Depression Medication: Which One Is Right for You?

Depression is a mood disorder which is not the same for everyone. The causes and types of depression may vary from person to person and so does the treatment. For some people, psychotherapy, natural remedies or certain lifestyle changes may improve the symptoms of depression. However, some people may have to take medication under the guidance of a psychiatrist. Numerous antidepressants are available, but you need to know which one can be best suitable for you.

In this article, let us understand the process of selecting a perfect antidepressant, the types of antidepressants and the risk factors associated with these depression medications.

How to Select an Antidepressant?

Antidepressants are prescription medications which are chosen by the healthcare provider after evaluating certain parameters. The doctor will recommend an antidepressant based on −

• Symptoms experienced by the depression patient

• Presence of other medical conditions

• Medical history of the patient

• Other medicines the patient is taking

• Potential side effects

• Family history of depression and medicines that have been effective in treating the other family members

• Pregnancy or breastfeeding

If a person has had depression before, the doctor may prescribe the same medicine to which the body had responded positively in the past. Generally, the doctor will prescribe a low dose of the antidepressant and will gradually increase it until there is an improvement in the health condition.

These medicines are usually prescribed for six months to one year who are being treated for first-time depression. The effects of the treatment may take one to two months and the healthcare provider will closely monitor the health of the patient to determine the effectiveness of the antidepressant or detect any potential side effects.

Types of Antidepressants

Certain neurotransmitters (brain chemicals) like serotonin, norepinephrine and dopamine, are linked with depression. Most antidepressants help relieve depression by affecting these neurotransmitters and improving the communication between brain cells. The types of antidepressants include the following −

Selective serotonin reuptake inhibitors (SSRIs)

These are the most commonly prescribed antidepressants and are known to inhibit serotonin to regulate mood. These antidepressants increase the level of serotonin in the body and thereby stop it from breaking down.

Some of the most popular SSRIs which are approved by the United States Food and Drug Administration (FDA) are Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac, Sarafem, Symbyax), Fluvoxamine (Luvox, Luvox CR), Paroxetine (Paxil, Paxil CR, Pexeva), Sertraline (Zoloft) and Vilazodone (Viibryd).

SSRIs may have some side effects like nausea, vomiting, dry mouth, extreme weight gain or loss, diarrhoea, insomnia, dizziness, headache, restlessness, irritation or agitation and sexual problems.

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

These antidepressants block the reabsorption of serotonin and norepinephrine and thereby make them available to the brain. Some of the commonly prescribed SNRIs are Duloxetine (Cymbalta), Venlafaxine (Effexor XR), Levomilnacipran (Fetzima) and Desvenlafaxine (Pristiq). SNRIs may have some side effects like nausea, dry mouth, dizziness, headache, excessive sweating, constipation, insomnia, loss of appetite, sexual dysfunction and tiredness.

Cyclic Antidepressants

Tricyclic and tetracyclic antidepressants block the reabsorption of serotonin and norepinephrine through a different mechanism as compared to the SNRIs. Some of the prescribed tricyclic antidepressants are Amoxapine (Asendin), Amitriptyline (Elavil), Nortriptyline (Aventyl, Pamelor), Desipramine (Norpramin), Doxepin (Sinequan, Silenor), Imipramine (Tofranil) and Protriptyline (Vivactil). Moreover, the FDA-approved tetracyclic maprotiline (Ludiomil) can also be used to treat depression.

Nevertheless, these prescribed medications are not widely used as they can cause a range of side effects. Some people have reported serious side effects like disorientation or confusion. The side effects of these drugs include drowsiness, blurred vision, constipation, dry mouth, urine retention and sudden drop in blood pressure which can cause lightheadedness. Healthcare providers may recommend these medications when other antidepressants don't work for the patients.

Monoamine Oxidase Inhibitors (MAOIs)

These are the oldest class of prescribed medications for treating depression. They block the enzyme monoamine oxidase in our brain from breaking down the neurotransmitters including serotonin, norepinephrine and dopamine. MAOIs may help people with depression but are not widely prescribed because of their potential side effects.

These drugs may also interact with certain foods, beverages and other medications like cold and allergy medicines, herbal supplements or painkillers. In rare cases, MAOIs if combined with other serotonin-containing medications, can cause serotonin syndrome which is a potentially life-threatening condition. Some of the FDA-approved MAOIs are Isocarboxazid (Marplan), Phenelzine (Nardil), Tranylcypromine (Parnate) and Selegiline (Emsam) which can also be used as a skin patch.

Atypical Antidepressants

These antidepressants don't fit neatly into any of the other antidepressant categories and hence, are called atypical antidepressants. These medications alter the levels of different neurotransmitters in the brain and aid in treating depression. Some of the FDA-approved atypical antidepressants are Trazodone (Desyrel), Nefazodone (Serzone), Mirtazapine (Remeron) and Vortioxetine (Brintellix, Trintellix).

Are Antidepressants Safe?

The majority of antidepressants are usually safe but children, teenagers and young adults under 25 may experience an increase in suicidal thoughts. This may happen during the first few months of the treatment or when the dosage is changed.

The side effects of antidepressants in adults may vary depending on their type. Always ask the doctor about any possible side effects before taking any antidepressants. In people with bipolar disorder, antidepressants have a small but important risk for triggering manic or hypomanic symptoms. For people with bipolar disorder, antidepressants are generally not recommended without a mood stabilizer.

Antidepressant discontinuation syndrome may develop if a person suddenly stops taking the antidepressants. The symptoms of this syndrome are fatigue, headache, achiness, excessive sweating, insomnia, nausea, dizziness, burning, tingling, anxiety, irritability or agitation. These symptoms typically last one to two weeks and are usually mild. One should never stop taking the antidepressant without consulting your healthcare provider.

Novel Medications to Treat Depression

The FDA granted approval to some other medicines for depression in 2019 and 2022 respectively.

• Esketamine (Spravato) − It is a nasal spray which is derived from ketamine. While many other traditional antidepressants may take weeks to show their effectiveness, this nasal spray may show effect within hours. This medicine could be an option for people who may not have had effective results with other antidepressants.

• Brexanolone (Zulresso) − This medication is administered as an intravenous infusion in a healthcare setting for 60 hours (two and a half days) continuously. This medicine is chemically similar to endogenous allopregnanolone, which is a hormone. This hormone decreases in women’s bodies after giving birth. Brexanolone is the first prescribed medication for women to treat postpartum depression.

• Dextromethorphan-bupropion (Auvelity) − FDA granted approval to this medicine in August 2022. This drug acts as an N-methyl D-aspartate receptor antagonist and may help to treat the major depressive disorder. This drug may relieve symptoms of depression rapidly as compared to other antidepressants and often work within a week of consistent use.

Conclusion

Depression medications should be taken under a doctor's supervision and antidepressants are the most common prescription medications for treating depression. One needs to select the right antidepressant and hence, it should be done with the help of a doctor. These medicines shouldn't be stopped suddenly or they may cause some health issues.