Antidepressant Medications
Depression can make you feel hopeless and worthless and cause you to lose interest in everyday activities such as work, hobbies or sex. Depression is a common illness that costs billions in health care costs and lost productivity in the United States each year, according to the National Institute of Mental Health (NIMH).
Nearly 25 percent of U.S. adults have depression at some point. Many things can trigger depression, such as serious illness, divorce or the death of a loved one. Often a cause can't be found.
Alone or along with psychotherapy, antidepressants are widely used for depression. More than 80 percent of those with depression feel better when they get the right treatment, according to NIMH.
How drugs help depression
The brain communicates thoughts and feelings through special chemicals that send messages. Two important chemical messengers, called neurotransmitters, are serotonin and norepinephrine.
There is a strong connection between the amount of these chemicals in the brain and mood. If levels of serotonin and norepinephrine get too low, people usually feel depressed. Drugs can help improve levels of these brain chemicals.
The newer antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), are popular because they have fewer side effects than older medications, which include tricyclics and monoamine oxidase inhibitors (MAOIs). Although both generations of drugs help relieve depression, some people will respond to one type of drug, but not another.
Certain antidepressants can interact with other prescription and over-the-counter medications, herbs, alcohol and even foods. Talk with your doctor or pharmacist before starting treatment to find out about taking them with other substances and other important precautions.
Antidepressants
What follows is a breakdown of common antidepressants. Your doctor may give you others that are either not on this list or are not specifically approved for depression. You may have side effects not listed here. Call your doctor immediately if you are concerned about your side effects.
Children, teens and adults being treated with antidepressants, particularly anyone being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.
SSRIs
SSRIs, or selective serotonin reuptake inhibitors, increase the brain's level of serotonin to improve mood. They make serotonin more available to the receiving nerve by preventing the return of the chemical serotonin to the sending nerve. SSRIs can help with depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social phobia, premenstrual dsyphoric disorder and generalized anxiety disorder (GAD). These drugs generally have fewer bothersome side effects than other types of antidepressants and work well for many people. Side effects usually go away; however SSRIs tend to cause sexual problems that may be ongoing. Call your doctor immediately if you are concerned about any side effect. SSRIs may worsen symptoms of bipolar disorder.
Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.
Common side effects of SSRIs include:
Headache Tremor Nervousness Trouble concentrating Nausea Diarrhea Dry mouth Changes in weight or hunger Weakness Increased sweating Sleeping problems Sexual problems Brand Name What Makes it Different and What It Is Used to Treat Possible Side Effects Precautions Citalopram (Celexa®) Has fewer drug interactions than other antidepressants. May cause less withdrawal than other antidepressants when stopped. May help with depression, panic disorder and OCD with off label usage. Nausea, dry mouth, drowsiness, insomnia, increased sweating, tremor, diarrhea and sexual problems Should not be taken during treatment with escitalopram (Lexapro®). If you have had an allergic reaction to escitalopram, you may also have an allergic reaction to citalopram. Before taking the medication, tell your doctor if you have liver disease, kidney disease, have seizures, mania or have suicidal thoughts. Fluvoxamine (Luvox®) Can be used to treat OCD, depression and panic disorder. Constipation, dizziness, drowsiness, headache, nausea, trouble sleeping, unusual tiredness and vomiting. May cause a dangerous interaction with thioridazine (Mellaril), cisapride (Propulsid) or pimozide (Orap). You must wait five weeks after stopping fluvoxamine before taking thioridazine (Mellaril). Before taking the medication, tell your doctor if you have liver disease, kidney disease, have seizures, mania or have suicidal thoughts. Paroxetine (Paxil CR®) Used to treat OCD, depression, social phobia, panic disorder, generalized anxiety disorder, premenstrual dysphoric disorder (PMDD) and PTSD. A common side effect is nausea, which may be lessened by taking with food. Other possible side effects: injury, infection, diarrhea, constipation, decreased appetite, sleepiness, weakness, dry mouth, insomnia, dizziness, tremor, yawning, sweating, abnormal vision and sexual problems. Before taking the medication, tell your doctor if you have liver disease, kidney disease, have seizures, mania or have suicidal thoughts. Fluoxetine (Prozac®) Less likely to cause weight gain and drowsiness. Used to treat depression, OCD, panic disorder bulimia and PMDD. Nausea, trouble sleeping, drowsiness, anxiety, nervousness, weakness, loss of appetite, tremors, dry mouth, sweating, sexual problems and yawning. Do not take this if you are taking thioridazine (Mellaril®) because dangerous, even fatal irregular heartbeats may occur. You must wait five weeks after stopping fluoxetine before taking thioridazine Before taking this, tell your doctor if you have liver disease, kidney disease, have seizures or have diabetes, mania or have suicidal thoughts. Sertaline (Zoloft®) Helps with both anxiety and depression. used to treat OCD, social phobia, panic disorder and PTSD and PMDD. Dry mouth, trouble sleeping sexual problems, diarrhea, nausea and drowsiness. Taking pimozide (Orap®) with this could be dangerous. Before taking the medication, tell your doctor if you have liver disease, kidney disease, have seizures, mania or have suicidal thoughts. Escitalopram (Lexapro®) Depression, panic disorder and GAD. Nausea, trouble sleeping, sexual problems, drowsiness, increased sweating and feeling tired Escitalopram should not be taken during treatment with citalopram. If you have had an allergic reaction to citalopram, you may also have an allergic reaction to escitalopram. Before taking the medication, tell your doctor if you have liver disease, kidney disease, have seizures, mania or have suicidal thoughts.
SNRIs (Serotonin and norepinephrine reuptake inhibitors)
Class of Medication Most Common Medications Used How They Are Used Precautions Common Side Effects Serotonin and norepinephrine reuptake inhibitors (SNRIs) Venlafaxine (Effexor® and Effexor XR®)duloxetine (Cymbalta®) Can serve as first-line treatments and can also help people who have not responded to other medications. Cause fewer side effects than TCAs and MAOIs. At high doses, venlafaxine can raise blood pressure significantly. Venlafaxine can also raise cholesterol. Do not take or be careful if you have narrow-angle glaucoma or raised intraocular pressure. Nausea, problems sleeping, vomiting, sweating, dry mouth, gas, constipation
People who take antidepressant drugs (SSRIs or SNRIs) can develop a problem called serotonin syndrome. This is a rare but life-threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells.
Serotonin syndrome is more likely to occur when you first start taking or increase the doses of SSRIs or SNRIs. It can occur when you take drugs for headaches called triptans along with antidepressants. Other depressants, St. Johns Wort, illegal drugs like Ectasy, certain pain medicines and other drugs can lead to this condition. It's important to tell you doctor all the medicines you take before starting antidepressants.
Tricyclics
Tricyclics are an older class of antidepressants that work against depression, but are more likely than SSRIs to cause side effects such as drowsiness, dry mouth and constipation. Tricyclics work on the neurotransmitters called norepinephrine and serotonin.
These are some tricyclics that tend to be used more often for treating depression. Side effects may include:
Dizziness Drowsiness Dry mouth Blurred sight Constipation Mild tremor Sweating Headache Increased heart rate Agitation Ringing in the ears Nausea Weight gain Sexual problems Name Used to Treat Precautions Imipramine (Tofranil®) Depression, bedwetting, bulimia, attention deficit hyperactivity disorder (ADHD), OCD, and panic disorder. Serious and fatal reactions have been known to occur when taken with MAOI. You should not take this if you are recovering from a heart attack Also be careful if you have or have had narrow-angle glaucoma, trouble urinating, heart, liver, kidney or thyroid disease, or seizure. They also can cause cardiac arrhythmias, or irregular heartbeats. Amitriptyline (Elavil®) Depression, bulimia, chronic pain and migraines If you have had allergic reactions to tricyclics, you should not take this. Nortriptyline (Pamelor®) Depression, chronic hives, premenstrual depression, ADHD and bedwetting May make you drowsy. Use carefully if you have trouble urinating, seizures, diabetes, eye conditions such as glaucoma, heart disease, high blood pressure or an overactive thyroid. Tell your doctor if you are having surgery. Desipramine (Norpramin®) Depression, bulimia and ADHD. Tell your doctor if you have a history of seizures, heart or thyroid problems, glaucoma or problems urinating. Can make you drowsy. Tell your doctor if you are having surgery.
MAOIs
Because MAOIs can have life-threatening interactions with drugs and certain foods, MAOIs are rarely prescribed except for people who haven't improved with other antidepressants.
If you take an MAOI, talk with your doctor before taking any other medicines. Your doctor will also tell you to avoid foods that have high levels of tyramine, such as many cheeses, pickled foods, chocolate, beer, wine, avocados, figs, certain meats and things with caffeine. Combining these medications with certain foods can cause a serious and even deadly rise in blood pressure. Ask your doctor for a complete list of restricted foods.
Side effects may include:
Blurred vision Dry mouth Diarrhea Constipation Decreased hunger Stomachache Problems sleeping Anxiety Weakness Dizzines Drowsiness Brand Name Used to Treat Precautions Phenelzine (Nardil®)tranylcypromine (Parnate®) andisocarboxazid (Marplan®) Depression, and anxiety and phobias that are mixed with depression. You must avoid certain foods including anything with tyramine and caffeine. Serious problems also could arise if you combine MAOIs with asthma and diabetes medications, SSRIs, tricyclics, and some over-the-counter drugs. Be sure to tell your doctor if you have or have had seizures, chest pain, severe headaches, high blood pressure, heart or blood vessel disease, liver disease, Parkinson's, or recent heart attack or stroke. Also be sure your doctor knows if you have high blood pressure, kidney disease, or overactive thyroid.
Other antidepressants
Some antidepressants don't fall into a particular class and work in different ways.
Name Used to Treat Side Effects Trazodone (Desyrel®) Used mainly to treat insomnia. Anger, stomachache, diarrhea, drowsiness, weakness, sleeping problems, dry mouth, blurred sight and changes in appetite and weight. Bupropion (Wellbutrin®) May act upon brain chemicals called dopamine and norepinephrine. Fewer sexual side effects and weight gain. Less likely to cause blurred vision, dry mouth, indigestion, constipation, heart problems. May cause birth defects. May include restlessness, insomnia, headache, worsening of migraine conditions, tremor, dry mouth, agitation, confusion, fast heartbeat, dizziness, nausea, constipation, menstrual problems and rash. Mirtazapine (Remeron®) Stimulates the brain chemicals called norepinephrine and serotonin and can block serotonin receptors. Drowsiness, increased hunger, weight gain and dizziness. Some side effects may go away but the weight gain often does not.
What to expect during treatment
Although some people begin to notice improvement in the first week or two of treatment, most require four to six weeks of taking the medication before they begin to feel better.
Keep taking your medication, even if symptoms don't improve right away. If after some time has passed and you don't feel any better, a change in medication or adjustment in dose may be needed only with a doctor's guidance.
When treatment starts, your doctor may want to see you as often as every week. This is to check dosage (how much and how often you take the medicine), to watch for side effects (problems caused by the medicine) and to see how well treatment is working. Once you start feeling better, you probably will visit the doctor less often.
If you take antidepressants, keep all appointments whether you feel better or worse so your doctor can check your progress and watch for side effects. Write down your symptoms to help your doctor keep track of how you are doing.
Side effects
Up to half of those taking antidepressants have some side effects early in treatment (the first four to six weeks). Side effects usually get better later on. Sometimes side effects are bad enough to require the doctor to stop the medicine and then try something else.
Even though any antidepressant can cause side effects, not everyone gets them or the same ones. Let your doctor know about any problems that you may be having with medications. Whether you have problems or feel better with antidepressants, do not stop your medication without talking to your doctor. Some medications need to be tapered off slowly. If you stop antidepressants too soon, you increase the chance of your depression returning.
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