In order to manage your depression your primary care physician can prescribe medications, alternative therapies, lifestyle changes and refer you to a psychiatrist. In this article we will overview the antidepressant medications.

Medications

There is a variety of antidepressant medications. In collaboration with your physician, you can find the correct medication and dosage for you.

There are different categories of antidepressants depending on:

  • Your particular symptoms
  • How the medication acts
  • What its side effects are
  • How it interacts with other medications
  • If it worked for a close relative
  • If you are pregnant or breastfeeeding
  • Other health conditions you may have
  • Cost and insurance coverage.

If you are taking an antidepressant and have difficulty sleeping, a medication that has a side effect of drowsiness may be preferred. Some anti-depressants have negative side effects such as weight gain or loss of sexual libido. Some medications may help to stop smoking or reduce pain.

Some antidepressants can cost a lot of money so inquire about a generic version and whether it works as well as the proprietary drug. Check with your insurance company about coverage and what insurance limitations may exist on your choice of antidepressants.

Categories and effects

Categories of antidepressants include:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants
  • Monoamine oxidase inhibitors (MAOIs)
  • Atypical antidepressants
  • Other antidepressants

Neurotransmitters, which are chemicals in the brain associated with depression including serotonin, norepinephrine, and dopamine, all serve as chemical messengers which communicate between brain cells. Each category of antidepressant affects each of these neurotransmitters in slightly varied ways.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors are the first choice of medication for depressants because they have fewer side effects than other antidepressants and are less apt to cause issues at higher doses.

They work by increasing serotonin and have a good effect on sleep, emotion, and mood. A rise in serotonin levels can make people more responsive to other therapies such as cognitive behavioral therapy. It is taken in tablet form and takes two to four weeks for you to feel the benefit. Some side effects include feeling agitated, shaky, or anxious, dry mouth dizziness, and blurred vision. Names of some common SSRIs are Prozac, Paxil, and Lexapro.

Serotonin and norepinephrine reuptake inhibitors

Serotonin and norepinephrine reuptake inhibitors increase the amount of the neurotransmitter norepinephrine in the brain by preventing its reuptake in the synapses, or spaces, between nerve cells.

Norepinephrine plays a role in several functions including attention, memory, energy levels, stress reactions, and the regulation of emotions. These drugs tend to produce more side effects such as SSRIs including additional side effects such as sleep disturbances, sweating, and nausea/vomiting. Samples of SNRIs include Effexor XR, Cymbalta, and Pristiq.

Norepinephrine and dopamine reuptake inhibitors

Norepinephrine and dopamine reuptake inhibitors (NDRIs) are another class of reuptake inhibitors and are newer than the first generation of antidepressants but they're represented by only one drug Wellbutrin.

It affects the reuptake of norepinephrine and dopamine. These are usually used to treat attention deficit hyperactivity disorder but can assist in weight loss, and seem to have a role in stopping smoking. Side effects are mild and include insomnia, somnolence, decreased appetite, dizziness, and headaches.

Tricyclics

Tricyclic antidepressants generally are not prescribed until other antidepressants have been tried. They block the reabsorption of serotonin and norepinephrine, increasing the levels of these two neurotransmitters in the brain. Older antidepressants tricyclic antidepressants – such as Pamelor and Tofranil – tend to cause more side effects.

Some side effects include drop in blood pressure when changing position, tremor, and urinary retention. So, tricyclic antidepressants typically are not prescribed unless the use of other antidepressants has not proved beneficial.

Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs). MAOIs are enzymes involved in removing neurotransmitters such serotonin, norepinephrine, and dopamine from the brain.

MAOIs prevent this from occurring, which makes more of these brain chemicals accessible to cause changes in both brain cells and circuits that have been impacted by depression.

These medications are generally not recommended because of their serious side effects. A rigid diet must be followed due to deadly interaction with foods such as pickles, wines, and some kinds of cheeses. There is also interaction with other medication including decongestants and pain medicines. An MAOI is used in patch format.

Others

There are atypical antidepressants that don’t fit into any other category. Some of these include Remeron and Trintellix. Bupropion, also in this category is one of the few that does not typically have sexual side effects.

Your physician may also prescribe a combination of antidepressants. Sometimes one antidepressant may enhance the function of another.

Safety issues

Most antidepressants are typically safe, but the US Federal Drug Administration requires that all carry a warning that those under the age of 25 may have suicidal thoughts when starting or changing the dosage, especially in the first several weeks.

Consistency when taking an antidepressant is critical

  • You need to be patient when taking an antidepressant as it could take sic or more weeks to be effective.
  • Understand that the side effects improve with time.
  • Worsening depression may occur when taking an antidepressant. Suicide risk decreases in the long run and mood does improve.
  • Discuss the with your physician if the side effects are annoying, so you can explore other options. Don't stop your antidepressant without discussing it with your physician.
  • Avoid alcohol and drugs as it may ultimately make your symptoms worse.

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