Medications to Treat Depression

Reviewed May 15, 2017

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Summary

All of these treatments come with side effects, but in most cases the side effects are an acceptable trade-off for the relief of depression.
 

Antidepressants are drugs that safely and successfully treat depression or major depressive illness. They can be used along with talk therapy, but they are often the only treatment a depressed person gets. Drugs and talk therapy have different benefits. Using them at the same time is often better than using just one.

Talk therapy can help a person see herself in new ways. It can help her better deal with stressful feelings, thoughts, events, memories, and relationships.

Drugs can help to cut back on signs of low mood such as crying, loss of fun, low energy, poor sleep, changes in eating, poor focus, and worry. Some drugs used to treat low mood can help cut back on even more serious signs like hearing voices or having thoughts of killing oneself. In rare cases, some of these drugs also have been said by some to increase these thoughts.

Role of the FDA

The U.S. Food and Drug Administration (FDA) is the government agency that monitors and approves new drugs. They make sure that drugs are safe for doctors to give to people. They also make sure that the drugs do what they are supposed to do.

The FDA has approved more than 25 drugs to treat major depressive illness. They fall into different groups.

Monoamine oxidase inhibitors (MAOIs)

MAOIs block the breakdown of major brain chemicals. Phenelzine (Nardil®) and tranylcypromine (Parnate®) are the most widely used.

These can be very helpful, mainly for people who are both nervous and sad. But they can cause unsafe reactions when given with certain foods or other drugs.  A doctor will provide additional information on this before prescribing them.

Tricyclic antidepressants (TCAs)

Of the TCAs, nortriptyline and desipramine are the most common ones used.

Like MAOIs, TCAs can help both worry and low spirits. They can also have some bad side effects. They can make people lightheaded or tired. They can add to feelings of hunger. Less commonly, they can cause harmful physical reactions such as heart rhythm problems or trouble having a bowel movement. Also, they can be deadly when taken in an overdose.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs treat low mood and some forms of worry without the same serious side effects of TCAs or MAOIs. But they can cause other problems like increased bleeding, lighter sleep, nightmares, and sexual problems.

Fluoxetine (Prozac®), the first of these, has helped many people. Its success led to competition from other new antidepressants with a similar type of action: sertraline (Zoloft®), paroxetine (Paxil®), fluvoxamine (Luvox®), citalopram (Celexa®), escitalopram (Lexapro®), and vilazodone (Viibryd®). They are known for targeting only one brain chemical.

Serotonin norepinephrine reuptake inhibitors (SNRIs)

Scientists trying to increase drug benefits invented those that change two brain compounds, norepinephrine and serotonin. These serotonin norepinephrine reuptake inhibitors (SNRIs) include venlafaxine XR and venlafaxine (Effexor XR® and Effexor®), duloxetine (Cymbalta®), and desvenlafaxine (Pristiq®). They can have side effects like or a little worse than SSRIs. But they also sometimes help people who have not been helped by SSRIs.

Buproprion (Wellbutrin®) increases the release of norepinephrine and dopamine in the brain. Many doctors think it is most useful for depression without anxiety.

Mirtazapine (Remeron®) is great for anxiety but can make people tired or hungry.

Drugs and other treatments

There is no perfect drug. Not only do they all have side effects, but also none will help everyone who takes it. However, about two out of every three people who try one drug will get much better with it.

Studies have taught doctors some good ways of treating depression that doesn’t get better with the first method. When it is possible to add one more drug or switch to some other type, it is likely that 80 percent or more of people with major depression will get much better.

When drugs are given along with talk therapy, the mixture of benefits can be very helpful too. When these treatments fail, electroconvulsive therapy can be helpful. All of these treatments come with side effects. In most cases the side effects are an acceptable trade-off for the relief of low mood.

Before starting drug treatment, please remember to check your prescription drug coverage to find out which drugs are covered under your plan.

By James M. Ellison, MD, MPH
Source: Stahl SM. Stahl’s Essential Psychopharmacology. Cambridge University Press, 2008. pp 453-666; Ellison JM, Sivrioglu EY, Salzman C. Pharmacotherapy of late-life depression: evidence-based Recommendations. Informa Healthcare pp 239-290.
Reviewed by Mario Testani, MD, Physician Advisor, Beacon Health Options

Summary

All of these treatments come with side effects, but in most cases the side effects are an acceptable trade-off for the relief of depression.
 

Antidepressants are drugs that safely and successfully treat depression or major depressive illness. They can be used along with talk therapy, but they are often the only treatment a depressed person gets. Drugs and talk therapy have different benefits. Using them at the same time is often better than using just one.

Talk therapy can help a person see herself in new ways. It can help her better deal with stressful feelings, thoughts, events, memories, and relationships.

Drugs can help to cut back on signs of low mood such as crying, loss of fun, low energy, poor sleep, changes in eating, poor focus, and worry. Some drugs used to treat low mood can help cut back on even more serious signs like hearing voices or having thoughts of killing oneself. In rare cases, some of these drugs also have been said by some to increase these thoughts.

Role of the FDA

The U.S. Food and Drug Administration (FDA) is the government agency that monitors and approves new drugs. They make sure that drugs are safe for doctors to give to people. They also make sure that the drugs do what they are supposed to do.

The FDA has approved more than 25 drugs to treat major depressive illness. They fall into different groups.

Monoamine oxidase inhibitors (MAOIs)

MAOIs block the breakdown of major brain chemicals. Phenelzine (Nardil®) and tranylcypromine (Parnate®) are the most widely used.

These can be very helpful, mainly for people who are both nervous and sad. But they can cause unsafe reactions when given with certain foods or other drugs.  A doctor will provide additional information on this before prescribing them.

Tricyclic antidepressants (TCAs)

Of the TCAs, nortriptyline and desipramine are the most common ones used.

Like MAOIs, TCAs can help both worry and low spirits. They can also have some bad side effects. They can make people lightheaded or tired. They can add to feelings of hunger. Less commonly, they can cause harmful physical reactions such as heart rhythm problems or trouble having a bowel movement. Also, they can be deadly when taken in an overdose.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs treat low mood and some forms of worry without the same serious side effects of TCAs or MAOIs. But they can cause other problems like increased bleeding, lighter sleep, nightmares, and sexual problems.

Fluoxetine (Prozac®), the first of these, has helped many people. Its success led to competition from other new antidepressants with a similar type of action: sertraline (Zoloft®), paroxetine (Paxil®), fluvoxamine (Luvox®), citalopram (Celexa®), escitalopram (Lexapro®), and vilazodone (Viibryd®). They are known for targeting only one brain chemical.

Serotonin norepinephrine reuptake inhibitors (SNRIs)

Scientists trying to increase drug benefits invented those that change two brain compounds, norepinephrine and serotonin. These serotonin norepinephrine reuptake inhibitors (SNRIs) include venlafaxine XR and venlafaxine (Effexor XR® and Effexor®), duloxetine (Cymbalta®), and desvenlafaxine (Pristiq®). They can have side effects like or a little worse than SSRIs. But they also sometimes help people who have not been helped by SSRIs.

Buproprion (Wellbutrin®) increases the release of norepinephrine and dopamine in the brain. Many doctors think it is most useful for depression without anxiety.

Mirtazapine (Remeron®) is great for anxiety but can make people tired or hungry.

Drugs and other treatments

There is no perfect drug. Not only do they all have side effects, but also none will help everyone who takes it. However, about two out of every three people who try one drug will get much better with it.

Studies have taught doctors some good ways of treating depression that doesn’t get better with the first method. When it is possible to add one more drug or switch to some other type, it is likely that 80 percent or more of people with major depression will get much better.

When drugs are given along with talk therapy, the mixture of benefits can be very helpful too. When these treatments fail, electroconvulsive therapy can be helpful. All of these treatments come with side effects. In most cases the side effects are an acceptable trade-off for the relief of low mood.

Before starting drug treatment, please remember to check your prescription drug coverage to find out which drugs are covered under your plan.

By James M. Ellison, MD, MPH
Source: Stahl SM. Stahl’s Essential Psychopharmacology. Cambridge University Press, 2008. pp 453-666; Ellison JM, Sivrioglu EY, Salzman C. Pharmacotherapy of late-life depression: evidence-based Recommendations. Informa Healthcare pp 239-290.
Reviewed by Mario Testani, MD, Physician Advisor, Beacon Health Options

Summary

All of these treatments come with side effects, but in most cases the side effects are an acceptable trade-off for the relief of depression.
 

Antidepressants are drugs that safely and successfully treat depression or major depressive illness. They can be used along with talk therapy, but they are often the only treatment a depressed person gets. Drugs and talk therapy have different benefits. Using them at the same time is often better than using just one.

Talk therapy can help a person see herself in new ways. It can help her better deal with stressful feelings, thoughts, events, memories, and relationships.

Drugs can help to cut back on signs of low mood such as crying, loss of fun, low energy, poor sleep, changes in eating, poor focus, and worry. Some drugs used to treat low mood can help cut back on even more serious signs like hearing voices or having thoughts of killing oneself. In rare cases, some of these drugs also have been said by some to increase these thoughts.

Role of the FDA

The U.S. Food and Drug Administration (FDA) is the government agency that monitors and approves new drugs. They make sure that drugs are safe for doctors to give to people. They also make sure that the drugs do what they are supposed to do.

The FDA has approved more than 25 drugs to treat major depressive illness. They fall into different groups.

Monoamine oxidase inhibitors (MAOIs)

MAOIs block the breakdown of major brain chemicals. Phenelzine (Nardil®) and tranylcypromine (Parnate®) are the most widely used.

These can be very helpful, mainly for people who are both nervous and sad. But they can cause unsafe reactions when given with certain foods or other drugs.  A doctor will provide additional information on this before prescribing them.

Tricyclic antidepressants (TCAs)

Of the TCAs, nortriptyline and desipramine are the most common ones used.

Like MAOIs, TCAs can help both worry and low spirits. They can also have some bad side effects. They can make people lightheaded or tired. They can add to feelings of hunger. Less commonly, they can cause harmful physical reactions such as heart rhythm problems or trouble having a bowel movement. Also, they can be deadly when taken in an overdose.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs treat low mood and some forms of worry without the same serious side effects of TCAs or MAOIs. But they can cause other problems like increased bleeding, lighter sleep, nightmares, and sexual problems.

Fluoxetine (Prozac®), the first of these, has helped many people. Its success led to competition from other new antidepressants with a similar type of action: sertraline (Zoloft®), paroxetine (Paxil®), fluvoxamine (Luvox®), citalopram (Celexa®), escitalopram (Lexapro®), and vilazodone (Viibryd®). They are known for targeting only one brain chemical.

Serotonin norepinephrine reuptake inhibitors (SNRIs)

Scientists trying to increase drug benefits invented those that change two brain compounds, norepinephrine and serotonin. These serotonin norepinephrine reuptake inhibitors (SNRIs) include venlafaxine XR and venlafaxine (Effexor XR® and Effexor®), duloxetine (Cymbalta®), and desvenlafaxine (Pristiq®). They can have side effects like or a little worse than SSRIs. But they also sometimes help people who have not been helped by SSRIs.

Buproprion (Wellbutrin®) increases the release of norepinephrine and dopamine in the brain. Many doctors think it is most useful for depression without anxiety.

Mirtazapine (Remeron®) is great for anxiety but can make people tired or hungry.

Drugs and other treatments

There is no perfect drug. Not only do they all have side effects, but also none will help everyone who takes it. However, about two out of every three people who try one drug will get much better with it.

Studies have taught doctors some good ways of treating depression that doesn’t get better with the first method. When it is possible to add one more drug or switch to some other type, it is likely that 80 percent or more of people with major depression will get much better.

When drugs are given along with talk therapy, the mixture of benefits can be very helpful too. When these treatments fail, electroconvulsive therapy can be helpful. All of these treatments come with side effects. In most cases the side effects are an acceptable trade-off for the relief of low mood.

Before starting drug treatment, please remember to check your prescription drug coverage to find out which drugs are covered under your plan.

By James M. Ellison, MD, MPH
Source: Stahl SM. Stahl’s Essential Psychopharmacology. Cambridge University Press, 2008. pp 453-666; Ellison JM, Sivrioglu EY, Salzman C. Pharmacotherapy of late-life depression: evidence-based Recommendations. Informa Healthcare pp 239-290.
Reviewed by Mario Testani, MD, Physician Advisor, Beacon Health Options

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