Medications for Depression

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider.

There are several types of antidepressant drugs that can be used to treat depressive disorders. You may have success with the first medication prescribed, or you may need to try other antidepressants before finding the right one or ones for you. Sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for three to four weeks (in some cases, as many as eight weeks) before the full therapeutic effect occurs.

Do not stop taking your medication without talking to our doctor. Even if you feel better and think you no longer need the medication, or you may think the medication isn’t helping, do not stop before you speak with your doctor. You need to continue taking the medication until it has a chance to work. Call your doctor if you experience side effects from the medication.

Once you are feeling better, keep taking your medication for as long as your doctor recommends (usually at least six months) to prevent a recurrence of depression. Some medications must be slowly tapered to give your body time to adjust. If stopped abruptly, some drugs may cause withdrawal symptoms. If you have chronic or recurrent depression, you may need to take medication indefinitely.

Prescription Medications

Selective serotonin reuptake inhibitors (SSRIs)

  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)

Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants .

On June 30, 2005, the FDA issued a similar advisory regarding antidepressant use by adults, warning about a possible increase in suicidal thinking or behavior early in treatment or when dosage of the medication is changed. The advisory covers all the drugs in the above paragraph plus Cymbalta (duloxetine).

Tricyclic antidepressants

  • Doxepin (Adapin, Sinequan)
  • Clomipramine (Anafranil)
  • Nortriptyline (Aventyl, Pamelor)
  • Amitriptyline (Elavil)
  • Imipramine (Janimine, Tofranil)
  • Maprotiline (Ludiomil)
  • Desipramine (Norpramin, Pertofrane)
  • Trimipramine (Surmontil)
  • Protriptyline (Vivactil)

Monoamine oxidase inhibitors (MAOIs)

  • Isocarboxid (Marplan)
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
  • Selegiline patch (Ensam)

Serotonin/norepinephrine reuptake inhibitors (SNRIs)

  • Venlafaxine (Effexor, Effexor XR)
  • Duloxetine (Cymbalta)

Atypical antidepressants

  • Trazodone (Desyrel)
  • Nefazodone
  • Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)
  • Mirtazapine (Remeron)

Selective Serotonin Reuptake Inhibitors (SSRIs)

***see note above

Common names include:

  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration in the brain of the neurotransmitter serotonin, which plays a role in depression. The SSRIs are often a preferred class of antidepressants because they are thought to be easier to use, tend to produce fewer side effects, are as effective, and are less likely to be fatal in an overdose compared to other medications available. SSRIs are not addictive.

Improvement is usually seen in four to six weeks after beginning treatment. You should not drink alcohol while taking this medication. Do not take an SSRI if you have taken a monoamine oxidase inhibitor (MAOI) in recent weeks.

Possible side effects include:

  • Nausea
  • Diarrhea
  • Insomnia
  • Loss of appetite or weight loss
  • Nervousness
  • Dizziness
  • Sexual dysfunction

Tricyclic Antidepressants

Common names include:

  • Doxepin (Adapin, Sinequan)
  • Clomipramine (Anafranil)
  • Nortriptyline (Aventyl, Pamelor)
  • Amitriptyline (Elavil)
  • Imipramine (Janimine, Tofranil)
  • Maprotiline (Ludiomil)
  • Desipramine (Norpramin, Pertofrane)
  • Trimipramine (Surmontil)
  • Protriptyline (Vivactil)

Tricyclic antidepressants are thought to regulate serotonin and norepinephrine in the brain. They have been used effectively for the treatment of depression. Improvement is usually seen in three to six weeks after beginning treatment. These drugs are highly toxic if taken in large doses; therefore, they are often not prescribed for suicidal patients. Tricyclic antidepressants are not addictive.

Possible side effects include:

  • Dizziness
  • Dry mouth
  • Constipation
  • Difficulty urinating
  • Weight gain
  • Low blood pressure
  • Sexual dysfunction

Monoamine Oxidase Inhibitors (MAOIs)

Common names include:

  • Isocarboxid (Marplan)
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
  • Selegiline patch (Ensam)

Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant that prevent the breakdown of serotonin and norepinephrine, and they have been shown to be effective in treating depression. This medication is especially effective for people whose symptoms have not responded to other treatments. Improvement is usually seen in two to six weeks after beginning treatment. MAOIs are not widely used today because of dietary restrictions and unpleasant side effects. Ensam (selegiline patch), the lowest dose, is an exception to this.

MAOIs can cause severe adverse reactions when combined with many other types of drugs, including other types of antidepressants. Ask your doctor and pharmacist for complete directions about what drugs to avoid. When taking MAOIs, there are foods you should avoid, as well. These are foods with a high tyramine content, such as:

  • Cheese
  • Alcohol
  • Pickled, marinated, smoked, cured, or fermented foods
  • Organ meats
  • Nuts and peanut butter
  • Fava beans
  • Onions
  • Avocados
  • Canned figs
  • Chocolate
  • Excess amounts of caffeine
  • Foods containing monosodium glutamate (MSG)

The above dietary restrictions do not apply to the 6 mg dose. Ask your doctor, pharmacist, or nutritionist for a complete list of foods you should avoid.

Possible side effects include:

  • Changes in blood pressure, including hypertensive crisis
  • Weight gain
  • Reduced sexual response
  • Insomnia

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)

Common names include:

  • Venlafaxine (Effexor, Effexor XR)
  • Duloxetine (Cymbalta)

SNRIs affect the level of two neurotransmitters in the brain, serotonin and norepinephrine. Some studies suggest that these drugs are more effective than SSRIs, but these results have been questioned. Improvement is usually seen about three to six weeks after starting treatment.

Possible side effects include:

  • Dry mouth
  • Constipation
  • Nausea
  • Decreased appetite
  • Fatigue
  • Drowsiness
  • Venlafaxine may cause elevated blood pressure.

Atypical Antidepressants

Common names include:

  • Trazodone (Desyrel)
  • Nefazodone (Serzone)
  • Mirtazapine (Remeron)
  • Bupropion (Wellbutrin)

Atypical antidepressants affect the concentration of the neurotransmitter serotonin and can be effective in treating depression. Improvement is usually seen in four to six weeks after beginning treatment.

Nefazodone (Serzone) has been associated with reports of life-threatening liver failure. People with pre-existing liver disease should not take it. Patients who are taking nefazodone are advised to immediately report symptoms of liver toxicity, such as jaundice , loss of appetite, malaise, and gastrointestinal symptoms, to their doctor.

Depending on the drug, possible side effects include:

  • Dizziness
  • Weight gain
  • Nervousness
  • Drowsiness
  • Dry mouth
  • Increased appetite
  • Bupropion may increase risk of seizures.

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, and not at a different time.
  • Do not stop taking them without consulting your healthcare provider.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your healthcare provider.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.

When to Contact Your Healthcare Provider

Contact your healthcare provider if you have any questions about your medication, any side effects that are troublesome, or if you feel that the medication is not working after the allotted time period.

References:

Abnormal Psychology and Modern Life . 11th edition. Allyn and Bacon; 2000.

Adults being treated with antidepressant medications. FDA Public Health Advisory. Federal Drug Administration website. Available at: http://www.fda.gov/cder/drug/advisory/SSRI200507.htm . Accessed March 31, 2007.

Depression. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/healthinformation/depressionmenu.cfm . Accessed March 31, 2007.

FDA approves Ensam (selegiline) as first drug patch for depression. Lowest dose can be used without restrictions required of MAOI class of depression drugs. FDA News. Federal Drug Administration website. Available at: http://www.fda.gov/bbs/topics/NEWS/2006/NEW01326.html . Accessed March 31, 2007.

Fochtmann LJ, Gelenberg AJ. Guideline Watch: Practice Guideline for the Treatment of Patients with Major Depressive Disorder. 2nd ed. Arlington, VA: American Psychiatric Association; 2005. American Psychiatric Association website. Available at: http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm . Accessed March 25, 2007.

Karasu TB, Gelenberg A, Merriam A, Wang P. Practice Guideline: Treatment of Patients with Major Depressive Disorder. 2nd ed. American Psychiatric Association; 2000. Available at: http://www.psych.org/psych_pract/treatg/pg/MDD2e_05-15-06.pdf . Accessed March 31, 2007.

National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/ .

Pies R, Rogers D. The recognition and treatment of depression: A review for the primary care clinician. Medscape website. Available at: http://www.medscape.com/viewprogram/4572 . Accessed October 11, 2005.



Last reviewed April 2007 by Janet Greenhut, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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