Antidepressants – What You Should Know

Depression is a medical disorder, like diabetes. The types of medication used to treat depression are called antidepressants. Research has found that antidepressants are effective, but it’s not clear exactly how they work.

One thing they all have in common is that antidepressants don’t start working right away. They must be taken as prescribed for three to four weeks before you can expect to see positive results. So it’s important that you don’t stop taking your medication because you think it’s not working. Give it time!

What Antidepressants Do

Researchers believe that brain chemicals called neurotransmitters (chemical messengers) help us regulate mood. Antidepressant medications work to increase the number of neurotransmitters like serotonin, norepinephrine, and/or dopamine, which control our moods.

Keep Working to Find the Right Fit

Sometimes the first antidepressant you try may not lead to mood improvements. Each person’s brain chemistry is unique. What works well for one person may not do as well for another. So it’s important to stay open to trying other medications or combinations of medications in order to find a good fit.

Studies have shown that people who did not get better after taking a first medication increased their chances of becoming symptom-free after they switched to another medication or added another medication to their existing one. Let your doctor know if your symptoms have not improved and most importantly, do not give up searching for the right one!

Prevent Relapse: Don’t Stop

If you have only had one episode of depression, treatment with antidepressants will usually go on for six to nine months. If you’ve had multiple episodes of depression, your doctor may recommend treatment for a longer period of time.

To prevent depression from coming back or getting worse, do not abruptly stop taking your medications, even if you are feeling better. Stopping your medication can cause a relapse. Medication should only be stopped under your doctor ’s supervision. If you want to stop taking your medication, talk to your doctor about how to correctly stop them.

Side Effects of Antidepressants

Like all medications, antidepressants can have side effects. In most cases they are mild and tend to diminish with time. Your doctor will discuss some common side effects with you. If you experience side effects, talk to your doctor before making any decisions about discontinuing treatment.

There are five different classes of antidepressants. Below, you’ll see antidepressant medications listed by class along with common side effects. All medicines may cause side effects, but many people have none or only minor ones.

Usually, the side effects are tolerable and subside in a few days. Check with your doctor if any of the common side effects listed persist or become bothersome.

In rare cases, these medications can cause severe side effects. Contact your doctor immediately if you experience one or more severe symptoms.

Antidepressant Class 1: Serotonin Reuptake Inhibitors (SSRIs)

This group includes the selective serotonin reuptake inhibitors (SSRIs) which are the most commonly prescribed antidepressants because they have relatively few side effects. SSRIs increase the level of serotonin by inhibiting reuptake of the neurotransmitter. Serotonin modulators are new drugs that act like SSRIs but also affect other serotonin receptors. Their side effects overlap with those of SSRIs.

SSRIs:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Serotonin Modulators:

• Vilazodone (Viibryd)
• Vortioxetine (Brintellix)

Common side effects for SSRIs

Abnormal dreams; anxiety; blurred vision; constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; flu-like symptoms (e.g., fever, chills, muscle aches); flushing; gas; increased sweating; increased urination; lightheadedness when you stand or sit up; loss of appetite; nausea; nervousness; runny nose; sore throat; stomach upset; stuffy nose; tiredness; trouble concentrating; trouble sleeping; yawning; vomiting; weight loss.

Antidepressant Class 2: Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are similar to SSRIs in that they increase levels of serotonin in the brain. They also increase norepinephrine in the brain to improve mood.

SNRIs:

• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)
• Levomilnacepran (Fetzima)
• Venlafaxine (Effexor)

Common side effects for SNRIs:

Anxiety; blurred vision; changes in taste; constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; fatigue; flushing; headache; increased sweating; loss of appetite; nausea; nervousness; sore throat; stomach upset; trouble sleeping; vomiting; weakness; weight loss; yawning.

Antidepressant Class 3: Atypical Antidepressants

In addition to targeting serotonin and/or norepinephrine, the atypical antidepressants may also target dopamine. They also tend to have fewer side effects than the older classes of medication listed below (antidepressant Classes 4 and 5).

The common side effects differ for each of the medications in this class of antidepressants.

Bupropion (Wellbutrin)

Common side effects: constipation; dizziness; drowsiness; dry mouth; headache; increased sweating; loss of appetite; nausea; nervousness; restlessness; taste changes; trouble sleeping; vomiting; weight changes.

Mirtazapine (Remeron)

Common side effects: constipation; dizziness; dry mouth; fatigue; increased appetite; low blood pressure; sedation; weight gain.

Nefazodone (Serzone)

Common side effects: abnormal dreams; abnormal skin sensations; changes in taste; chills; confusion; constipation; decreased concentration; decreased sex drive; diarrhea; dizziness; drowsiness; dry mouth; fever; frequent urination; headache; incoordination; increased appetite; increased cough; indigestion; lightheadedness; memory loss; mental confusion; ringing in the ears; sleeplessness; sore throat; swelling of the hands and feet; tremor; urinary retention; urinary tract infection; vaginal infection; weakness.

Trazodone (Desyrel)

Common side effects: blurred vision; constipation; decreased appetite; dizziness; drowsiness; dry mouth; general body discomfort; headache; lightheadedness; muscle aches/pains; nausea; nervousness; sleeplessness; stomach pain; stuffy nose; swelling of the skin; tiredness; tremors.

Antidepressant Class 4: Tricyclics and Tetracyclics (TCA and TECA)

This is an older class of antidepressants that also works by increasing levels of serotonin and norepinephrine in the brain. These medications are good alternatives if the newer medications are ineffective.

TCAs AND TECAs:

• Amitriptyline (Elavil or Endep)
• Amoxapine (Asendin)
• Clomipramine (Anafranil)
• Desipramine (Norpramin or Pertofrane)
• Doxepin (Sinequan or Adapin)
• Imipramine (Tofranil)
• Maprotiline (Ludiomil)
• Nortriptyline (Pamelor)
• Protriptyline (Vivactil)
• Trimipramine (Surmontil)

Common side effects for the TCAs and TECAs:

Abnormal dreams; anxiety or nervousness; blurred vision; change in appetite or weight; change in blood pressure; change in sexual desire or ability; clumsiness; confusion; constipation; decreased memory or concentration; dizziness; drowsiness; dry mouth; excess sweating; excitement; headache; heartburn; indigestion; nausea; nightmares; pounding in the chest; pupil dilation; restlessness; stuffy nose; swelling; tiredness; tremors; trouble sleeping; upset stomach; urinary retention; vomiting; weakness.

Antidepressant Class 5: Monoamine Oxidase Inhibitors (MAOIs)

MAOIs are an older class of antidepressants which are not frequently used because of the need to follow a special diet to avoid potential side effects. However, these medications can be very effective. These drugs work by blocking an enzyme called monoamine oxidase, which breaks down the brain chemicals serotonin, norepinephrine, and dopamine.

When taking MAOIs, it is important to follow a low tyramine diet which avoids foods such as cheeses, pickles, and alcohol and to avoid some over-the-counter cold medications. Most people can adopt to a low tyramine diet without much difficulty. Your doctor will provide a complete list of all food, drinks, and medications to avoid.

MAOIs:

• Phenelzine (Nardil)
• Selegiline (Emsam) patch
• Tranylcypromine (Parnate)

Common side effects for MAOIs:

Blurred vision; changes in sexual function; constipation; diarrhea; difficulty swallowing; dizziness; drowsiness; dry mouth; fainting; gas; headache; heartburn; lightheadedness; muscle pain or weakness; nausea; purple blotches on the skin; rash; redness, irritation or sores in the mouth (if you are taking the orally disintegrating tablets); sleep problems; stomach pain; tiredness; tremors; twitching; unusual dreams; unusual muscle movements; upset stomach; vomiting; weakness.

Want to Learn More?

Here are some other articles you might find helpful:

• What Is Major Depression: The Symptoms
• What Causes Depression… And How Common Is It?
• Family Support for Depression: How You Can Help
• Evidence-Based Treatment for Depression