What do medicines for depression do? — Medicines for depression, also called "antidepressants," can:
●Help you feel better and more able to do everyday tasks
●Reduce the symptoms of depression
Each of the antidepressants works in a different way. But in general, they all change the chemistry of the brain (figure 1).
Which medicine might I need? — Your doctor will decide which medicine is best for you. He or she might ask if any of your family members have had good results with a particular antidepressant. If so, that might be a good place for you to start. The section at the end lists the most common antidepressant choices. Most people take just 1 antidepressant, but some people take 2 or 3 of the medicines together.
The first medicine you try might not help enough. If that happens, tell your doctor or nurse, and don't give up. People sometimes need to try a few different medicines or combinations of medicines before they find the treatment that works for them.
The section at the end includes some basic information on the main medicines used in depression. For more detailed information about your medicines, ask your doctor or nurse for the patient hand-out from Lexicomp available through UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.
How long before I feel better? — Most antidepressants start to help within 2 weeks of when you start taking them. But it usually takes 4 to 6 weeks before you get the full effect. If you don't feel any better after 2 to 4 weeks, ask your doctor or nurse what you can do. He or she might increase your dose, prescribe a second medicine, or offer another solution.
What if I have side effects? — If you have minor side effects when you start taking an antidepressant, try staying on the medicine for a few weeks. Minor side effects often go away after your body gets used to the new medicine. If side effects do not go away or worry you, mention your problems to your doctor or nurse. He or she might have suggestions for how to reduce or deal with your side effects.
Each of the medicines is different, but in general, side effects from antidepressants can include:
●Feeling jittery or restless
●Having trouble sleeping
●Nausea, diarrhea, or constipation
●Problems with sex
Cutting back on alcohol and getting regular exercise can lower the chance of side effects. These things can also help you feel better.
How long do I keep taking the medicines? — Most people stay on antidepressants for at least 6 to 9 months. If you have severe depression, it might make sense to stay on your antidepressant for a year or more. People with severe depression who recover and then go off their medicines often get depressed again.
If and when you do go off your medicine, do it with the help of your doctor or nurse. You will need to slowly decrease your dose over a few weeks. Stopping most antidepressants all of a sudden can make you feel ill.
Medicines to treat depression:
●SSRIs (selective serotonin reuptake inhibitors) – SSRIs are usually the first medicines doctors prescribe when they are treating someone with depression. SSRIs often work well, are safe, and have fewer side effects than many of the other medicines. Some examples of SSRIs include citalopram (brand name: Celexa), fluoxetine (brand name: Prozac), and sertraline (brand name: Zoloft).
●SNRIs (serotonin-norepinephrine reuptake inhibitors) – SNRIs work in a similar way to SSRIs, but they also have other effects. Doctors sometimes suggest these medicines when SSRIs do not help enough. Some examples of SNRIs include duloxetine (brand name: Cymbalta) and venlafaxine (brand name: Effexor). SNRIs can increase your blood pressure. Talk to your doctor if you have high blood pressure.
●Atypical antidepressants – Atypical antidepressants include bupropion (brand name: Wellbutrin) and mirtazapine (brand name: Remeron). These medicines do not tend to cause sex-related side effects, so doctors sometimes give them to people who have those side effects with other antidepressants. Bupropion does not cause weight gain, and it can be especially helpful to people who lack energy, but it can cause jitteriness. Mirtazapine increases appetite and can cause weight gain, so doctors sometimes give it to people with low appetite.
●Serotonin modulators – Serotonin modulators include nefazodone, trazodone, and vilazodone (brand name: Viibryd). Nefazodone and trazodone can both improve sleep, so doctors sometimes prescribe one of these medicines to people who have trouble sleeping. Nefazodone also is less likely than other antidepressants to cause sexual problems, but it can harm the liver, so doctors are very careful about prescribing it. Vilazodone is more likely than other antidepressants to cause nausea, vomiting, and diarrhea.
●TCAs (tricyclic and tetracyclic antidepressants) – TCAs are not used as much as SSRIs and SNRIs, because TCAs can cause more side effects, such as constipation and drowsiness. In addition, TCAs can disrupt the heart's rhythm and cause other serious problems. In elderly people, these medicines can also cause falls, confusion, and memory problems. Even so, TCAs can help some people with depression, especially if they do not get better with SSRIs or SNRIs. Some examples of TCAs include nortriptyline (brand name: Pamelor) and desipramine (brand name: Norpramin).
●MAOIs (monoamine oxidase inhibitors) – MAOIs are not used very often because they can cause a lot of side effects, and because people who take them must avoid certain foods and medicines. Still, MAOIs can help people who have depression along with other problems or who do not get better with other medicines. Some examples of MAOIs include selegiline (sample brand name: Emsam patch), tranylcypromine (brand name: Parnate), and phenelzine (brand name: Nardil). If you need to follow a special diet, your doctor or nurse can give you list of foods that are safe to eat (table 3).
Patient education: Depression (The Basics)
Patient education: Generalized anxiety disorder (The Basics)
Patient education: Serotonin syndrome (The Basics)
Patient education: Bipolar disorder (The Basics)
Patient education: Brand versus generic medicines (The Basics)
Patient education: What are clinical trials? (The Basics)
Patient education: When you have depression and another health problem (The Basics)
Patient education: Postpartum depression (The Basics)
Patient education: Seasonal affective disorder (The Basics)
Patient education: Electroconvulsive therapy (ECT) (The Basics)
Patient education: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (The Basics)
Patient education: Side effects from medicines (The Basics)
Patient education: Depression in adults (Beyond the Basics)
Patient education: Depression treatment options for adults (Beyond the Basics)
Patient education: Depression in children and adolescents (Beyond the Basics)
Patient education: Depression treatment options for children and adolescents (Beyond the Basics)
Patient education: Reducing the costs of medicines (Beyond the Basics)