talking therapy and medicine. If a medicine is used, doctors generally start with a low dose, explain what to expect, and review you regularly. The two families described here are both proven treatments; the skill is matching the medicine to your particular pattern of symptoms and side effects.

Self-care at home

• Keep a steady sleep routine where you can — same wake-up time each day, and a wind-down without screens
• Get some daylight and gentle movement most days, even a short walk
• Cut back on alcohol, which disturbs sleep and lowers mood, and watch your caffeine intake
• Eat regularly, even when appetite is poor — small, frequent meals can help
• Keep a simple diary of mood, sleep and side effects to bring to appointments
• Stay in touch with one or two people you trust rather than withdrawing
• Ask for practical help with money, work or caring duties if stress is a big driver
• Do not stop or change your medicine on your own — check with your doctor or pharmacist first

Medical treatments

Your doctor will discuss two common approaches. The first is a group of medicines called SSRIs, which raise serotonin levels and are often a first choice for anxiety, worry and repetitive upsetting thoughts. The second is a single medicine that acts on serotonin and also on noradrenaline; it is more calming and is often chosen when sleep is badly broken or weight has fallen. Both are started at a low dose and increased gradually. Both usually take a few weeks to work, and side effects often ease after the first week or two. Your doctor may also offer talking therapy such as cognitive behavioural therapy (a structured way of spotting and changing unhelpful thought patterns), counselling, or guided self-help. If one medicine does not suit you, another can be tried. Never take a medicine prescribed for someone else, and always tell any doctor, dentist or pharmacist what you are taking.

When is surgery considered?

Surgery is not a treatment for depression or anxiety. But if you are having an operation or a procedure, tell the surgical and anaesthetic team about every medicine you take, including antidepressants and any supplements. Do not stop your medicine before surgery unless the team caring for you advises it.

Living with this condition

The early weeks on a new antidepressant can feel like a waiting game. Set small, realistic goals and treat a walk, a shower or a phone call to a friend as a win. Expect some ups and downs rather than a straight line. Keep your appointments, even when you feel well, and write down questions as they come to you. If a side effect worries you, contact your doctor or pharmacist rather than putting up with it or stopping suddenly.

Lifestyle tips

• Go to bed and get up at roughly the same time each day, including weekends
• Build gentle daily movement into your routine, starting small
• Limit alcohol and caffeine, especially in the evening
• Keep some contact with people, even when you do not feel like it
• Plan something to look forward to each week, however small
• Be careful with driving or operating machinery until you know how your medicine affects you — ask your doctor or pharmacist

Diet and exercise

There is no special diet that treats depression, but regular meals, plenty of vegetables, fruit and fibre, and enough fluids support both mood and energy. If your appetite is poor, try smaller meals more often. If one of these medicines makes you hungry, planning meals and snacks can help you avoid unwanted weight gain. Movement is one of the most reliable mood boosters we know — it does not need to be a gym session; a brisk walk, gardening or dancing at home all count. Aim for something most days, built up gradually, and check with your doctor first if you have heart or joint problems.

Mental health and emotional wellbeing

Depression and anxiety affect how you think about yourself, and it is common to feel hopeless or to blame yourself. Those thoughts are symptoms, not facts. Talking therapy can help you notice and challenge them. If you ever have thoughts of harming yourself, treat that as an emergency and get help straight away — this is exactly what crisis services are for.

Prevention

Depression and anxiety cannot always be prevented, but the chance of another episode can be lowered. Staying on your medicine for the full course your doctor recommends — often several months after you feel better — reduces the risk of relapse. Learning the early warning signs that were there for you last time, keeping sleep and activity steady, limiting alcohol and staying connected to people all help. If you have had several episodes, your doctor may discuss staying on treatment for longer.

Vaccines

Vaccines do not prevent or treat depression or anxiety. Keeping up with routine vaccinations is still good for your general health, especially if you have a long-term condition.

Screening programmes

There is no national screening test for depression, but doctors often ask short mood questions during routine appointments, and this is especially likely after childbirth, after a bereavement, or if you have a long-term illness. If you are not asked and you are struggling, say so — you do not need to wait to be invited.

Complications

If left untreated

• Depression and anxiety that are not treated can deepen and last longer
• Sleep, appetite and energy can worsen, and physical health can suffer
• Work, study, relationships and money can come under strain
• Some people turn to alcohol or drugs to cope, which makes things harder
• The risk of self-harm or suicidal thoughts rises, which is why help should not be delayed
• Untreated side effects from a medicine — or stopping it suddenly — can cause unnecessary distress

Long-term outlook

The outlook is genuinely good. Most people who get treatment for depression or anxiety start to feel better, and both of the medicine families described here are well studied and effective. Finding the right fit can take a little trial and adjustment, and that is normal rather than a failure. Combining medicine with talking therapy, support and steady daily habits gives the best chance of feeling well and staying well. Work with your doctor, ask questions, and give it time.

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