Depression Medications and Side Effects

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  • Introduction

    Introduction

    Treatment for major depressive disorder (also known as major depression or clinical depression) depends on the individual and the severity of the illness. However, doctors often find the best results when both prescription medicine (antidepressants) and psychotherapy are used in combination.

    Currently, more than two dozen antidepressant medications are available. For 60 to 80 percent of patients, antidepressants are successful in treating depression, but no single medication has been shown to be the most effective—it depends entirely on the patient and his or her individual circumstances. You will have to take the medication regularly for several weeks or months in order to see results and observe any side effects. Here are the most frequently prescribed antidepressant medicines and their most common side effects.

  • Selective Serotonin Reuptake Inhibitors (SSRIs)

    Selective Serotonin Reuptake Inhibitors (SSRIs)

    The typical course of treatment for depression initially begins with a prescription for a selective serotonin reuptake inhibitor (SSRI). When the brain does not make enough serotonin, or it cannot use existing serotonin correctly, the balance of chemicals in the brain may become uneven. SSRIs work to change the level of serotonin in the brain—specifically, SSRIs block the reabsorption of serotonin. By blocking the reabsorption, neurotransmitters may send and receive chemical messages more effectively. This is thought to increase the mood-boosting effects of serotonin and improve depression symptoms.

    The most common SSRIs include fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft), and escitalopram (Lexapro).

  • Side Effects of Selective Serotonin Reuptake Inhibitors (SSRIs)

    Side Effects of Selective Serotonin Reuptake Inhibitors (SSRIs)

    The most common side effects experienced by people who use SSRIs include:

    • digestive problems, including diarrhea
    • nausea
    • restlessness
    • headaches
    • insomnia or drowsiness
    • decreased sexual desire and difficulty reaching orgasm
    • erectile dysfunction
    • agitation (jitteriness)

  • Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

    Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

    Serotonin and norepinephrine reuptake inhibitors (SNRIs) are sometimes called dual reuptake inhibitors. They work by blocking the reuptake (reabsorption) of serotonin and norepinephrine. With additional serotonin and norepinephrine circulating in the brain, the brain’s chemical balance is reset, and neurotransmitters are thought to communicate more effectively. This improves mood and helps relieve symptoms of depression. The most commonly prescribed SNRIs include venlafaxine (Effexor and Effexor XR), desvenlafaxine (Pristiq), and duloxetine (Cymbalta).

  • Side Effects of Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

    Side Effects of Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

    The most common side effects experienced by people who use SNRIs include:

    • increased sweating
    • increased blood pressure
    • heart palpitations
    • dry mouth
    • fast heart rate
    • digestive problems, typically constipation
    • changes in appetite
    • nausea and dizziness
    • restlessness
    • headaches
    • insomnia or drowsiness
    • decreased sexual desire and difficulty reaching orgasm
    • agitation (jitteriness)

  • Tricyclic Antidepressants (TCAs)

    Tricyclic Antidepressants (TCAs)

    Tricyclic antidepressants (TCAs) have been used for many years and were among the earliest antidepressants created. TCAs work by blocking the reabsorption of noradrenaline and serotonin. This helps the body prolong the mood-boosting benefits of the noradrenaline and serotonin it releases naturally, which improves mood and reduces the effects of depression.

    Many doctors prescribe TCAs because they are thought to be as safe as newer medicines, but side effects from this class of antidepressants tend to be severe. Men tend to experience fewer side effects from TCAs than women. The most commonly prescribed TCAs include amitriptyline (Elavil), imipramine, doxepin (Prothiaden), trimipramine (Surmontil), and dosulepin (Prothiaden).

  • Side Effects of Tricyclic Antidepressants (TCAs)

    Side Effects of Tricyclic Antidepressants (TCAs)

    The most common side effects experienced by people who use TCAs include:

    • weight gain
    • dry mouth
    • blurred vision
    • drowsiness
    • fast heartbeat
    • confusion
    • bladder problems (difficulty urinating)
    • constipation
    • loss of sexual desire

  • Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)

    Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)

    Norepinephrine and dopamine reuptake inhibitors (NDRIs), such as bupropion (Wellbutrin), can be used to treat depression. These medicines block the reabsorption of norepinephrine and dopamine, which helps reset the balance of these chemicals in the brain. NDRIs are also used to help people stop smoking and treat the symptoms of seasonal affective disorder (SAD). Unlike many other antidepressants, NDRIs do not cause sexual side effects.

  • Side Effects of Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)

    Side Effects of Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)

    The most common side effects experienced by people who use NDRIs include:

    • seizures, when taken at high doses
    • anxiety
    • hyperventilation
    • nervousness
    • agitation (jitteriness)
    • irritability
    • shaking
    • trouble sleeping
    • restlessness

  • Monoamine Oxidase Inhibitors (MAOIs)

    Monoamine Oxidase Inhibitors (MAOIs)

    Monoamine oxidase inhibitors (MAOIs) are a medication of last resort—that is, they are typically prescribed only when other medications and treatments have failed. MAOIs prevent the brain from breaking down the chemicals norepinephrine, serotonin, and dopamine. This allows the brain to maintain higher circulating levels of these chemicals, which boosts mood and improves neurotransmitter communications. The most common MAOIs include phenelzine (Nardil); selegiline (Emsam, Eldepryl, and Zelapar); tranylcypromine (Parnate); and isocarboxazid (Marplan).

  • Side effects of Monoamine Oxidase Inhibitors (MAOIs)

    Side effects of Monoamine Oxidase Inhibitors (MAOIs)

    MAOIs tend to have multiple side effects, many of them serious and harmful. MAOIs also have the potential for dangerous interactions with foods and over-the-counter medications. For those reasons, doctors prefer to prescribe other, safer antidepressants over MAOIs when possible.  The most common side effects experienced by people who use MAOIs include:

    • daytime sleepiness
    • insomnia
    • dizziness
    • low blood pressure
    • dry mouth
    • nervousness
    • weight gain
    • reduced sexual desire or difficulty reaching orgasm
    • erectile dysfunction
    • bladder problems, including difficulty urinating

  • Add-On or Augmentation Medications

    Add-On or Augmentation Medications

    For treatment-resistant depression or for patients who continue to have unresolved symptoms, a secondary medication may be prescribed. These add-on medications are generally used for another mental health disorder and may include anti-anxiety medications, mood stabilizers, and antipsychotics. Examples of antipsychotics that have been approved by the FDA for use as add-on therapies for depression include aripiprazole (Abilify), quetiapine (Seroquel), and olanzapine (Zyprexa). The side effects of these additional medications can be similar to other antidepressants.

  • Other Antidepressant Medications

    Other Antidepressant Medications

    Atypical medications, or those that do not fit into any of the other drug categories, include mirtazapine (Remeron) and trazodone (Oleptro).

    Side effects of these medications include:

    • drowsiness—Both of these medicines are sedating, so they are typically taken at night to prevent attention and focus problems.

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