Antidepressants

Medication prescribed by a doctor is one way to manage major depression. It often is most effective when combined with psychotherapy. While individuals may worry that antidepressants will have personality altering effects, they can be very helpful in managing and/or improving symptoms, especially when taken at the right dosage.

Antidepressants affect brain chemicals associated with emotion, including dopamine, norepinephrine and serotonin. It can take 2 to 4 weeks for the medications to have an effect and 6 to 12 weeks for them to reach their full effect. Family members and friends may notice an improvement before the patient does. Individuals often have to try different doses and/or drugs before they find the combination that is most beneficial.

There are easy ways to help remember to use medications each day. Place them on your night stand, especially if they are taken in the morning and/or at bedtime, set an alarm on your phone or link them with a daily habit like brushing your teeth. Put reminders in your calendar to ensure that you order refills from the pharmacy on time or use an automatic prescription refill if possible.

Side effects typically present early and range from fatigue/sleepiness to nausea and weight gain. While antidepressants generally reduce symptoms of depression, including suicidal thoughts, young adults and youth under the age of 25 do have an increased risk of suicide and/or suicidality when taking them and should be monitored frequently, especially during the first several weeks of treatment.

Consuming alcohol while taking antidepressants is not recommended. The National Alliance on Mental Illness has detailed information about specific drugs on its website. Types of medications for depression include:

Selective serotonin reuptake inhibitors (SSRIs) specifically target the neurotransmitter serotonin. They are the most commonly prescribed drug to treat depression worldwide. SSRIs increase serotonin by blocking its uptake from synapses to nerves and include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). Common side effects of SSRIs are gastrointestinal problems and sexual dysfunction.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second most popular antidepressants worldwide and expand the amount of serotonin and norepinephrine by blocking their reuptake. Desvenlafaxine (Pristiq), duloxetine (Cymbalta) and venlafaxine (Effexor) are all SNRIs.

Bupropion (Wellbutrin) is a norepinephrine-dopamine reuptake inhibitor. It increases the neurotransmitters dopamine and norepinephrine in the brain. While bupropion has less side effects than most antidepressants, it can cause agitation, dizziness, dry mouth, headaches (or a worsening of existing migraine tendencies), insomnia, menstrual problems, a rapid heartbeat, rashes, restlessness and tremors. It is not recommended for individuals who have eating or seizure disorders and/or have suffered head injuries.

Mirtazapine (Remeron) targets norepinephrine and serotonin receptors in the brain, expanding circuit activity. Because it is associated with sedation, sleepiness and weight gain, mirtazapine is not used as frequently as the above medications. It should be avoided by those with hepatic or renal dysfunction, a history of mania or a seizure disorder.

Atypical antipsychotics include aripiprazole (Abilify) and quetiapine (Seroquel), and are used with antidepressants to augment treatment. Symbyax, another atypical antipsychotic, is a combination of fluoxetine and olanzapine.

Tricyclic antidepressants, like amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Aventyl and Pamelor) and protriptyline (Viactil), are older drugs. While they function in a manner similar to SNRIs, they have greater side effects, such as bladder issues and blurred vision, and usually are prescribed when other medications have not worked.

Monoamine oxidase inhibitors (MAOIs), which inactivate enzymes in the brain that breakdown dopamine, norepinephrine and serotonin, are no longer commonly utilized. They can be effective for individuals whose depression is atypical with marked anxiety, excessive sleeping, hypochondria, irritability or phobias. MAOIs, such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine sulfate (Parnate) and the selegiline patch (Emasm), have significant food and drug interactions, which can cause dangerously high blood pressure and must be accompanied by strict adherence to a low tyramine diet. Prohibited foods and beverages include aged cheese, cured meats, draft beer, fermented soy products (miso, soy sauce and tofu), sauerkraut and sometimes wine.

Antidepressants are not habit forming, however, withdrawal, including headaches, insomnia, lethargy, muscle aches and nausea or vomiting, can occur if patients suddenly stop taking them. Approximately 80 percent of individuals who abruptly discontinue their medication experience symptoms, which appear within days and can last up to two weeks. (If antidepressants are restarted, withdrawal quickly ends.) Similarly, symptoms of anxiety and depression return at least half of the time when individuals discontinue their medication. As a result, you should always consult with a doctor and pharmacist before making any changes.

To avoid a recurrence of depression, physicians typically recommend staying on medication for a minimum of one year after youth have stopped experiencing any symptoms. It also is important to determine the optimal timing as stopping before major standardized tests or immediately before leaving for college is not a good idea. Taking medication not only improves depression it also can significantly enhance individuals’ quality of life. Along with regular follow-up, close monitoring and talk therapy, antidepressants can be a vital part of mental health treatment.