Depression Medicines

Overview

Should you treat your depression with medications?

You might be asking your healthcare provider this question if you have been feeling low and your friends and family have mentioned this to you. Your provider might have mentioned medication if your mood interferes with work, family or socializing for more than two weeks. Some people with depression might even have legal troubles linked to outbursts.

How do antidepressants work?

Various antidepressant medications are available for prescription use. There is no single best antidepressant, and the best one for you depends on your symptoms and individual needs.

Usually, antidepressants help balance the levels of neurotransmitters, which are chemicals responsible for communications between neurons in the brain. These chemicals include serotonin, dopamine and norepinephrine. Higher levels of these chemicals usually correspond with lower levels of depression.

While antidepressants can be helpful in depression, effectiveness varies from patient to patient. How long the drugs stay in your body also varies. Some drugs stay in your body for about 36 hours, while others last as long as several days.

Procedure Details

How are antidepressant medications selected?

The type of drug prescribed will depend on your symptoms, the presence of other medical conditions, other medicines you are currently taking, the cost of the prescribed treatments, and potential side effects. If you have had depression before, your provider may prescribe the same medicine that worked for you in the past. If you have a family history of depression, medicines that have been effective in treating your family member(s) may also be considered.

Usually you will start taking the medicine at a low dose. The dose will be gradually increased until it has reached the therapeutic dose, or until you start to see an improvement (unless side effects emerge).

Risks / Benefits

What are the side effects of antidepressant medications?

The provider prescribing your medicine will discuss its potential side effects with you. He or she will try to prescribe drug(s) with the least number of side effects for your health condition. Sometimes, more than one medicine may be tried before the desired benefits are achieved.

You will be monitored closely so that your provider can detect the development of harmful side effects and make the necessary changes.

All medications – not just antidepressants – can cause side effects. Keep in mind that your provider prescribes the medication only if its expected benefits outweigh the risk of side effects.

Side effects, if they occur, are usually mild. Some side effects decrease after you have taken the drug for a while. However, if side effects don't go away, they will once the drug is stopped. Be sure to discuss your concerns with your provider before taking any medicine.

Classes of antidepressant medications and common side effects

Currently there are six different classes of medications approved to treat depression. These are:

  • Selective serotonin reuptake inhibitors (SSRIs).
  • Serotonin and noradrenaline reuptake inhibitors (SNRIs).
  • Tricyclic antidepressants (TCAs).
  • Monoamine oxidase inhibitors (MAOIs).
  • Norepinephrine and dopamine reuptake inhibitors (NDRIs).
  • Non-competitive N-methyl-D-aspartate receptor antagonists.

Selective serotonin reuptake inhibitors

SSRIs are among the most commonly prescribed medications. Some examples of SSRIs include sertraline (Zoloft®), paroxetine (Paxil®), fluoxetine (Prozac®) and citalopram (Celexa®). Side effects of selective serotonin reuptake inhibitors (SSRIs) include:

Serotonin and noradrenaline reuptake inhibitors

SNRIs treat depression as well as long-term pain and anxiety. Some examples of SNRIs include venlafaxine (Effexor®), desvenlafaxine (Pristiq®) and duloxetine (Cymbalta®). Side effects of SNRIs include:

  • Headache.
  • Dizziness.
  • Nausea.
  • Heavy sweating.
  • Dry mouth.
  • Constipation.
  • Insomnia.
  • Sexual problems including low sex drive or inability to have an orgasm.

Tricyclic antidepressants

TCAs were among the first antidepressants approved. Because other, newer antidepressants are associated with fewer side effects, TCAs tend to be prescribed less often. Some examples of these drugs includes nortriptyline (Pamelor®), amitriptyline (Elavil®), and imipramine (Tofranil®). Side effects of tricyclic antidepressants include:

Monoamine oxidase inhibitors

MAOIs were the first antidepressants approved. Their use has largely been replaced by newer antidepressants, which are safer and have fewer side effects. Some examples of MAOIs include phenelzine (Nardil®), tranylcypromine (Parnate®) and isocarboxazid (Marplan®). Side effects of monoamine oxidase inhibitors (MAOIs) include:

  • Drowsiness.
  • Dry mouth.
  • Dizziness.
  • Headache.
  • Nausea.
  • Insomnia.
  • Diarrhea or constipation.
  • Weight gain.
  • Low blood pressure.
  • Tremors.
  • Increased sweating.
  • Sexual problems including low sex drive or inability to have an orgasm.
  • Bladder problems (difficulty starting urine flow).

Norepinephrine and dopamine reuptake inhibitors

NDRIs treat depression as well as seasonal affective disorder. It is often prescribed by doctors for many “off label” psychiatric uses including anxiety, bipolar disorder and attention deficit/hyperactivity disorder (ADHD). Bupropion (Wellbutrin®) is the only member of this drug class. Some of its known side effects include:

  • Headache.
  • Insomnia.
  • Dry mouth.
  • Constipation.
  • Nausea.
  • Tiredness.
  • Tremor.
  • Increased sweating.

Non-competitive N-methyl-D-aspartate receptor antagonists

Esketamine (Ketanest®, Spravato®) is a non-competitive N-methyl-D-aspartate receptor antagonist approved in 2019. This antidepressant is only available as a nasal spray and is to be used together with an oral antidepressant for adults whose depression hasn't been able to be effectively treated with other drugs. Esketamine has the potential for abuse and misuse and is associated with an increased risk of suicidal thoughts and behaviors. It can only be administered in a certified medical office under the direct supervision of a healthcare provider. Esketamine isn't available at pharmacies for at-home use. Some of its known side effects include:

  • Dizziness.
  • Nausea.
  • Sedation.
  • Anxiety.
  • Increased blood pressure.
  • Dissociation (distortion of time, space, illusions).
  • Vomiting.
  • Feeling drunk.
  • Lack of energy.

It's important to remember that most patients taking antidepressants don't develop side effects. However, all patients should be carefully monitored. Don't drink alcoholic beverages while taking antidepressant medicines. Alcohol may interfere with their beneficial effects.

Can antidepressants give you suicidal thoughts?

In 2004, the FDA issued a black box label warning for suicidal ideation among 18- to 24-year-olds for common antidepressant drugs. This warning is the FDA’s strictest warning for labeling prescription drugs.

The effect of suicidal thoughts is most common with SSRIs, occurring in about 4% of people who take them. However, untreated depression is considered to be much more of a suicide risk than taking antidepressants.

Will you become addicted if you take antidepressants?

Antidepressant medicines aren't addictive. They don't make you "high," have a tranquilizing effect or produce a craving for more. They aren't "happy pills."

Recovery and Outlook

How long will you have to take antidepressants?

Usually, these drugs must be taken regularly for at least 4 to 8 weeks before their full benefit takes effect. You are monitored closely during this time to detect the development of side effects and to determine the effectiveness of treatment.

In order to prevent a relapse of depression, medicines are generally prescribed for 6 to 12 months after a first-time depression. When you and your provider determine that you are better, you should expect to continue the medication for at least 4 to 6 additional months. After this, your provider may gradually taper you off your medicine.

If you feel better, can you stop taking antidepressants?

Once you and your provider have determined it is safe for you to stop taking your medicine altogether, you should continue to be monitored during periodic follow-up appointments (about every three months) to detect any signs of depression returning.

Long-term treatment with antidepressant medicine may be recommended to prevent further episodes of depression in people who have already had two or more episodes of major depression. A history of depression in one’s family is another factor that supports long-term treatment.

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy