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Antidepressant Medications
From Leonard Holmes, former About.com Guide
Updated March 18, 2010
About.com Health's Disease and Condition content is reviewed by our Medical Review Board

Filed In:
1. Mental Illness
2. > Depression
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 There are several types of antidepressant medications used to treat depressive disorders. These
include selective serotonin reuptake inhibitors (SSRIs), tricyclics, and monoamine oxidase inhibitors
(MAOIs). The SSRIs, as well as other medications that affect neurotransmitters such as dopamine or
norepinephrine, generally have fewer side effects than tricyclics. Sometimes your doctor will try a
variety of antidepressants before finding the medication or combination of medications most effective
for you.

What Conditions Are Antidepressants Used For?

"Major depression" is the type of depression that will most likely benefit from treatment with
medications. It is a condition that lasts 2 weeks or more, and interferes with a person's ability to carry
on daily tasks and enjoy activities that previously brought pleasure.

Depression can be caused by a number of factors, but the brain functions differently in people who are
depressed. Depression runs in families, and genes appear to be involved. Your environment and
learning may also play a role. Episodes of depression may be triggered by stress, difficult life events,
side effects of medications, medication/substance withdrawal, or even infections that can affect the
brain.

Symptoms of depression may include:

• Feeling sad or "down"

• Being unable to enjoy normal activities
• Feeling "numb" or emotionless rather than sad
• Having no appetite and losing weight (although some people eat more and gain weight when
depressed)
• Sleeping too much or too little, having difficulty going to sleep, sleeping restlessly, or awakening
very early in the morning
• Feeling guilty, worthless, or hopeless

Some depressed people lack energy while others feel jumpy and agitated. In severe depression,
people can have delusions that they are unworthy, sinful, or terminally ill. Feelings of depression are
sometimes worse at a particular time of day.

You don't need to have all of these symptoms to be depressed. Depression can be mild or
severe, and it can can occur along with other medical disorders such as cancer, heart disease, stroke,
Parkinson's disease, Alzheimer's disease, and diabetes. Depression may be overlooked while the more
obvious physical aspects of these diseases are treated.

The antidepressant medications that are used for serious depression also may help some people who
have milder depression. Antidepressants work by gradually reducing the symptoms of depression and
helping depressed people feel the way they did before they became depressed.

How Are Antidepressants Prescribed?

Your doctor or health care provider will choose an antidepressant based on your particular symptoms.
You may notice improvement in the first couple of weeks, but usually the medication should be taken
regularly for at least 6-8 weeks before the full therapeutic effect occurs.
If there is little or no change in symptoms after 6 or 8 weeks, you may be switched to a different
medication, or a second medication may be added. There is no way of knowing beforehand which
medication will be effective, so you may have to try a few different drugs.

Antidepressants are usually given for at least 6 to 12 months. When a patient and the healthcare
provider feel that medication can be discontinued, they should discuss how to best taper off the
medication gradually. Never discontinue medication without talking to your doctor about it.
For people who have had several bouts of depression, long-term treatment with medication is the
most effective means of preventing more episodes.

The dose of your antidepressant depends on the type of drug and your body chemistry, age, and
weight. Antidepressant dosages are often started low and raised gradually over time until the desired
effect is reached without the appearance of troublesome side effects. Some of the newer
antidepressants may be started at or near the target dose.

Keep reading for more details...

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Classes of Antidepressants
From Leonard Holmes, former About.com Guide
Updated March 18, 2010
About.com Health's Disease and Condition content is reviewed by our Medical Review Board

Filed In:
1. Mental Illness
2. > Depression
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(Continued from Page 1)

Tricyclic Antidepressants

Tricyclic antidepressants were the first line of treatment for major depression from the 1960s through
the 1980s. We now know that these medications affect two chemical neurotransmitters called
norepinephrine and serotonin. Tricyclics are as effective in treating depression as the newer
antidepressants, but their side effects are somewhat more unpleasant. They are no longer the first
medication tried for most depressed patients.

Tricyclic antidepressants such as imipramine, amitriptyline, nortriptyline, and desipramine are used
when newer medications are not effective. They may also be used at night to improve sleep. Some of
these medications are also used to treat neuropathic (nerve-related) pain.

Monoamine Oxidase Inhibitors

Monoamine oxidase inhibitors (MAOIs) are older antidepressants that are effective for some people
with major depression who do not respond to other antidepressants. They are also effective for the
treatment of panic disorder and bipolar depression. MAOIs approved for the treatment of depression
are Nardil (phenelzine), Parnate (tranylcypromine), and Marplan (isocarboxazid).

These medications can have severe side effects in some situations, so patients must follow directions
very carefully. Because substances in certain foods, beverages, and medications can cause dangerous
interactions when combined with MAOIs, people on these agents must adhere to dietary restrictions.

Newer Antidepressants

Other antidepressants have been introduced since the early 1990s. The first of these medications were
the selective serotonin reuptake inhibitors (SSRIs). It has been thought that these medications work
by increasing the amount of serotonin (a neurotransmitter) between nerve cells. Neurotransmitters
are chemicals that pass a nerve impulse from one cell to another. Research has shown that these
medications may also help people grow new brain cells.

SSRIs include Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), Paxil (paroxetine), Celexa
(citalopram), and Lexapro (escitalopram). Many people may notice sexual side effects when taking
SSRIs.
Other newer medications include Effexor (venlafaxine), Cymbalta (duloxetine) and Serzone
(nefazadone). Serzone was taken off the market in the U.S. because of cases of liver failure, although
generic nefazadone is still available.

Other medications include Remeron (mirtazepine), which can have a sedating effect, and Wellbutrin
(bupropion), which tends to be more activating. Wellbutrin has not been associated with weight gain
or sexual dysfunction, but it needs to be used with caution in anyone at risk for a seizure.

Keep reading for a detailed list of side effects...

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Side Effects of Antidepressants

From Leonard Holmes, former About.com Guide
Updated March 18, 2010
About.com Health's Disease and Condition content is reviewed by our Medical Review Board

Filed In:
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2. > Depression
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(Continued from Page 2)

Antidepressants have different side effects in different people. Older medications may cause dry
mouth and sedation, while newer ones may have sexual side effects.

Side Effects of Antidepressant Medications

Antidepressants may cause mild, and often temporary, side effects in some people. These are usually
not serious. Any reactions or side effects that are unusual, annoying, or that interfere with functioning
should be reported to your healthcare provider immediately.

Tricyclic antidepressant side effects include:

• Dry mouth: It can be helpful to drink sips of water and chew sugarless gum.
• Constipation: Bran cereals, prunes, fruit, and vegetables should be included in your diet.
• Bladder problems: Emptying the bladder completely may be difficult, and the urine stream may
not be as strong as usual. Older men with enlarged prostate conditions may be at particular risk for
this problem. You should notify your doctor if you have any pain.
• Sexual problems: Sexual functioning may be impaired; if this is worrisome, it should be discussed
with your doctor.
• Blurred vision: Patients with glaucoma should consult with their physician before starting tricyclic
antidepressants.
• Dizziness: Rising from the bed or chair slowly is helpful.
• Drowsiness during the day: This usually passes soon. A person who feels drowsy or sedated
should not drive or operate heavy equipment. The more sedating antidepressants are generally
taken at bedtime to help sleep and to minimize daytime drowsiness.
• Increased heart rate: Pulse rate is often elevated when taking tricyclic antidepressants. Older
patients should have an electrocardiogram (EKG) before beginning tricyclic treatment.

Side effects of newer antidepressants, including SSRIs, include:

• Sexual problems: These are fairly common, and most commonly involve orgasmic and
ejaculatory disturbances or decreased libido. These are sometimes self-limiting or can be managed
by medication adjustments. The doctor should be consulted if the problem is persistent or
worrisome.
• Headache: This will usually go away after a short time.
• Nausea: This is more likely to occur as the medication is being started or as doses are increased.
It will often disappear over time, but if it doesn’t you should consult with your doctor.
• Nervousness and insomnia (trouble falling asleep or waking often during the night): This may
occur during the first few weeks; time or having your doctor reduce your dose will usually resolve
them.
• Agitation (feeling jittery): If this happens for the first time after the drug is taken and is more
than temporary, the doctor should be notified.

Any of these side effects may be amplified when an SSRI is combined with other medications that
affect serotonin. In the most extreme cases, such a combination of medications (e.g., an SSRI and an
MAOI, or an SSRI and tramadol) may result in a potentially serious or even fatal "serotonin
syndrome," characterized by fever, confusion, muscle rigidity, and cardiac, liver, or kidney problems.

Special Considerations When Taking Antidepressants

MAOIs are not used frequently. The few people people for whom MAOIs are the best treatment need
to avoid taking decongestants and consuming certain foods that contain high levels of tyramine, such
as many cheeses, wines, and pickles. The interaction of tyramine with MAOIs can bring on a sharp
increase in blood pressure that can lead to a stroke. Your doctor should give you a complete list of
prohibited foods that you should carry at all times. Other forms of antidepressants require no food
restrictions. MAOIs also should not be combined with other antidepressants, especially SSRIs, due to
the risk of serotonin syndrome.

Medications of any kind (whether prescribed, over-the-counter, or herbal supplements) should never
be mixed without consulting your healthcare provider. Always tell your doctor what medications you
are taking, as some drugs are safe when taken alone but can cause dangerous side effects if taken
with other drugs or with alcohol. In addition, never borrow medications from another person.

Alcohol or street drugs may reduce the effectiveness of antidepressants. Their use should be
minimized or avoided by anyone taking antidepressants. Some people who have not had a problem
with alcohol use may be permitted by their doctor to use a modest amount of alcohol while taking one
of the newer antidepressants. The potency of alcohol may be increased by medications since both are
metabolized by the liver -- meaning, one drink may feel like two.

Some people have experienced withdrawal symptoms when stopping an antidepressant too abruptly.
Therefore, when discontinuing an antidepressant on your doctor's advice, gradual withdrawal is
generally advisable.

Be sure to discuss any changes in medications with your doctor, and ask any questions that you have.
He or she is your most important source of information about your medications.

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