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Diseases & Conditions

Medications in the Treatment of Depression

What are the types of treatment for depression?

A physician can treat depression by prescribing any number of lifestyle changes and medical therapies, including:

Lifestyle changes
  • Stopping the intake of alcohol and/or sedatives
  • Exercising regularly (stopping regular exercise can lead to depression)
  • Eating a healthy diet, particularly getting enough omega 3 fatty acids
Medication and other medical therapies
  • Switching current medications (such as antihypertensives, contraceptives, and steroids) to reduce side effects that may be causing depression
  • Diagnosing and treating other conditions known to cause depression (such as various endocrine disorders like hypothyroidism)
  • Counseling (psychotherapy: cognitive-behavior therapy, , dialectic behavior therapy, interpersonal therapy, and others)
  • Light therapy (exposure to white fluorescent light to reduce symptoms of seasonal affective disorder)
  • Antidepressant medication
  • Electroconvulsive therapy (controlled electrical discharge to induce seizure-like activity in the brain)
  • Combinations of therapy, augmenting with quetiapine (Seroquel®), aripiprazole (Abilify®), buspirone (Buspar®), lurasidone (Latuda®), thyroid medication, lithium, L methylfolate (Deplin®), creatine, NSAIDS, and other anti-inflammatory medications
  • Hypericum (St. John's Wort) for a single episode of mild depression, S- adenyl methionine SAM-e) “alternative medication”
Ongoing research
  • Norepinephrine reuptake inhibitor
    • Reboxetine
  • Substances "P" antagonists
  • Vagal nerve stimulation
  • Deep brain stimulation
  • Transcranial magnetic stimulation (TMS or rTMS)
  • Intravenous ketamine
  • Scopolamine augmentation
  • Agomelatine, melatonin analog (not available in the US)
  • Ramelteon augmentation (Rozerem®)
  • S-mecamylamine, binding to the nicotinic receptor
  • Vortioxetine
  • Levominacipran
  • D-cycloserine
  • Moclobemide, a reversible monoamine oxidase inhibitor
  • Atomoxetine (Strattera®), whose indication is currently attention deficit disorder
  • New biomarkers that may predict treatment responses to different agents

What conditions can be treated with antidepressant medications?

Antidepressants can be used for the treatment of:

  • Major depression (symptoms of depression that persist for more than two weeks)
  • Panic disorder
  • Chronic pain
  • Bed wetting (enuresis)
  • Chronic depression (dysthymia)
  • Migraine prevention
  • Chronic fatigue syndrome
  • Eating disorders
  • Anxiety, generalized
  • Obsessive compulsive disorder (SSRIs and clomipramine)

How effective are antidepressants in the treatment of depression?

All antidepressant medications are effective in treating depression. Antidepressants have been shown to be 60 to 70 percent effective for treating depression, although it may take trials of more than one medication and then combinations if there is only a partial response. The effectiveness of individual types of antidepressants can vary from patient to patient. A recent study questioned evidence of their efficacy but they clearly do help many patients.

How are antidepressant medications prescribed?

Antidepressants are chosen based on:

  • Any medical illnesses that are present
  • Safety of a particular medication in a specific individual
  • Tolerability of the actions of a unique drug
  • Side effects from previous treatments with antidepressants or concern over side effects that may occur with a new choice
  • Effectiveness of medication in other family members
  • Medications being taken for other conditions
  • Effectiveness of a medication in controlling a past episode of depression
  • The presence of another psychiatric disorder (such as panic disorder)
  • Cost

What are the types of antidepressants?

Selective serotonin reuptake inhibitors (SSRIs) include:

  • Fluoxetine (Prozac®)
  • Sertraline (Zoloft®)
  • Paroxetine (Paxil® or Pexeva®)
  • Fluvoxamine (Luvox®)
  • Citalopram (Celexa®)
  • Escitalopram (Lexapro®)

SSRIs have advantages over other antidepressants including fewer side effects and effectiveness at lower dosages. They are also used in obsessive compulsive disorder, along with clomipramine in the tricyclic group. Small doses are recommended to start for panic disorder. Generics are now available, reducing the expense. Side effects can include sexual dysfunction, nausea and diarrhea, and headache.

Tricyclics include:

  • Amitriptyline (Elavil®)
  • Amoxapine (Asendin®)
  • Clomipramine (Anafranil®) (for obsessive-compulsive disorder)
  • Desipramine (Norpramin®)
  • Doxepin (Sinequan®)
  • Imipramine (Tofranil®)
  • Nortriptyline (Pamelor®)
  • Protriptyline (Vivactil®)
  • Trimipramine (Surmontil®)

Tricyclics (TCA) can be helpful for reducing pain, providing weight gain, and improving sleep. They can cause dizziness, constipation, and urinary retention.

Other common antidepressants include:

  • Mirtazepine (Remeron®)
  • Trazodone (Desyrel®) ; extended release trazodone (Oleptro®)
  • Nefazodone (Serzone®)
  • Vilazodone (Viibryd®)
  • Bupropion (Wellbutrin®) two extended release forms
  • Venlafaxine (Effexor®); extended release desvenlafaxine (Pristiq®)
  • Duloxetine (Cymbalta®)
  • Monoamine oxidase inhibitors (MAOIs)
    • Tranylcypromine (Parnate®)
    • Phenelzine (Nardil®)
    • Isocarboxazid (Marplan®)
    • Selegiline (Emsam®) daily patch form

When MAOIs are prescribed for chronic depression, the patient must restrict tyramine-containing foods from his or her diet and avoid certain medications.

How soon does an antidepressant begin working and how long should it be continued?

Some symptoms may begin to improve after a few days. More significant improvement should occur after 2 to 3 weeks of treatment. In elderly patients, symptoms may take up to 12 weeks to improve.

The length of time needed to determine efficacy of the medication depends on a number of factors, including age, the severity of depression, and whether you have suffered from depression in the past.

Generally, if this depression is the first episode, the medication should be continued for 1 year. After two episodes of depression, the recommendation is the continuation of the medication for 2 to 5 years. Persons who have had three or more episodes of depression generally need to take medication for life to prevent depression from recurring (maintenance medication).

How can I know when to stop my medication?

Fifty to 85 percent of patients who have had one episode of major depression will go on to have a second episode, usually within 2 to 3 years. Lifelong maintenance through the use of medication may prevent depression from recurring.

Maintenance medication is recommended when the person has had:

  • Three or more episodes of major depression
  • Two episodes of major depression plus a family history for depression (unipolar or bipolar manic depression)
  • History of recurrence within 1 year after effective medication has been stopped
  • Early onset of depression (first episode before age 20)
  • Two episodes, both severe (requiring hospitalization and/or suicidal thoughts) and sudden

If the individual plans to stop medication, it should be tapered off slowly over months rather than stopped abruptly. However, abrupt discontinuation may be required in cases of medical emergency.

Where can I learn more?

National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
Phone: 703.524.7600
Email: www.nami.org

National Mental Health Association
2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Phone: 703.684.7722
Email: www.nmha.org

References

© Copyright 1995-2013 The Cleveland Clinic Foundation. All rights reserved.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/18/2013...#6377