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Medications for Depression

Antidepressant medications are very effective; reports indicate that they are 90% successful in treating depression. In general, medications are taken for at least 4 to 8 months to assure complete and effective treatment. However, antidepressants often cause adverse side effects, making it difficult for some people to comply with taking their medications. Medications must not be stopped without first discussing this change with a physician. Most antidepressants cause withdrawal symptoms if they are not discontinued slowly over time with guidance from a physician.

There are several classes of antidepressant medications, including:

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs increase the activity of a chemical in the brain called serotonin. Most healthcare practitioners will prescribe SSRIs before any other antidepressant medication for depression, in part because the side effects associated with SSRIs are generally fewer than for other classes of antidepressants. Typical side effects caused by SSRIs include stomach upset, weight gain or loss, drowsiness, sexual dysfunction (such as impotence, decreased libido, and diminished orgasm), headache, jaw grinding, and apathy. Very unusual side effects from this class of prescription drugs include extreme agitation, impulsivity, tremors, and insomnia. People who discontinue taking SSRIs due to side effects usually attribute their discontent to sexual dysfunction.

Drugs classified as SSRIs include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil) - most likely in this class to cause sexual dysfunction
• Fluvoxamine (Luvox)
• Citalopram (Celexa) - least likely in this class to cause sexual dysfunction

Another group of antidepressant medications (which are similar to SSRIs, but target other brain chemicals in addition to serotonin) may cause fewer negative sexual side effects. These include:

• Bupropion (Wellbutrin) - should not be used if there is history of or risk for seizure. Low sexual side-effect profile.
• Nefazodone (Serzone) - no sexual dysfunction reported; begins to work very quickly; may cause a decrease in blood pressure when going from lying or sitting to standing
• Venlafaxine (Effexor) - may impair sexual function; not recommended in the elderly; may improve quality of life more effectively than other antidepressants, but can cause irregular heart rhythm; withdrawal from the medication is difficult
• Mirtazapine - may be particularly effective if feelings of anxiety are also present; helps with insomnia but may cause drowsiness; other side effects are blurred vision, weight gain, and damage to production of cells in the bone marrow (very rare)
• Maprotiline - may cause dry mouth, drowsiness, sensitivity to the sun, and seizures

Tricyclic Antidepressants

Tricyclics increase the activity of the brain chemicals serotonin and norepinephrine. They are as effective as SSRIs, but are usually prescribed only to those who do not respond well to SSRIs because side effects are quite common and are usually less tolerable. Dry mouth, blurred vision, constipation, sexual dysfunction, weight gain, dizziness, drowsiness, urinary urgency (a sense that one has to urinate even when the bladder is empty), drop in blood pressure when going from lying or sitting to standing (causes dizziness and lightheadedness), and irregular heart rhythm are among the side effects of tricyclics.

Tricyclic antidepressants include:

• Amitriptyline
• Amoxapine - increases risk of seizure in those who are prone to have a seizure
• Clomipramine - used for obsessive/compulsive disorder
• Desipramine
• Doxepin - may help with insomnia
• Imipramine - may cause a rare lung disorder called idiopathic pulmonary fibrosis
• Nortriptyline - less risk of irregular heart rhythm than others in this class
• Protriptyline - less drowsiness than others in this class and may even cause weight loss; may lead to sun sensitivity
• Trimipramine - high risk for irregular heart rhythm

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs include:

• Phenelzine—should be avoided with a history of seizures or bipolar disorder (manic-depression)
• Isocarboxazid—side effects include drowsiness, sexual dysfunction, weakness, trembling, and blurred vision
• Tranylcypromine—should not be used if there is any history of kidney disease or bipolar disorder

Surgery and Other Procedures

• Electroconvulsive Therapy (ECT) for depression is usually reserved for cases in which all other therapies have been unsuccessful. In this procedure, a small electrical current induces a seizure lasting approximately 40 seconds. A muscle relaxant and mild sedative are administered prior to the procedure. ECT is generally repeated every 2 to 5 days for a total of six treatments. It may cause temporary confusion, memory impairment, headache, muscle aches, irregular heart rhythm, or nausea.
• Magnetic Resonance Imaging (MRI) - Guided Cingulotomy involves the application of an electrical current to a specific part of the brain; the MRI is used as a guide for an exact placement. Long-term improvement has been reported using this technique in over 50% of people with depression who have not responded to other modes of therapy.

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Reviewed: 03/2006