Medications

Medications used to treat depression are known as antidepressants. They work by normalizing naturally occurring brain chemicals called neurotransmitters, which appear to be involved in regulating mood. Three neurotransmitters targeted by antidepressants include serotonin, norepinephrine, and dopamine. Classes of antidepressants include selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) and the older tricyclics and monoamine oxidase inhibitors (MAOIs).

The two newer, more-popular classes of antidepressants are SSRIs— including Prozac® (fluoxetine), Celexa® (citalopram), Zoloft® (sertaline), and several others—and SNRIs— including Effexor® (venlafaxine) and Cymbalta® (duloxetine). They tend to have fewer side effects that tricyclics and MAOIs, though some people have better outcomes with the older classes.

Taking Antidepressants

Before they start to work, antidepressants need to be taken at regular doses for at least three to four weeks. A patient should continue to take antidepressant medication for the prescribed time—even when feeling better—to prevent a relapse. Medication should only be stopped (if appropriate to stop—some individuals with chronic or recurrent depression stay on medication indefinitely) under a doctor’s supervision; even though antidepressants are non-habit-forming, the body will still need to adjust.

Side Effects of Antidepressants

Side effects vary by the type of antidepressant and are generally mild and often temporary. Sometimes, however, more-severe side effects that interfere with normal functioning occur. These should be discussed with a doctor.

Side Effects of SSRIs and SNRIs:

  • Headache—usually temporary and will subside
  • Nausea—temporary and usually short-lived
  • Insomnia and nervousness (trouble falling asleep or waking often during the night)—may occur during the first few weeks but often subside over time or if the dose is reduced
  • Agitation (feeling jittery)
  • Sexual problems—both men and women can experience sexual problems including reduced sex drive, erectile dysfunction, delayed ejaculation, or inability to have an orgasm.

Side Effects of Tricyclic Antidepressants:

  • Dry mouth
  • Constipation
  • Bladder problems
  • Sexual problems—Sexual functioning may change, and side effects are similar to those of SSRIs.
  • Blurred vision (often passes soon and usually will not require a new corrective lens prescription)
  • Drowsiness during the day— Driving or operating heavy machinery should be avoided when drowsiness occurs. Antidepressants that cause drowsiness are generally taken at bedtime to help sleep and minimize daytime drowsiness.

Side Effects of MAOIs:

  • Significant food restrictions—Foods containing certain levels of the chemical tyramine must be avoided (wine, cheese, and pickles, for example); a doctor can provide a complete list.
  • Medical restrictions—Serious interactions with other medications can occur.

FDA Warning on Antidepressants

Antidepressants are relatively safe, but studies do suggest that some people may experience unintentional effects. Adolescents and young adults (up to age 24) in particular may experience an increase in suicidal thoughts or suicide attempts while taking antidepressants. To address this issue, the FDA had adopted a “black box” warning label on antidepressants that alerts the public of this risk.

With the risk of suicidal thinking—and other side effects associated with antidepressant medication—it’s very important that these medicines are only taken under a doctor’s supervision and that warning signs (worsening depression, suicidal thinking or behavior, sleeplessness, agitation, or withdrawal from normal social situations) are watched for and immediately addressed with a doctor or by dialing 911 or the National Suicide Prevention Lifeline at 1-800-TALK (8255).

Taking Antidepressants During Pregnancy and Breastfeeding

Research into the effect of antidepressants on the fetus and baby are inconclusive, though some studies suggest potential risks. It’s therefore very important that pregnant women and women thinking about becoming pregnant discuss antidepressant use with their doctors. Breastfeeding is associated with few problems, but risks and benefits of antidepressants while breastfeeding should still be discussed.

St. John’s Wort

The herbal remedy St. John’s Wort is sometimes used to treat mild or moderate depression. Research into its effectiveness is inconclusive, but the significant concern about St. John’s Wort is that it may interact badly with other medications. These include medicines used to treat heart disease, depression, seizures, certain cancers, and organ transplant, as well as oral contraceptives. It’s always important to consult with a doctor before taking St. John’s Wort or any herbal supplement.

Living with Depression

In addition to medical treatment and psychotherapy, you can take personal measures to manage your depression and improve your well-being. Taking action will certainly require effort—especially in the early stages of treatment—but you’ll be well rewarded as you feel better and begin to again enjoy things that were once pleasurable.

Try, for example, mild activity or exercise—something you once enjoyed. Get involved in your community and with your friends. Set realistic goals and tackle large tasks in small steps. Remember that it may take time for your mood to improve; enjoy the gradual progress. Don’t make major decisions until you are feeling better. Focus on the positive!

You may want to find support beyond your healthcare providers, therapist, and family to help you manage your depression and its impact on your life. Here is a list of possibilities:

  • Social workers
  • Health maintenance organizations
  • Community mental health centers
  • Hospital psychiatry departments and outpatient clinics
  • Mental health programs at universities or medical schools
  • State hospital outpatient clinics
  • Family services, social agencies, or clergy
  • Peer support groups
  • Private clinics and facilities
  • Employee assistance programs
  • Local medical and/or psychiatric societies
  • Also, check your local phone book for listings under “mental health,” “health,” “social services,” and “hotlines.”

If you are thinking about harming yourself, get help immediately. Call 911 or go to the emergency room. Call your doctor or therapist. You can also speak to a trained counselor at the the National Suicide Prevention Lifeline at 1-800-TALK (8255).

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