Severe depression is an illness that can cause both emotional and physical problems if it goes untreated. The standard treatment, in addition to psychological counseling, is antidepressant medication. If you suffer symptoms of depression such as deep sadness, sleep problems, fatigue or loss of interest in your normal activities, and especially if you entertain suicidal thoughts, you may need medical treatment to get better. Antidepressants are also used to treat anxiety and other mood disorders. With your doctor's help and advice, you can choose from several types of antidepressant medications.
Function
Antidepressants help balance chemicals in the brain known as neurotransmitters that are responsible for our moods and emotional outlook. The neurotransmitters that play the most active roles in depression are serotonin, norepinephrine and dopamine. Different types of antidepressants have different effects on these neurotransmitters.
Although you might start to feel better soon after you start taking an antidepressant, it can take up to 2 or 3 months to feel the full effect.
Types
Serotonin reuptake inhibitors (SSRIs) are often the first medication prescribed for depression because they are usually effective and have more tolerable side effects than others. The SSRIs include escitalopram (brand name Lexapro), paroxetine (brand name Paxil), sertraline (brand name Zoloft), citalopram (brand name Celexa) and fluoxetine (brand name Prozac or Sarafem).
Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as veniafaxine (brand name Effexor) and duloxetine (brand name Cymbalta) are similar to SSRIs.
Tricyclic antidepressants (TCAs) are an older class of antidepressants that are still in use because they are effective for some people. TCAs tend to have more side effects than SSRIs, so they are usually prescribed only when SSRIs don't do the job.
Monoamine oxidase inhibitors (MAOIs) are generally prescribed only for hard-to-treat depression because this type of medication can have more serious side effects than any of the other types of antidepressants. An MAOI called Emsam was the first antidepressant medication to be approved in the form of a skin patch.
Side Effects
Different types of antidepressant medications have different side effects, and some are more bothersome than others. Not everyone gets side effects, and the good news for those who do is that side effects often go away within the first month. The most common side effects include fatigue, weight gain, nausea, insomnia, dry mouth, dizziness, constipation, loss of interest in sex and difficulty achieving orgasm.
If side effects are particularly bothersome or do not go away after several weeks, your doctor might be able to make adjustments to your dose, switch you to another antidepressant or supplement your antidepressant with medication that counters the side effects.
Withdrawal
When abruptly discontinued, antidepressants can cause unpleasant withdrawal symptoms in approximately 20 percent of people who are taking them, according to a survey published in the journal American Family Physician in August 2006 by Christopher Warner et al. Withdrawal symptoms are similar to those of depression and can include headaches, fatigue, dizziness, anxiety, sadness and irritability. Do not stop taking any antidepressant without first speaking to your doctor about the correct way to taper off medication.
Warning
Although most antidepressant medications are considered safe and effective, all carry a "black-box" warning on their labels, indicating a possibility of serious risk. That's because children, teens and young adults are at increased risk of having suicidal thoughts or exhibiting suicidal behavior while taking antidepressant medication. Doctors and caregivers must monitor this group very closely.
