Depression

Medications

Types of Medication

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 itching See 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.