Medications for Depression

FDA Public Health Advisory for Antidepressants

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.

Although the warning is for all antidepressants, of most concern are the SSRI class such as:

• Prozac (fluoxetine]]>), Zoloft (]]>sertraline]]>), Paxil (]]>paroxetine]]>), Luvox (]]>fluvoxamine]]>), Celexa (]]>citalopram]]>), Lexapro(]]>escitalopram]]>)

For more information, please visit: http://www.fda.gov/cder/drug/antidepressants/

Selective Serotonin Reuptake Inhibitors (SSRIs)

See FDA Public Health Advisory]]> 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 4-6 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 (ranging from decreased arousal to ]]>erectile dysfunction]]> and/or delayed time to orgasm)

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 3-6 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)

Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant that prevent the breakdown of serotonin and norepinephrine. 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 2-6 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 3-6 weeks after starting treatment.

Possible side effects include:

• Dry mouth
• Constipation
• Nausea
• Decreased appetite
• Fatigue
• Drowsiness
• High blood pressure (when taking venlafaxine)

Atypical Antidepressants

Common names include:

• Trazodone]]> (Desyrel)
• ]]>Venlafaxine]]> (Effexor)
• Nefaxadone (Serzone)

Atypical antidepressants affect the concentration of the neurotransmitter serotonin and can be effective in treating depression. Improvement is usually seen in 4-6 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
• Increase risk of seizures (when taking bupropion)