(Prepared by, Dr. Brian
Campbell, © 2013)
depression is the type of depression that will most
likely benefit from treatment with medications
depression is more than just "the blues."
condition 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 is associated with abnormal functioning
of the brain.
interaction between genetic tendency and life
history appears to determine a person's chance of
depression may be triggered by stress, difficult
life events, side effects of medications, or
medication/substance withdrawal, or even viral
infections that can affect the brain.
people will seem sad, or "down," or may be unable to
enjoy normal activities.
have no appetite and lose weight (although some
people eat more and gain more weight when
sleep too much or too little, have difficulty going
to sleep, sleep restlessly, or awaken very early in
speak of feeling guilty, worthless, or hopeless
lack energy or be jumpy and agitated.
think about killing themselves, or may even attempt
depressed people have delusions (false, fixed ideas)
about poverty, sickness, or sinfulness that are
related to their depression.
feelings of depression are worse at a particular
time of day, for instance, every morning or evening.
everyone who is depressed has all these symptoms.
Antidepressants primarily work on brain chemicals called
neurotransmitters, especially serotonin and
antidepressants work on the neurotransmitter dopamine.
found that these particular chemicals are involved in
regulating mood, but they are unsure of the exact ways
that they work. The
latest information on medications for treating
depression is available on the U.S.
Food and Drug Administration (FDA) website.
Popular newer antidepressants
Some of the
newest and most popular antidepressants are called
selective serotonin reuptake inhibitors (SSRIs).
(Prozac), sertraline (Zoloft), escitalopram (Lexapro),
paroxetine (Paxil), and citalopram (Celexa) are some of
the most commonly prescribed SSRIs for depression.
available in generic versions.
norepinephrine reuptake inhibitors (SNRIs) are similar
to SSRIs and include venlafaxine (Effexor) and
SSRIs and SNRIs
tend to have fewer side effects than older
antidepressants, but they sometimes produce headaches,
nausea, jitters, or insomnia when people first start to
take them. These
symptoms tend to fade with time.
Some people also
experience sexual problems with SSRIs or SNRIs, which
may be helped by adjusting the dosage or switching to
antidepressant that works on dopamine is bupropion (Wellbutrin).
to have similar side effects as SSRIs and SNRIs, but it
is less likely to cause sexual side effects.
However, it can
increase a person's risk for seizures.
older antidepressants. Tricyclics
are powerful, but they are not used as much today
because their potential side effects are more serious.
They may affect the heart in people with heart
sometimes cause dizziness, especially in older adults.
They also may cause drowsiness, dry mouth, and weight
gain. These side
effects can usually be corrected by changing the dosage
or switching to another medication. However, tricyclics
may be especially dangerous if taken in overdose.
include imipramine and nortriptyline.
oxidase inhibitors (MAOIs) are the oldest class of
antidepressant medications. They can be especially
effective in cases of "atypical" depression, such as
when a person experiences increased appetite and the
need for more sleep rather than decreased appetite and
sleep. They also may help with anxious feelings or panic
and other specific symptoms.
who take MAOIs must avoid certain foods and beverages
(including cheese and red wine) that contain a substance
called tyramine. Certain
medications, including some types of birth control
pills, prescription pain relievers, cold and allergy
medications, and herbal supplements, also should be
avoided while taking an MAOI.
can interact with MAOIs to cause dangerous increases in
blood pressure. The
development of a new MAOI skin patch may help reduce
these risks. If
you are taking an MAOI, your doctor should give you a
complete list of foods, medicines, and substances to
MAOIs can also
react with SSRIs to produce a serious condition called
"serotonin syndrome," which can cause confusion,
hallucinations, increased sweating, muscle stiffness,
seizures, changes in blood pressure or heart rhythm, and
other potentially life-threatening conditions.
MAOIs should not
be taken with SSRIs.
How should I take medication?
antidepressants must be taken for at least 4 to 6 weeks
before they have a full effect.
You should continue to take the medication, even
if you are feeling better, to prevent the depression
should be stopped only under a doctor's supervision.
need to be gradually stopped to give the body time to
antidepressants are not habit-forming or addictive,
suddenly ending an antidepressant can cause withdrawal
symptoms or lead to a relapse of the depression.
individuals, such as those with chronic or recurrent
depression, may need to stay on the medication
In addition, if
one medication does not work, you should consider trying
research has shown that people who did not get well
after taking a first medication increased their chances
of beating the depression after they switched to a
different medication or added another medication to
their existing one.
stimulants, anti-anxiety medications, or other
medications are used together with an antidepressant,
especially if a person has a co-existing illness.
anti-anxiety medications nor stimulants are effective
against depression when taken alone, and both should be
taken only under a doctor's close supervision.
information about mental health medications is available
on the NIMH
unusual side effects to a doctor immediately.
FDA warning on antidepressants
relative safety and popularity of SSRIs and other
antidepressants, studies have suggested that they may
have unintentional effects on some people, especially
adolescents and young adults.
In 2004, the
Food and Drug Administration (FDA) conducted a thorough
review of published and unpublished controlled clinical
trials of antidepressants that involved nearly 4,400
children and adolescents.
revealed that 4 percent of those taking antidepressants
thought about or attempted suicide (although no suicides
occurred), compared to 2 percent of those receiving
information prompted the FDA, in 2005, to adopt a "black
box" warning label on all antidepressant medications to
alert the public about the potential increased risk of
suicidal thinking or attempts in children and
adolescents taking antidepressants. In 2007, the FDA
proposed that makers of all antidepressant medications
extend the warning to include young adults up through
age 24. A "black
box" warning is the most serious type of warning on
prescription drug labeling.
emphasizes that patients of all ages taking
antidepressants should be closely monitored, especially
during the initial weeks of treatment.
effects to look for are worsening depression, suicidal
thinking or behavior, or any unusual changes in behavior
such as sleeplessness, agitation, or withdrawal from
normal social situations. The warning adds that families
and caregivers should also be told of the need for close
monitoring and report any changes to the doctor.
information from the FDA can be found on their website.
adolescents, and young adults taking antidepressants
should be closely monitored.
Results of a
comprehensive review of pediatric trials conducted
between 1988 and 2006 suggested that the benefits of
antidepressant medications likely outweigh their risks
to children and adolescents with major depression and
anxiety disorders.30 The study was funded in
part by NIMH.
Also, the FDA
issued a warning that combining an SSRI or SNRI
antidepressant with one of the commonly-used "triptan"
medications for migraine headache could cause a
life-threatening "serotonin syndrome," marked by
agitation, hallucinations, elevated body temperature,
and rapid changes in blood pressure.
dramatic in the case of the MAOIs, newer antidepressants
may also be associated with potentially dangerous
interactions with other medications.
St. John's wort?
The extract from the herb St. John's wort (Hypericum
perforatum) has been used for centuries in many folk and
herbal remedies. Today in Europe, it is used extensively
to treat mild to moderate depression.
In the United
States, it is one of the top-selling botanical products.
In an 8-week
trial involving 340 patients diagnosed with major
depression, St. John's wort was compared to a common
SSRI and a placebo (sugar pill).
The trial found
that St. John's wort was no more effective than the
placebo in treating major depression.31 However,
use of St. John's wort for minor or moderate depression
may be more effective. Its
use in the treatment of depression remains under study.
St. John's wort
can interact with other medications, including those
used to control HIV infection.
In 2000, the FDA
issued a Public Health Advisory letter stating that the
herb may interfere with certain medications used to
treat heart disease, depression, seizures, certain
cancers, and those used to prevent organ transplant
rejection. The herb also may interfere with the
effectiveness of oral contraceptives.
your doctor before taking any herbal supplement.
If you are
taking medications in addition to an antidepressant,
make sure you tell your doctor about them.
Also, make sure you tell your doctor about any
vitamins you are taking.
Vitamins, over-the-counter medications, and
prescription medications can all interact in ways that
could be harmful.
In addition to
telling your doctor about all vitamins, supplements,
over-the-counter medications, and prescription
medications, you should check for drug interactions by
entering your information into a website that checks for
From the homepage menu, click on:
at the top of the page)
In the table on the right, click on “Check Drug
If it appears
that there are potential adverse interactions, print out
the information and consult your physician.
Medications for Major Depression