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Depression medications

Anyone can develop depression. But, treatment is effective in about 80% of identified cases, when treatment is provided. Psychotherapy and medication are the two primary treatment approaches. Antidepressant medications can make psychotherapy more effective, for some people. Someone who is too depressed to talk, for instance, can't get much benefit from psychotherapy or counseling; but often, the right medication will improve symptoms so that the person can respond better.

This page explains many issues related to the treatment of depression with medication. It is intended to help you understand how and why drugs can be used as part of the treatment of depression. It is important for you to be well informed about depression medication, if you are taking any of these medications, but this is not a "do-it-yourself" manual.

Self-medication can be dangerous. Interpretation of both the signs and symptoms of depression, and identification of possible side effects, are jobs for the professional. The prescription and management of medication, in all cases, must be done by a responsible physician working closely with the patient, his/her psychologist, and sometimes the patient's family. This is the only way to ensure that the most effective use of medication is achieved with minimum risk of side effects or complications.

Just as aspirin can reduce a fever without clearing up the infection that causes it, psychotherapeutic medications act by controlling symptoms. Like most drugs used in medicine, they correct or compensate for some malfunction in the body. Psychotherapeutic medications do not cure depression. In many cases, these medications can help a person get on with life despite some continuing mental pain and difficulty coping with problems. For example, antidepressants can lift the dark, heavy moods of depression. The degree of response ranging from little relief of symptoms to complete remission depends on a variety of factors related to the individual and the particular disorder being treated.

How long someone must take a psychotherapeutic medication depends on the disorder. Many depressed and anxious people may need medication for a single period perhaps for several months and then never have to take it again. For some depressions, medication may have to be taken indefinitely or, perhaps, intermittently.

Like any medication, psychotherapeutic medications do not produce the same effect in everyone. Some people may respond better to one medication than another. Some may need larger dosages than others do. Some experience annoying side effects, while others do not. Age, sex, body size, body chemistry, physical illnesses and their treatments, diet, and habits such as smoking, are some of the factors that can influence a medication's effect.

Antidepressant Medications

The kind of depression that will most likely benefit from treatment with medications is more than just "the blues." It's a condition that's prolonged, lasting 2 weeks or more, and interferes with a person's ability to carry on daily tasks and to enjoy activities that previously brought pleasure.

The depressed person will seem sad, or "down," or may show a lack of interest in his surroundings. He may have trouble eating and lose weight (although some people eat more and gain weight when depressed). He may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. He may speak of feeling guilty, worthless, or hopeless. He may complain that his thinking is slowed down. He may lack energy, feeling "everything's too much," or he might be agitated and jumpy. A person who is depressed may cry. He may think and talk about killing himself and may even make a suicide attempt. Some people who are depressed have psychotic symptoms, such as delusions (false ideas) that are related to their depression. For instance, a psychotically depressed person might imagine that he is already dead, or "in hell," being punished.

Not everyone who is depressed has all these symptoms, but everyone who is depressed has at least some of them. A depression can range in intensity from mild to severe.

Antidepressants are used most widely for serious depressions, but they can also be helpful for some milder depressions. Antidepressants, although they are not "uppers" or stimulants, take away or reduce the symptoms of depression and help the depressed person feel the way he did before he became depressed.

Antidepressants are also used for disorders characterized principally by anxiety. They can block the symptoms of panic, including rapid heartbeat, terror, dizziness, chest pains, nausea, and breathing problems. They can also be used to treat some phobias.

Your physician will choose a particular antidepressant based on your symptoms. When you begin taking an antidepressant, improvement generally will not begin to show immediately. With most of these medications, it will take from 1 to 3 weeks before changes begin to occur. Some symptoms diminish early in treatment; others, later. For instance, energy level, or sleeping and eating patterns may improve before the depressed mood lifts. If there is little or no change in symptoms after 5 to 6 weeks, a different medication may be indicated, and you should discuss this with your physician. Some people respond better to one medication than to another. There is no certain way to determine which medication will be effective, so your doctor may have to prescribe first one, then another, until an effective one is found. Treatment with medication is continued for a minimum of several months and may last up to a year or more.

While some people have one episode of depression and then never have another, or remain symptom-free for years, others have more frequent episodes or very long-lasting depressions that may go on for years. Some people find that their depressions become more frequent and severe as they get older. For these people, continuing (maintenance) treatment with antidepressants can be an effective way of reducing the frequency and severity of depressions. Those that are commonly used have no known long-term side effects and may be continued indefinitely. The prescribed dosage of the medication may be lowered if side effects become troublesome. Lithium may also be used for maintenance treatment of repeated depressions whether or not there is evidence of a manic or manic-like episode in the past.

The dosage of antidepressants varies, depending on the type of drug, the person's body chemistry, age, and, sometimes, body weight. Dosages are generally started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects.

There are a number of different types of antidepressant medications available. They differ in their side effects and, to some extent, in their level of effectiveness. Tricyclic antidepressants (named for their chemical structure) used to be the most commonly used medications for treatment of major depressions. Monoamine oxidase inhibitors (MAOIs) were often used for "atypical" depressions in which there are symptoms like oversleeping, anxiety, panic attacks, and phobias. More recently, newer antidepressants have been developed. Several of them are called "selective serotonin reuptake inhibitors" (SSRIs). Some examples of SSRIs are fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). (Luvox has been approved for obsessive-compulsive disorder , and Paxil has been approved for panic disorder.) Though structurally different from each other, all the SSRI antidepressant effects are due to their action on one specific neurotransmitter, serotonin. Two other antidepressants that affect two neurotransmitters serotonin and norepinephrine have also been approved by the FDA. They are venlafaxine (Effexor) and nefazodone (Serzone). All of these newer antidepressants seem to have less bothersome side effects than the older tricyclic antidepressants.

The tricyclic antidepressant clomipramine (Anafranil) affects serotonin but is not as selective as the SSRIs. It was the first medication specifically approved for use in the treatment of obsessive- compulsive disorder (OCD). Prozac and Luvox have now been approved for use with OCD.

Another of the newer antidepressants, bupropion (Wellbutrin), is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin. Wellbutrin has not been associated with weight gain or sexual dysfunction. It is contraindicated for individuals with, or at risk for, a seizure disorder or who have been diagnosed with bulimia or anorexia nervosa.

Questions for Your Doctor About the depression medication

To increase the likelihood that a medication will work well, you and your family must actively participate with the doctor prescribing it. Tell the doctor about your past medical history, other medications being taken, anticipated life changes such as planning to have a baby and, after some experience with a medication, whether it is causing side effects. When a medication is prescribed, you should ask the following questions, recommended by the US Food and Drug Administration (FDA):

• What is the name of the depression medication, and what is it supposed to do?
• How and when do I take it, and when do I stop taking it?
• What foods, drinks, other medications, or activities should I avoid while taking the prescribed medication?
• What are the side effects, and what should I do if they occur?
• Is there any written information available about the medication?

On this page, medications are listed with their generic (chemical) names matched with their trade names (brand names used by drug companies). If you cannot find additional information using the trade name, search for information using the generic name.

Side Effects of Antidepressant Medications

1. Tricyclic Antidepressants

There are a number of possible side effects with tricyclic antidepressants that vary, depending on the medication. For example, amitriptyline (Elavil) may make people feel drowsy, while protriptyline (Vivactil) hardly does this at all and, in some people, may have an opposite effect, producing feelings of anxiety and restlessness. Because of this kind of variation in side effects, one antidepressant might be highly desirable for one person and not recommended for another. Tricyclics on occasion may complicate specific heart problems, and for this reason the physician should be aware of all such difficulties. Other side effects with tricyclics may include blurred vision, dry mouth, constipation, weight gain, dizziness when changing position, increased sweating, difficulty urinating, changes in sexual desire, decrease in sexual ability, muscle twitches, fatigue, and weakness. Not all these medications produce all side effects, and not everybody gets them. Some will disappear quickly, while others may remain for the length of treatment. Some side effects are similar to symptoms of depression (for instance, fatigue and constipation). For this reason, the patient or family should discuss all symptoms with the doctor, who may change the medication or dosage.

Tricyclics also may interact with thyroid hormone, antihypertensive medications, oral contraceptives, some blood coagulants, some sleeping medications, antipsychotic medications, diuretics, antihistamines, aspirin, bicarbonate of soda, vitamin C, alcohol, and tobacco.

An overdose of these antidepressants is serious and potentially lethal. It requires immediate medical attention. Symptoms of an overdose of tricyclic antidepressant medication develop within an hour and may start with rapid heartbeat, dilated pupils, flushed face, and agitation, and progress to confusion, loss of consciousness, seizures, irregular heart beats, cardiorespiratory collapse, and death.

2. The Newer SSRI Antidepressants

The most common side effects of these antidepressants are gastrointestinal problems and headaches. Some people complain of insomnia, anxiety, and agitation. Because of the potentially serious interaction between these medications and monoamine oxidase inhibitors, it is advisable to stop taking one medication from 2 to 4 or 5 weeks before starting the other, depending on the specific medications involved. In addition, some SSRIs have been found to affect metabolism of certain other medications in the liver, creating possible drug interactions. As with all medications, be sure to tell your physician if any other doctor, including your dentist, has prescribed any medications for you. This is necessary to prevent potentially dangerous drug interactions.

3. Monoamine Oxidase Inhibitors (MAOIs)

MAOIs may cause some side effects similar to those of the other antidepressants. Dizziness when changing position and rapid heartbeat are common. MAOIs also react with certain foods and alcoholic beverages (such as aged cheeses, foods containing monosodium glutamate (MSG), Chianti and other red wines), and other medications (such as over-the-counter cold and allergy preparations, local anesthetics, amphetamines, insulin, some narcotics, and antiparkinsonian medications). These reactions often do not appear for several hours. Signs may include severe high blood pressure, headache, nausea, vomiting, rapid heartbeat, possible confusion, psychotic symptoms, seizures, stroke, and coma. For this reason, people taking MAOIs must stay away from restricted foods, drinks, and medications. They should be sure that they are furnished, by their doctor or pharmacist, a list of all foods, beverages, and other medications that should be avoided.

Precautions to be Observed When Taking Antidepressants

When taking antidepressants, it is important to tell all your doctors (and dentists) about all medications being used, including over-the-counter preparations and alcohol. Antidepressants should be taken only in the amount prescribed and should be kept in a secure place away from children. When used with proper care, following the doctor's instructions, antidepressants are useful medications that can control many of the physical symptoms of depression, while you work on changing the life stressors that contributed to its cause.

Medication Precautions

Special Considerations

Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing.

Children

Studies consistently show that about 15 percent of the US population below age 18, or over 9 million children, have been diagnosed with a psychological problem that compromises their ability to function. In children, these disorders may present symptoms that are different or less clear-cut than the same disorders in adults. Younger children, especially, may not talk about what's bothering them, but this is sometimes a problem with older children as well. For this reason, having both a physician and psychologist evaluate the child is especially important.

There are many psychological treatments that can help children. These include psychotherapy, behavioral therapy, social skills training, parental and family therapy, group therapy and medications. The treatment, or combination of treatments, used for an individual child is based on the child's diagnosis and individual needs. When your child appears to have a psychological problem, it is very important to consult with a psychologist to determine what should be done.

If a decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, others who have charge of the child) is essential. Children should be watched and questioned for side effects (many children, especially younger ones, do not volunteer information). They should also be monitored to see that they are actually taking the medication and taking the proper dosage.

The use with children of the medications described here is more limited than with adults. In the list of medications, those that have specific indications and dose guidelines for children, as listed in the Physicians' Desk Reference, are indicated by a double asterisk (**).

The Elderly

Persons over the age of 65 make up 12 percent of the population of the United States, yet they receive 30 percent of prescriptions filled. The elderly generally have more medical problems and often are taking medications for more than one of these problems. In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication.

The elderly may sometimes accidentally take too much of a medication because they forget that they have taken a dose and take another dose. The use of a 7-day pill box is especially helpful to an elderly person.

The elderly, their friends, relatives, and caretakers, need to watch for adverse (negative) physical and psychological responses to medication. Because the elderly often take more medications (prescribed, over-the-counter drugs, and home or natural remedies), the possibility of negative drug interactions is higher.

Pregnant, Nursing, or Childbearing-Age Women

In general, during pregnancy, all medications (including psychotherapeutic medications) should be avoided where possible, and other methods of treatment should be tried.

A woman who is taking a psychotherapeutic medication and plans to become pregnant should discuss her plans with her doctor; if she discovers that she is pregnant, she should contact her doctor immediately. During early pregnancy, there is a possible risk of birth defects with some of these medications, and for this reason:

1) Lithium is not recommended during the first 3 months of pregnancy.

2) Benzodiazepines are not recommended during the first 3 months of pregnancy.

The decision to use a psychotherapeutic medication should be made only after a careful discussion with the doctor concerning the risks and benefits to the woman and her baby. Small amounts of medication pass into the breast milk; this is a consideration for mothers who are planning to breast-feed.

A woman who is taking birth-control pills should be sure that her doctor is aware of this. The estrogen in these pills may alter the breakdown of medications by the body, and/or reducing their efficacy to relieve symptoms of anxiety.

index of Medications

This list pairs the Trade Names of antidepressants with their generic names. Sometimes you can find additional information about a medication under its generic name, that might not be listed under its trade name. As we gather more information about specific medications, we will be adding links from the medication name directly to expanded information on that specific drug. Otherwise, please consult the reference list at the bottom of the page for additional information.

Antidepressant Medications

Trade Name - Generic Name

Adapin - doxepin

Anafranil** - clomipramine

Asendin - amoxapine

Aventyl - nortriptyline

Desyrel - trazodone

Effexor - venlafaxine

Elavil - amitriptyline

Ludiomil - maprotiline

Luvox (SSRI) - fluvoxamine

Marplan (MAOI) - isocarboxazid

Nardil (MAOI) - phenelzine

Norpramin - desipramine

Pamelor - nortriptyline

Parnate (MAOI) - tranylcypromine

Paxil (SSRI) - paroxetine

Pertofrane - desipramine

Prozac (SSRI) - fluoxetine

Remeron - mirtazapine

Serzone - nefazodone

Sinequan - doxepin

Surmontin - trimipramine

Tofranil** - imipramine

Vivactil - protriptyline

Wellbutrin - bupropion

Zoloft (SSRI) - sertraline

References

AHFS Drug Information, 91. Gerald K. McEvoy, Editor. Bethesda, Maryland: American Society of Hospital Pharmacists, Inc., 1991.

Goodwin F.K. and Jamison K.R. Manic-Depressive Illness. New York: Oxford University Press, 1990.

Jensen P.S., Vitiello B., Leonard H., and Laughren T.P. Child and adolescent psychopharmacology: expanding the research base. Psychopharmacology Bulletin, Vol. 30, No. 1, 1994.

Physicians' Desk Reference, 52nd edition. Montvale, New Jersey: Medical Economics Data Production Company, 1998.