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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

There are several types of antidepressant drugs that can be used to treat depressive disorders. You may have success with the first medication prescribed, or you may need to try other antidepressants before finding the right one for you. Sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for 3-4 weeks (in some cases, as many as eight weeks) before the full therapeutic effect occurs.

Do not stop taking your medication without talking to your doctor. Even if you feel better and think you no longer need the medication, or you may think the medication is not helping, do not stop taking them before you speak with your doctor. You need to continue taking the medication until it has a chance to work. Call your doctor if you experience side effects from the medication.

Once you are feeling better, keep taking your medication for as long as your doctor recommends (usually six months to a year) to prevent a recurrence of depression. Some medications must be slowly tapered to give your body time to adjust. If stopped abruptly, certain medications may cause withdrawal symptoms. If you have chronic or recurrent depression, you may need to take medication indefinitely.

Prescription Medications

Selective serotonin reuptake inhibitors (SSRIs)

  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
  • Escitalopram

Tricyclic antidepressants

  • Doxepin
  • Clomipramine
  • Nortriptyline
  • Amitriptyline
  • Imipramine
  • Maprotiline
  • Desipramine
  • Trimipramine
  • Protriptyline

Monoamine oxidase inhibitors (MAOIs)

  • Isocarboxid
  • Phenelzine
  • Tranylcypromine
  • Selegiline patch

Serotonin/norepinephrine reuptake inhibitors (SNRIs)

  • Venlafaxine
  • Duloxetine
  • Desvenlafaxine

Other antidepressants

  • Trazodone
  • Nefazodone
  • Bupropion
  • Mirtazapine
Selective Serotonin Reuptake Inhibitors (SSRIs)

Common names include:

  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
  • Escitalopram

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration in the brain of the neurotransmitter serotonin, which plays a role in depression. The SSRIs are often a preferred class of antidepressants because they are thought to be easier to use, tend to produce fewer side effects, are as effective, and are less likely to be fatal in an overdose compared to other classes of antidepressants.

Improvement is usually seen in 4-6 weeks after beginning treatment. You should not drink alcohol while taking this medication. Do not take an SSRI if you have taken a monoamine oxidase inhibitor (MAOI) in recent weeks.

Possible side effects include:

  • Risk of severe mood and behavior changes, including self-harm and attempted or completed suicide in:
    • Children and young adults (generally under age 25)
    • The risk is greatest in the first few weeks of treatment
  • Nausea
  • Stomach irritation
  • Diarrhea
  • Insomnia
  • Loss of appetite or weight loss
  • Increase in appetite or weight gain
  • Nervousness
  • Lightheadedness
  • Sexual dysfunction (ranging from decreased arousal to erectile dysfunction and/or delayed time to or lack of orgasm)
  • Serotonin syndrome (a serious medical condition caused by an overload of serotonin)
Tricyclic Antidepressants

Common names include:

  • Doxepin
  • Clomipramine
  • Nortriptyline
  • Amitriptyline
  • Imipramine
  • Maprotiline
  • Desipramine
  • Trimipramine
  • Protriptyline

Tricyclic antidepressants are thought to regulate primarily serotonin and norepinephrine as well as other chemicals in the brain. They have been used effectively for the treatment of depression. Improvement is usually seen in 3-6 weeks after beginning treatment. These drugs are highly toxic if taken in large doses; therefore, they are often not prescribed for suicidal patients. Tricyclic antidepressants are not addictive.

Possible side effects include:

  • Lightheadedness
  • Dry mouth
  • Constipation
  • Difficulty urinating
  • Low blood pressure
  • Irregular or rapid heartbeat
  • Sedation
  • Nausea
  • Diarrhea
  • Increase in appetite or weight
  • Nervousness
  • Blurry vision
  • Sexual dysfunction (ranging from decreased arousal to erectile dysfunction and/or delayed time to orgasm)
  • Serotonin syndrome (a serious medical condition caused by an overload of serotonin)
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients
    • Young adults may be at a higher risk for this side effect
    • The risk is greatest in the first few weeks of treatment
Monoamine Oxidase Inhibitors (MAOIs)

Common names include:

  • Isocarboxid
  • Phenelzine
  • Tranylcypromine
  • Selegiline patch

Monoamine oxidase inhibitors (MAOIs) are a class of antidepressants that prevent the breakdown of serotonin and norepinephrine. They have been shown to be effective in treating depression. This medication is especially effective for people whose symptoms have not responded to other treatments. Improvement is usually seen in 2-6 weeks after beginning treatment.

One of the side effects of MAOIs is that the drugs stop the body from breaking down a substance called tyramine. Tyramine is found in some common foods, like cheese and alcohol. People who are taking MAOIs have to follow a special diet that is low in tyramine. This is to avoid the substance from building up and causing hypertensive crisis (severe high blood pressure), which can be fatal.

Examples of foods that need to be avoided include:

  • Alcoholic drinks
  • Many types of cheese, such as aged cheddar, Gouda, or Parmesan
  • Overripe or spoiled fruits
  • Chicken and beef liver
  • Dried meats
  • Certain kinds of beans, such as broad bean or fava bean
  • Food containing monosodium glutamate (MSG)

If you are prescribed MAOIs, your doctor will recommend a diet that is right for you.

In addition to the effect on tyramine, MAOIs have other side effects, as well, including:

  • Lightheadedness, sleepiness, blurred vision, changes in the ability to think clearly
  • Headache
  • Constipation
  • High blood pressure (in rare cases)
  • Insomnia
  • Skin irritation (selegiline patch)
  • Sexual dysfunction
  • Serotonin syndrome (a serious condition caused by an overload of serotonin)
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients
    • Young adults may be at a higher risk for this side effect
    • The risk is greatest in the first few weeks of treatment

MAOIs can cause severe adverse reactions when combined with many other types of drugs, including other antidepressants. Ask your doctor for a list of drugs to avoid.

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)

Common names include:

  • Venlafaxine
  • Duloxetine
  • Desvenlafaxine

SNRIs affect the level of two neurotransmitters in the brain, serotonin, and norepinephrine. A majority of studies suggest that these drugs are as effective as SSRIs. Improvement in symptoms is usually seen about 3-6 weeks after starting treatment.

Possible side effects include:

  • Dry mouth
  • Constipation
  • Nausea
  • Fatigue
  • Drowsiness
  • Excessive sweating
  • Higher heart rate
  • High blood pressure (when taking venlafaxine)
  • Lightheadedness
  • Low blood pressure
  • Diarrhea
  • Increase in appetite or weight gain
  • Nervousness
  • Sexual dysfunction (ranging from decreased arousal to erectile dysfunction and/or delayed time to orgasm)
  • Serotonin syndrome (a serious medical condition caused by an overload of serotonin)
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients
    • Young adults may be at a higher risk for this side effect
    • The risk is greatest in the first few weeks of treatment
Other Antidepressants

Common names include:

  • Trazodone
  • Nefazodone
  • Bupropion
  • Mirtazapine

There are several other antidepressants that work in a variety of different ways and affect the concentrations of the neurotransmitters (natural substances found in the brain) serotonin, norepinephrine, and dopamine, which are all known to be involved in the regulation of mood. Improvement is usually seen in 4-6 weeks after beginning treatment.

Nefazodone has been associated with reports of life-threatening liver failure. People with pre-existing liver disease should not take it. Patients who are taking nefazodone are advised to immediately report symptoms of liver toxicity, such as jaundice , loss of appetite, malaise, and gastrointestinal symptoms, to their doctor.

Depending on the drug, possible side effects include:

  • Lightheadedness
  • Dry mouth
  • Constipation
  • Difficulty urinating
  • Low blood pressure
  • Sedation
  • Nausea
  • Diarrhea
  • Increase in appetite or weight gain
  • Decrease in appetite or weight loss
  • Nervousness
  • Blurry vision
  • Sexual dysfunction (ranging from decreased arousal to erectile dysfunction and/or delayed time to orgasm)
  • Serotonin syndrome (a serious medical condition caused by an overload of serotonin)
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients
    • Young adults may be at a higher risk for this side effect
    • The risk is greatest in the first few weeks of treatment
Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.
When to Contact Your Doctor

Contact your doctor if you:

  • Have any questions about your medication
  • Have any side effects that are troublesome
  • Feel that the medication is not working

Get help right away if you have thoughts of hurting yourself of others.

References:

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Published May 22, 2009. Accessed July 15, 2009.

Bailly D. Antidepressant use in children and adolescents. Arch Pediatr. 2009;16(10):1415-1418.

Brent DA. The treatment of SSRI-resistant depression in adolescents (TORDIA): in search of the best next step. Depress Anxiety. 2009;26(10):871-4.

Depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 19, 2012. Accessed July 30, 2012.

Depression. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/depression-easy-to-read-/nimh_depression_trifold_t_ln_2.pdf. Accessed July 30, 2012.

MAOI diet facts. University of Pittsburgh Medical Center website. Available at: http://www.upmc.com/patients-visitors/education/nutrition/Pages/maoi-diet-facts.aspx. Published 2003. Accessed July 30, 2012.

Price J, Cole V, Goodwin GM. Emotional side-effects of selective serotonin reuptake inhibitors: qualitative study. Br J Psychiatry. 2009 ;195(3):211-217.

Public health advisory: suicidality in adults being treated with antidepressant medications. Federal Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm053169.htm. Accessed July 30, 2012.

Selegiline. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 19, 2012. Accessed July 30, 2012.

7/28/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Miller M, Swanson SA, et al. Antidepressant dose, age, and the risk of deliberate self-harm. JAMA Intern Med. 2014;174(6):899-909.

7/28/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Barbui C, Esposito E, et al. Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ. 2009;180(3):291-297.



Last reviewed September 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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