Depression Medicines

Not only does it take time to get an accurate depression diagnosis, finding the right medication to treat depression can be a complicated, delicate process. Someone may have a serious medical problem, such as heart disease or liver or kidney disease, that could make some antidepressants unsafe. The antidepressant could be ineffective for you or the dose inadequate; there may not have been enough time to see an effect, or the side effects could be too bothersome -- leading to a failure of treatment.

As you approach taking antidepressants to treat depression, it is important to keep these points in mind:

1. Only about 30% of people with depression go into full remission after taking their first course of antidepressants. That’s according to a 2006 study funded by the National Institutes of Health. Those who got better were more likely to be taking slightly higher doses for longer periods.
2. Some antidepressants work better for certain individuals than others. It's not uncommon to try different depression medicines during treatment.
3. Some people need more than one medicine for depression treatment.
4. Antidepressants carry a boxed warning about increased risk compared to placebo for suicidal thinking and behavior in children, adolescents, and young adults 18-24 years old.

Working with your doctor, you can weigh the risks and benefits of treatment and optimize the use of medication that best relieves your symptoms.

What is an antidepressant?

Antidepressants, sometimes in combination with psychotherapy, are often the first treatment people get for depression. If one antidepressant doesn't work well, you might try another drug of the same class or a different class of depression medicines altogether. Your doctor might also try changing the dose. In some cases, your doctor might recommend taking more than one medication for your depression.

What are the different types of antidepressants?

Here are the main types of antidepressants along with brand names:

Bupropion (Aplenzin, Wellbutrin) is a unique antidepressant that is thought to affect the brain chemicals norepinephrine and dopamine. Side effects are usually mild, including upset stomach, headache, insomnia, and anxiety. Bupropion may be less likely to cause sexual side effects than other antidepressants.Esketamine (Spravato) is a unique medicine originally developed as an anesthetic and thought to treat depression though its effects on a brain chemical called glutamate. It is administered as a nasal spray and is for use in those who have not responded to treatment by other antidepressants. Its most common side effects include sedation, dissociation (having strange perceptions about time and space, or feeling as if things around you are not real), problems with thinking, and high blood pressure. If any of these side effects occur they are usually mild and temporary.Mirtazapine (Remeron) is also a unique antidepressant that is thought to affect mainly serotonin and norepinephrine through different brain receptors than other medicines. It is usually taken at bedtime because it often causes drowsiness. Side effects are usually mild and include sleepiness, weight gain, elevated triglycerides, and dizziness.Trazodone (Desyrel) is usually taken with food to reduce chance for stomach upset. Other side effects include drowsiness, dizziness, constipation, dry mouth, and blurry vision. It is often prescribed to help with sleep.

Are other medicines used with the antidepressants?

Other medicines may be prescribed in addition to antidepressants, particularly in treatment resistant depression. Here are examples of medicines that may be used to augment as an add-on to antidepressant treatment.

• Several specific antipsychotic medications have been shown to enhance the effects of an antidepressant when an initial response is poor. These include aripiprazole (Abilify), brexpiprazole (Rexulti), and quetiapine (Seroquel). Symbyax, a combination of the antipsychotic drug olanzapine (Zyprexa) and an SSRI (Prozac, or fluoxetine), is approved for treatment-resistant depression or depression in people with bipolar disorder.
• Lithium carbonate, usually thought of for its mood stabilizing effects in bipolar disorder, has also long been considered a useful add-on treatment to antidepressants for people with major depressive disorder.
• Stimulant medicines (such as lisdexamfetamine (Vyvanse) or methylphenidate (Ritalin)) are sometimes used "off label" as add-on treatments for some forms of depression.
• Buspirone (Buspar), an anti-anxiety medicine, also is sometimes useful for depression when added to an antidepressant drug.
• Your doctor may recommend or prescribe other medications or supplements not FDA approved for use in depression.

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