Ease your depression symptoms.
Anxiety and depression often go hand in hand, but there are differences. “In terms of brain biology, think of anxiety as an elaboration of fear or threat and depression as an elaboration of defeat — psychic exhaustion — or loss-grief or heartbreak,” says Dr. Michael Thase, professor of psychiatry and chief of the Division of Mood and Anxiety Disorders Treatment and Research Program at the University of Pennsylvania.
Despite these differences, many people are diagnosed with both; and depression and anxiety are, in fact, often treated with the same medications.
Antidepressants don’t cure depression, but they can reduce symptoms. Finding the right antidepressant may take some trial and error. The first try may work, but if it doesn’t, or if you find the side effects too bothersome, your physician can prescribe a different drug. There are many options available, and most patients find one (or a combination) that works well for them.
Common types of depression medications
The most common classes of drugs prescribed for depression are:
— Selective serotonin reuptake inhibitors, or SSRIs.
— Serotonin and norepinephrine reuptake inhibitors, or SNRIs.
— Tricyclic antidepressants.
— Monoamine oxidase inhibitors, or MAOIs.
In 2019, the FDA approved another drug, ketamine, for use in patients with treatment-resistant depression, also known as major depressive disorder, if other meds have been tried and failed to relieve symptoms, especially thoughts of suicide.
Selective serotonin reuptake inhibitors
SSRIs are often the first choice of physicians treating depression because they have a proven track record and fewer side effects than other choices.
SSRIs block the reuptake (reabsorption) of the neurotransmitter serotonin, a brain chemical that improves mood, making more serotonin available to the brain. “It’s a big mistake to think of all SSRIs as equivalent. They all get lumped together, but there is a lot of diversity in the class,” meaning a wide range of effectiveness in varying cases, says Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University.
Commonly prescribed SSRIs specifically for depression include:
— Citalopram (Celexa).
— Escitalopram (Lexapro).
— Fluoxetine (Prozac).
— Paroxetine (Paxil).
— Sertraline (Zoloft).
Side effects may include insomnia or sleepiness, sexual dysfunction and weight gain.
Serotonin-norepinephrine reuptake inhibitors
This class of medication increases the reuptake of two neurotransmitters, serotonin and norepinephrine, to help boost mood. These are also considered a first-line treatment option for their effectiveness and relatively mild side effects.
SNRI drugs include:
— Duloxetine (Cymbalta).
— Venlafaxine (Effexor XR).
— Desvenlafaxine (Pristiq).
— Levomilnacipran (Fetzima).
These may cause side effects like upset stomach, insomnia, headache, sexual dysfunction, weight gain and increased blood pressure.
These medications also affect neurotransmitters like dopamine, serotonin or norepinephrine to elevate mood, but they don’t fit into the chemical categories of the SSRI/SNRI types.
The FDA has approved these other medications for use as antidepressants:
— Bupropion (Wellbutrin SR, Wellbutrin XL).
— Mirtazapine (Remeron).
— Vilazodone (Viibryd).
— Vortioxetine (Trintellix).
According to the Mayo Clinic, bupropion is one of the few antidepressants that does not cause sexual side effects.
Tricyclic antidepressants were introduced in the 1950s. Like SSRI and SNRI medications, they modulate neurotransmitters. These include:
— Amitriptyline (Elavil).
— Imipramine (Tofranil).
— Nortriptyline (Pamelor).
— Desipramine (Norpramin).
They can be effective in depression treatment, but often cause significant side effects, including orthostatic hypotension (drop in blood pressure on standing), constipation, urinary retention, dry mouth and blurry vision. For that reason they have generally been replaced by the newer SSRI and SNRI meds and are typically prescribed only when other options have failed.
Monoamine oxidase inhibitors
As with tricyclics, MAOI medications are typically tried only when other medications haven’t worked, because they can have serious side effects.
— Tranylcypromine (Parnate).
— Phenelzine (Nardil).
— Isocarboxazid (Marplan).
The Mayo Clinic says that an MAOI can cause a severe, sometimes fatal reaction when it interacts with certain foods, including some cheeses, pickles and wines, and some other medications, like pain relievers, decongestants and herbal supplements.
In 2019, the FDA approved a ketamine nasal spray, called esketamine (Spravato) for use when other meds have failed, especially for suicidality in major depressive disorder, or MDD. Ketamine is also available through an IV infusion at an outpatient infusion center, but the nasal spray can be offered in a doctor’s office. It provides near-immediate relief for many patients contemplating self-harm, and when used with psychotherapy has shown to be very effective in treating MDD.
“Ketamine represents a major step forward in the treatment of depression and suicide prevention. This is also the first antidepressant with a novel mechanism of action that we have had in decades,” the Anxiety and Depression Association of America said in a statement.
However, the long-term efficacy of ketamine is not known, and there is the potential for abuse; ketamine is also used as a “club drug” and may be addictive.
“Patients considering the use of Spravato should ask their doctor what the long-term follow-up strategy should be and whether there are any potential negative consequences over time with continued use,” the ADAA says.
Depression in children
Antidepressant drugs can be effective treatments for depression and anxiety in children and teenagers. However, they must be closely managed by a physician because there can be severe side effects, including the risk for increased suicidal thinking and actions in patients under 25.
The FDA has approved certain antidepressants for use in children and teenagers for different types of diagnoses and various age groups. Work with a pediatric psychiatrist to find the right treatment for your child.
Work with your doctor.
Antidepressant medications are usually safe and effective, but they need to be managed carefully by a physician. It is imperative that you follow your doctor’s instructions exactly. “When effective and well-tolerated, antidepressants can be taken indefinitely,” Thase says. “Indefinitely is not exactly synonymous with lifelong, because who knows what will be known in 10, 20 or 30 years?”
These meds also may require time to take effect and may not resolve all your symptoms. And it’s common for patients to try more than one drug to find the one that works. For many if not most patients, combining an antidepressant with psychotherapy is more effective than taking an antidepressant alone, and it helps address the causes of depression in order to prevent a relapse.
Always report any side effects to your doctor. Ask questions about the medication so you understand its use.
Finally, you should never stop taking a medication without first talking to your prescribing physician. If you stop cold-turkey, that may cause withdrawal symptoms or other health risks, including suicidal thoughts. Antidepressants should be tapered off slowly and only under a doctor’s supervision, Ramsey says.
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