Understanding Antidepressant Medications (cont.)

Atypical antidepressants may be prescribed when SSRIs or TCAs have not worked. Atypical antidepressants include:

• bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL),
• duloxetine (Cymbalta),
• maprotiline (Ludiomil),
• mirtazapine (Remeron),
• nefazodone (Serzone),
• trazodone (Desyrel), and
• venlafaxine (Effexor).

How do atypical antidepressants work?

Each of these drugs inhibit uptake of the various neurotransmitters in the brain.

• Individuals with a prior allergic reaction to any atypical antidepressant
• Individuals with seizure disorders (Do not use bupropion and maprotiline.)
• Individuals taking MAOIs (Do not use duloxetine, maprotiline, and venlafaxine.)
• Other contraindications include the following:
  • Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL): Individuals with bulimia or anorexia nervosa, or those in the process of withdrawal from alcohol or sedatives should not take bupropion.
  • Duloxetine (Cymbalta): Individuals with uncontrolled narrow-angle glaucoma should not take duloxetine.
  • Maprotiline (Ludiomil), mirtazapine (Remeron), nefazodone (Serzone), and trazodone (Desyrel): Individuals who have experienced a recent heart attack should not take these medications.
  • Nefazodone (Serzone): Individuals should not take nefazodone if they have liver impairment or are currently using cisapride (Propulsid), pimozide (Orap), carbamazepine (Tegretol), or triazolam (Halcion).

Use

• Atypical antidepressants are administered orally.
• Mirtazapine (Remeron SolTab) is a tablet that dissolves when placed in the mouth instead of swallowing with water.
• Some atypical antidepressants are available as sustained-release tablets or capsules and should only be swallowed whole (do not crush, divide, or chew).
• Abrupt discontinuation of some atypical antidepressants, such as duloxetine, may cause withdrawal-like symptoms such as agitation, anxiety, confusion, dizziness, headache, and insomnia. Ask a doctor or pharmacist if the medication dose should be gradually tapered down to avoid these symptoms.

Children: Safety and efficacy of duloxetine, bupropion, maprotiline, mirtazapine, nefazodone, and trazodone have not been established in children younger than 18 years.

Drug or food interactions: Tell the doctor what medications are currently being taken because many drugs interact with atypical antidepressants. Do not take any nonprescription or herbal medications without first consulting the doctor or pharmacist. The following are examples of interactions, but they do not represent a complete list.