Medications to Treat Depression
Prescription antidepressant medication is the most common treatment for depression. Depression symptoms improve in approximately 80 percent of patients who take antidepressants. Treatment for a first depressive episode may last from 6 months to a year; recurrent depression typically warrants 2 years of antidepressant treatment; and chronic depression may require lifelong treatment. People respond differently to different medications, and in many cases, side effects and cost determine the type of medication used. Antidepressants may increase the risk for suicidal thinking in children and young adults.
In addition to considering side effects of an antidepressant, the physician and patient also address other important issues. For example, Prozac® effectively treats depression as well as bulimia nervosa (eating disorder that is sometimes associated with depression). Atypical antidepressants and SSRIs are the drugs most commonly prescribed for depression.
Antidepressant medications include the following:
- SSRIs (selective serotonin reuptake inhibitors)
- Atypical antidepressants, also called non-SSRIs
- TCAs (tricyclic antidepressants), also called tricyclics
- MAOIs (monoamine oxidase inhibitors)
These drugs include the following:
- Citalopram (Celexa®)
- Escitalopram (Lexapro®)
- Fluoxetine (Prozac®)
- Fluvoxamine (Luvox®)
- Paroxetine (Paxil®)
- Sertraline (Zoloft®)
- Vortioxetine (Brintellix)
Common side effects of SSRIs include sexual side effects, sun sensitivity, and slight weight loss. One-half of patients who take these medications experience one or more sexual side effects, including loss of libido, inability to experience orgasm, erectile dysfunction (in men), and vaginal dryness (in women). If these effects are intolerable, another medication can be prescribed. Vortioxetine (approved by the FDA in September 2013 to treat depression in adults) may cause nausea, constipation and vomiting.
In March 2012, the FDA approved the first generic version of Lexapro (escitalopram tablets) to treat depression and general anxiety disorder in adults. This medication is approved in three doses: 5 milligram, 10 mg and 20 mg.
These drugs, which have different mechanisms of action, include the following:
- Bupropion (Wellbutrin®)
- Velafaxine HCl (Effexor® XR)
Atypical antidepressants may cause the following side effects:
- Dry mouth
Tricyclic antidepressants generally are not the first choice for treatment because they may cause severe side effects. In high doses, they may cause seizures, stroke, and heart attack. The abrupt discontinuation of a TCA is not recommended and may cause headache, nausea, and malaise, and may intensify side effects.
TCAs include the following:
- Amitriptyline (Elavil®)
- Amoxapine (Asendin®)
- Clomipramine (Anafranil®)
- Desipramine (Norpramin®)
- Doxepin (Sinequan®)
- Imipramine (Tofranil®)
- Maprotiline (Ludiomil®)
- Nortriptyline (Aventyl®)
- Protriptyline (Vivactil®)
- Trimipramine (Surmontil®)
Side effects of these drugs include:
- Blurred vision
- Changes in appetite
- Decreased libido
- Dry mouth
- Impaired concentration
- Increased heart rate
MAOIs interact with tyramine, a chemical found in foods such as cheese, yeast products (e.g., beer), and chocolate. This interaction can result in a hypertensive crisis, which can be fatal. The risk is significant enough that many physicians avoid prescribing MAOIs. These drugs include phenelzine (Nardil®) and isocarboxazid (Marplan®).
Side effects are similar to those caused by TCAs and a potentially fatal condition called tyramine-induced hypertensive crisis.
In November 2007, the U.S. Food and Drug Administration (FDA) approved aripiprazole (Abilify®) for use in adults as an add-on treatment for major depressive disorder that does not respond to antidepressant therapy. Recent studies show that patients who take this drug in addition to antidepressants may experience an improvement in symptoms. Side effects include restlessness, insomnia, fatigue, and constipation.
SSRI and 5HT 1A Partial Agonist
In January 2011, the FDA approved vilazodone hydrochloride (Viibryd™) for the treatment of major depressive disorder in adults. Vilazodone is a combination of two medications: a selective serotonin reuptake inhibitor (SSRI) and a 5HT1a receptor partial agonist. The most common side effects are diarrhea, nausea, vomiting and insomnia. The medication should not be used with monoamine oxidase (MAO) inhibitors.
Second Generation Antipsychotics
Atypical antipsychotics, also called second generation antipsychotics, have been used to treat bipolar disorder and schizophrenia.
Over time, many doctors have seen success in using drugs in this class (together with antidepressants) off-label for the treatment of their depressed patients . Today, Aripiprazole (Abilify®), olanzapine (Symbyax®) and quetiapine (Seroquel XR®) are in fact approved by the FDA for this use.
If your symptoms have not improved on your antidepressant alone, tell your doctor. He or she may recommend adding one of these drugs to treatment plan.