Several types of medication are available for the treatment of depression. Antidepressants are considered very effective and are often used in combination with some form of talk therapy. Medication can often help alleviate symptoms sooner than therapy and enable patients to feel well enough to engage with a mental health professional. Some patients will find that they are able to go off of their antidepressants once a full course of therapy has been completed. Others may want to continue taking medication indefinitely. Because many drugs can have withdrawal symptoms, you should only discontinue medication under the careful monitoring of your physician.
It is also important to note that antidepressants may cause undesirable side effects. In 2005, the Food and Drug Administration (FDA) adopted a “black box” warning label on all antidepressant medication. This warning states that during initial treatment (generally the first one to two months) there is an increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA extended the warning to include adults up to the age of 24. If you decide to go on antidepressants, your doctor can help determine if they are safe and which one is right for you. The following is a list of the many different types of treatment options.
Selective Serotonin Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs) are among the most commonly prescribed antidepressants. They tend to be safer and have fewer side effects than older depression medications, such as Monoamine Oxidase Inhibitors (MAOIs) and tricyclic antidepressants (TCAs). SSRIs target serotonin, a neurotransmitter, or brain chemical that allows neurons to communicate. It’s believed that people with depression have abnormal levels of neurotransmitters that are associated with mood regulation. SSRIs help increase the amount of circulating serotonin in the brain by blocking neurotransmitter reabsorption (or reuptake). The most common side effects reported with SSRIs include low libido, decreased ability to orgasm, nausea, diarrhea, and headache. If the side effects are interfering with your quality of life, talk to your doctor about them.
Common SSRIs:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil or Pexeva)
- Sertraline (Zoloft)
Selective Serotonin and Norepinephrine Reuptake Inhibitors
Also known as dual reuptake inhibitors, Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) increase the amount of the mood-regulating neurotransmitters serotonin and norepinephrine in the brain by preventing their reabsorption, or reuptake, by nerve cells. SNRIs may have side effects including nausea, vomiting, insomnia, constipation, anxiety, and headache.
Common SNRIs
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor)
Tricyclic Antidepressants
Like SSRIs, tricyclic antidepressants (TCAs) work by making more neurotransmitters available in the brain. TCAs block the reuptake of not only serotonin, but also the mood-regulating chemicals norepinephrine and dopamine. TCAs block other cell receptors as well, so they may produce more side effects than other antidepressants. TCAs may cause weight gain, sleepiness, dizziness, constipation, dry mouth, sexual dysfunction, and blurred vision. People with glaucoma, an enlarged prostate, or heart disease should avoid taking TCAs
Common TCAs:
- Amitriptyline (Elavil)
- Amoxapine (Asendin)
- Clomipramine (Anafranil) (for obsessive-compulsive disorder)
- Desipramine (Norpramin)
- Doxepin (Sinequan)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
Monoamine Oxidase Inhibitors
Monoamine Oxidase Inhibitors (MAOIs) were the first class of antidepressants on the market. MAOIs work by blocking chemicals that break down the mood-regulating neurotransmitters serotonin, dopamine, and norepinephrine. It’s thought that this helps alleviate depression by correcting chemical imbalances in the brain. MAOIs also affect other chemicals in the body, leading to side effects such as low blood pressure, dizziness, constipation, fatigue, nausea, dry mouth, and lightheadedness. MAOIs can also cause dangerous interactions with certain foods and beverages, including many cheeses, pickled foods, chocolates, certain meats, beer, wine, and alcohol-free or reduced-alcohol beer and wine. Always consult with a doctor before taking an MAOI. MAOIs are not usually recommended unless other medications have failed.
Common MAOIs
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Selegiline (Emsam)
Other Antidepressants
- Bupropion (Wellbutrin) – Unlike other antidepressants, bupropion alters the chemical makeup of the brain by working primarily on a neurotransmitter called dopamine, which is responsible for our ability to experience pleasure and pain.
- Mirtazapine (Remeron) – Classified as an alpha-2 antagonist drug, mirtazepine increases the release of norepinephrine and serotonin. It may also help alleviate anxiety.
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