1. Understanding Depression Slideshow
2. Take the Depression Quiz
3. Benefits of Depression Treatment

Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The major types of antidepressant medication are the selective serotonin reuptake inhibitors (SSRIs), the tricyclic antidepressants (TCAs), the monoamine oxidase inhibitors (MAOIs), and the atypical antidepressants.

SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group of medicines. Examples of these medications are listed here. The generic name is first, with the brand name in parentheses. These drugs are best known by their brand names.

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)
• Citalopram (Celexa)
• Escitalopram (Lexapro)

TCAs are sometimes prescribed in severe cases of depression or when SSRI medications don't work. These medications affect a number of brain chemicals (neurotransmitters), especially epinephrine and norepinephrine (also called adrenaline and noradrenaline, respectively). Interestingly, premenopausal women tend to improve more and have fewer side effects when treated with SSRIs versus TCAs, while men tend to do better when their depression is treated with a TCA. Like the SSRIs, most of these are better known by their brand names. Examples include

• amitriptyline (Elavil),
• clomipramine (Anafranil),
• desipramine (Norpramin),
• doxepin (Adapin),
• imipramine (Tofranil),
• nortriptyline (Pamelor),
• protriptyline (Vivactil),
• trimipramine (Surmontil).

Atypical neuroleptic medications are increasingly being prescribed in addition to an antidepressant in people with unipolar depression who do not improve after receiving trials of different antidepressants and in addition to, or instead of, an antidepressant in people who suffer from bipolar disorder. Although clozapine (Clozaril) is often considered to be the first discovered atypical neuroleptic, the risk it carries for severe anemia and decrease in bone-marrow functioning generally disqualifies its use in depressed patients. Examples of other atypical neuroleptics include

• aripiprazole (Abilify),
• olanzapine (Zyprexa),
• paliperidone (Invega),
• quetiapine (Seroquel),
• risperidone (Risperdal),
• ziprasidone (Geodon),
• asenapine (Saphris),
• iloperidone (Fanapt).

Non-neuroleptic mood-stabilizer medications are also sometimes used with an antidepressant to treat people with unipolar depression who do not improve after receiving trials of different antidepressants and in addition to or instead of an antidepressant in those who suffer from bipolar disorder. Examples of non-neuroleptic mood stabilizers include

• lithium (Lithium Carbonate, Lithium Citrate),
• divalproex sodium (Depakote),
• carbamazepine (Tegretol),
• lamotrigine (Lamictal).

Of the non-neuroleptic mood stabilizers, Lamictal seems to be unique in its ability to also treat unipolar depression effectively by itself as well as in addition to an antidepressant.

The MAOIs are not used as often since the introduction of the SSRIs. Because of interactions with some antidepression medications and specific foods, the MAOIs may not be taken with many other types of medication and some types of foods that are high in tyramine (like aged cheeses, wines, and cured meats) must be avoided as well. Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate).

The atypical antidepressant medications work differently than the commonly used SSRIs. The following medications might be prescribed when SSRIs have not worked:

• Bupropion (Wellbutrin)
• Mirtazapine (Remeron)
• Nefazodone (Serzone)
• Trazodone (Desyrel)
• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Desvenlafaxine (Pristiq)

One-half to two-thirds of people who take antidepressant medications get better.

• It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better. Don't give up taking the medication if you don't feel better right away.
• Your health-care provider will see you again during this period to see if your body is tolerating the medication and if your symptoms are better. If they are not, he or she may adjust your dose or prescribe a different medication.

Even after you feel better, you should continue to take the medication for six to nine months.

• Stopping the medication too soon may cause your symptoms to return or to get worse.
• Some people need to take the medication for longer periods of time to keep the depression from returning.

Do not stop taking the medication without talking to your health-care provider.

• Stopping abruptly may cause serious withdrawal effects.
• If you and your health-care provider agree it is time to stop the medication, the dose usually will be slowly tapered to prevent these effects.

The side effects of antidepressant medications vary considerably from drug to drug and from person to person.

• Common side effects include dry mouth, sexual dysfunction, nausea, tremor, insomnia, blurred vision, constipation, and dizziness.
• You may need to follow some dietary restrictions if you are taking MAOI medications.
• In very rare cases, some patients have been thought to have become acutely more depressed once on the medication, even attempting or completing suicide or homicide. Children and teenagers are thought to be particularly vulnerable to this rare possibility. However, when considering this risk, it is important to also consider the risk of the potential serious outcomes that can result from untreated depression.
• If an antidepressant medication is prescribed for you, ask your health-care provider what kind of side effects you can expect.

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