Medications for Treating Depression

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Depression is a highly treatable condition. For treatment to work, you need help from an experienced provider, one who knows which medications are most effective for your form of depression.

A first step is a psychiatric evaluation. A physical exam and possibly laboratory tests also may be done to help find out if an undiagnosed medical problem may be related to your depression.

Many factors affect how well medications will work, such as your weight, health and metabolism. Medication can take three to six weeks before you feel better. If one form of medication doesn’t work, your provider may try another, change the dose or prescribe a combination of medications.

Common Medication Prescribed

All prescription medications approved to treat depression work. However, they don’t work for everyone. Everyone’s biology is different. So, you and your doctor may need to try a few different medications to find the one that works best for you.

Class of Medication Most Common Medications Used How They Are Used Precautions Common Side Effects
Tricyclics imipramine (Trofanil®)amitriptyline (Elavil®)

nortriptyline (Pamelor®)

desipramine (Norpramin®)

Older class of antidepressants that work on chemical imbalances in the brain. Reduce symptoms such as extreme sadness, hopelessness and lack of energy. May create troublesome side effects. Although effective, they have a high rate of side effects. They also can cause cardiac arrhythmias, or irregular heartbeats.See the alerts below. Dry eyes, drowsiness, weight gain, dry mouth and constipation
Serotonin and norepinephrine reuptake inhibitors (SNRIs) venlafaxine (Effexor® and Effexor XR®)duloxetine (Cybalta®) 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.See the alert below. Nausea, problems sleeping, vomiting, sweating, dry mouth, gas, constipation
SSRIs (selective serotonin reuptake inhibitors) fluoxetine (Prozac®)paroxetine (Paxil®)

escitalopram (Lexapro®)

sertraline (Zoloft®)

citalopram (Celexa®)

fluvoxamine (Luvox®)

These are usually medications that doctors may use first in treating depression because of low rate of side effects. SSRIs increase brain’s serotonin levels to improve mood and make serotonin more available to the receiving nerve by preventing the return of the chemical serotonin to the sending nerve. Serotonin may help control moods, sleep, body temperature, and appetite for sweets. Do not take with MAOIs, an older antidepressant class. Must be used carefully if given to people with bipolar disorder.See the alerts below. Side effects may include sexual problems, which might not go away unless the medication is stopped. Side effects that usually go away may include increased anxiety or restlessness, excessive sleepiness, trouble sleeping and heartburn, sexual dysfunction such as reduced sex drive, delayed ejaculation and an inability to have an orgasm.
MAOIs (monoamine oxidase inhibitors) phenelzine (Nardil®)isocarboxazid (Marplan®)

tranylcypromine (Parnate®)

selegiline patch(EnSam®)

MAOIs are the oldest class of antidepressants. Rarely prescribed except for people who have not responded to other treatments. Must follow a restrictive diet because MAOIs can interact with some foods and beverages, such as cheese and red wine. May also interact with medications, including SSRIs, which may cause dangerous elevations in blood pressure or other life-threatening reactions.See the alert below. Signs of unusually high blood pressure: Chest pain, large pupils, change in heartbeat, headache, sensitivity to light, heavy sweating, vomiting and stiff or sore neck
Common: Blurred vision, less urine, sexual problems, dizziness or lightheadedness, feeling tired, mild headache, increased hunger or weight gain; sweating, muscle twitching during sleep, nausea, restlessness, trembling, tiredness, trouble sleeping.

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.

Other medications

Medication How They Are Used Precautions Common Side Effects
bupropion (Wellbutrin XL®, Wellbutrin SR® and Wellbutrin®) A newer antidepressant medication that acts on the neurotransmitters dopamine and norepinephrine. Causes fewer side effects than TCAs and MAOIs. With all Wellbutrin formulations, there is a risk of seizure, which is increased in patients with certain medical problems. Do not take this medication if you have or had a seizure or eating disorder. Do not take this medication if you are taking Zyban® for smoking cessation because they contain the same compound. Weight loss, loss of appetite, dry mouth, skin rash, sweating, ringing in the ears, shakiness, stomach pain, agitation, anxiety, dizziness, trouble sleeping, muscle pain, nausea, fast heartbeat, sore throat, and urinating more often.See the alert below.
mirtazapine (Remeron®) First drug in a new class to target specific serotonin receptors. Along with being able to treat moderate to severe depression, mirtazapine can help with anxiety, motor retardation, and cognitive and sleep problems associated with depression. Watch for anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Side effects can include drowsiness, increased appetite, weight gain and dizziness. While some side effects typically fade away, the weight gain can be a continuing problem. See the alert below.
nefazodone (Serzone®) Inhibits serotonin reuptake and blocks one type of serotonin receptor. Fewer side effects than tricyclics and MAOIs. Treats moderate to severe depression. Can improve depression-related anxiety and relieve depression-related insomnia. Nefazodone does not cause weight gain. The Food and Drug Administration issued a special warning about nefazodone due to the risk of severe liver disease. Blurred vision or other changes in vision; clumsiness or unsteadiness, lightheadedness or fainting, ringing in the ears, skin rash or itchingSee the alert below.

Children and antidepressants

Because of growing concern about a link between antidepressants and increased suicidal thoughts, the Food and Drug Administration issued a warning. The warning asks doctors and parents to closely monitor children who are taking antidepressants. These warnings were meant to encourage doctors and parents to carefully weigh the pros and cons of the medicines before their children take them, but not to prevent their use altogether.

Prescriptions for SSRIs have risen dramatically in the past several years among 10- to 19-year-olds. Because of this, the Food and Drug Administration (FDA) is taking a closer look at existing research. Until a determination can be made, drug manufacturers are required to insert a warning on their products about the possible risk. The FDA has a tough assignment because it may be hard to tell if SSRIs actually do increase the risk of suicide in children especially because suicide is already a risk in depression. So far no suicide has been reported among the more than 4,100 children and teens enrolled in studies of SSRIs. Some research says an increase in the number of prescriptions has coincided with a drop in suicide rates among children and teens.

Three different studies show Prozac is safe and effective for children 8 and older. Two studies were supported by the National Institute of Mental Health and the other was done by the drug’s manufacturer, Eli Lilly. Research says Prozac improved symptoms for many children and did not increase the risk of suicide. But the drug did not help at least one-third of children. About one in 10 had side effects such as agitation and mania. Other SSRIs including Zoloft, Celexa, Paxil and Effexor are not approved for treatment of depression in children or teens. But doctors prescribe them for their young patients in what is called “off-label” use.

Anyone being treated with antidepressants, particularly people 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. This warning applies for everyone – adults, teens and children. Bring up your concerns immediately with a doctor.

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 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.

Depression therapy may involve combined treatments

Psychotherapy

In some cases, psychotherapy alone can help fight depression. Psychotherapy involves talking with a licensed professional who will help patients gain insights about themselves in order to make positive changes in their feelings, behavior and lives. Studies have shown that in some cases, psychotherapy can work as well as medication in relieving symptoms of depression, although results take longer to achieve. In general, psychiatrists agree that severely depressed patients respond best to a combination of medication and psychotherapy. However, be sure to see a doctor no matter what. It may be difficult for you on your own to determine how severe your depression is.

Electroconvulsive therapy (ECT)

This therapy uses an electric shock to affect the same transmitter chemicals in the brain that are corrected by medications. Although the use of ECT has decreased in recent years, it is still used to treat people who cannot take medications because of other health problems or who have not done well with medication. According to the American Psychiatric Association, ECT can be a life-saving treatment that is considered when other therapies have failed or when a person might kill themselves.

Light therapy

People with seasonal affective disorder are often treated with sessions of light generated by a special light box.

Coming out of the darkness

A first step in stepping out of the fog of depression is recognizing that it’s not part of who you are. It is a real condition just like high blood pressure, asthma and many other medical problems that can be treated by a qualified health professional. Thanks to huge advances, medications are better and more effective than ever before. Support from caring people and others with depression is readily available. With help, you usually can feel better in a matter of weeks and can ward off future episodes.

Additional Information for Depression

When to See the Doctor

If you are having thoughts of suicide, seek help immediately. Call your doctor, health care provider, family member, friend or counselor. Suicide hotlines are also set up to help you. Remember that you are not alone and there are people who can help you. If your plans are about to happen, dial 911!

If you have symptoms of depression, see your family doctor or primary care doctor. Symptoms include:

  • Prolonged sadness or unexplained crying spells.
  • Significant changes in appetite.
  • Sleeping too much or not being able to sleep.
  • Irritability, anger, worry, agitation, anxiety.
  • Pessimism, indifference.
  • Loss of energy, persistent lethargy.
  • Feelings of guilt, worthlessness.
  • Inability to concentrate, indecisiveness.
  • Inability to take pleasure in former interests.
  • Withdrawal from friends and family.
  • Unexplained aches and pains.
  • Recurring thoughts of death or suicide.

Sometimes, someone with undiagnosed depression may see the doctor for physical symptoms such as insomnia and lack of energy. An exam may turn up nothing. As a result, the doctor may overlook the possibility of depression. Sometimes people who are depressed believe their problem means they are weak or have a character flaw. They feel embarrassed and may not look for help for their depression. Depression is a serious illness, which affects your entire quality of life. It is important if you think you or a loved one has a form of depression, that you see a doctor immediately. In some cases, depression may lead to suicide.

Questions to Ask the Doctor

Ask your doctor about:

  • Your symptoms and your overall state of health. Talk about thoughts you may have of harming yourself or others.
  • How to handle stress in your life.
  • Your history of any psychiatric problems and how you’ve handled stress in the past.
  • The dangers or precautions of use of alcohol or unprescribed or illegal drugs.
  • The role of a family history of emotional problems or addictions.
  • What to do if there is an emergency such as thoughts or plans of suicide.
  • Your medical history and all the medications you are taking, including vitamins and herbal preparations. This is very important so the doctor can make sure that a medicine you are taking is not the cause of your depression.
  • The type and seriousness of depression you have.
  • The best treatment for your depression and the side effects of some depression medicines.
  • The length of treatment and your possible responses to it.
  • How to identify supportive people in your life.
  • How to plan for day-to-day home management so you aren’t overwhelmed.
  • Getting cognitive and behavioral therapy and learning stress management.
  • How to identify symptoms.

Make sure that you:

  • Understand how and when to take all of your medicines.
  • Have an appointment to return for a follow-up.
  • If you’re being referred for counseling or other therapy, you’ve made the appropriate arrangements.
  • Have emergency phone numbers and instructions should your symptoms worsen or should you develop thoughts of harming yourself or others.
  • Have identified at least one support person who is aware of your illness and your treatment plan.

Finding Help for Depression

It can be particularly difficult for the depressed individual to make that first step toward reaching out. Fight back against the helplessness and hopelessness by making a phone call that can help you.

You can get help from:

  • Physicians
  • Mental health specialists
  • Employee assistance programs (EAPs)
  • HMOs and PPOs
  • Community mental health centers
  • Hospital departments of psychiatry or outpatient psychiatric clinics
  • Universities or medical schools
  • State hospital outpatient clinics
  • Family service/social agencies
  • Private clinics and facilities.
  • Family and support groups.
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