Depression
Medications
Depression is often underdiagnosed and undertreated. Most depressed people need antidepressant medications. Antidepressants can improve or completely relieve the symptoms of depression.
Several medication options are available. There is no evidence that one medication works better than another; however, the side effects of the medications differ.9 You and your health professional can determine which medication is right for you.
You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.
Your doctor may prescribe an atypical antipsychotic, such as aripiprazole (Abilify), if your depression does not improve with antidepressants alone.
Medications affect your brain chemistry in different ways, so you may try several different medications or combinations of medications to find treatment that works for your depression. Most people find a drug that works within a few tries, but for some people, depression can be more difficult to treat. In some cases, a combination of antidepressants may be necessary. Sometimes an antidepressant combined with a different type of medication—such as an antiseizure, mood stabilizer, or antianxiety drug—is effective.
When taking antidepressant medication, it is important that you take the medication as prescribed. It may take several weeks before you notice the medication working. Side effects may improve after your body adjusts to the medication.
Taking your medicine for at least 6 months after you feel better can help keep you from getting depressed again. If this is not the first time you have been depressed, your doctor may want you to take these medicines even longer.
If you decide to quit taking antidepressants, it is important that you gradually reduce the dose over a period of several weeks. Quitting antidepressants abruptly can cause withdrawal symptoms. It is important to discuss quitting (or changing) medications with your health professional.
Medication Choices
Antidepressant medications include:
- Selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Zoloft, or Paxil.
- Tricyclic and tetracyclic antidepressants, such as Elavil, Pamelor, or maprotiline.
- Atypical antidepressants, such as Wellbutrin, Effexor, or Remeron.
- Monoamine oxidase inhibitors (MAOIs), such as Nardil, Marplan, or Parnate.
What To Think About
If you and your health professional decide that you need medication, there are several considerations when choosing the right medication:
- Understand the side effects of the medication.
- Tell your health professional about all of your current medical conditions and all the medications you are taking, including nonprescription drugs, herbs, and supplements, so he or she can determine whether there are potential drug interactions.
- If you are an older person, you may need lower doses of medication, and it may take longer to be effective.
- Your health professional will need to monitor your progress to determine whether a particular medication is working for you.
- Often the first medication you take will effectively treat your depression. If not, there are other choices that will usually work well. You may need to try several different medications before you find the one that works best for you.
- Taking your medicine for at least 6 months after you feel better can help keep you from getting depressed again. If this is not the first time you have been depressed, your doctor may want you to take these medicines even longer. 9
- Some people need to remain on medication for several months to years (maintenance therapy). Others need medication for the remainder of their lives, especially those who have had several episodes of major depression.
When deciding which medication to prescribe, your health professional will consider:
- Your response to medications in previous depressive episodes.
- Whether you have other illnesses. Your doctor will want to make sure you are not given a depression medicine that will interact poorly with other medicines you are taking. He or she also may be able to prescribe depression medicine that benefits both your other illness and your depression.
- Whether the medication used to treat your depression will make any other illness you have worse or more difficult to treat.
- Your age and overall physical health. Older adults may need to take lower doses of medication for depression.
- How much the side effects of the medication are likely to bother you.
Some people with depression do not continue taking their medications for depression or take them sporadically. It is important to continue taking medications for depression as prescribed, even after symptoms go away, to prevent recurrence of depression or to keep symptoms from getting worse. For more information see:
Side effects
You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. During this time, you may experience side effects of the medicine. Many of the side effects are temporary and go away with continued use of the medicine, although some (such as dry mouth, constipation, and sexual problems) may continue. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.
- Do not stop taking the medication on your own unless you are having chest pain, hives, shortness of breath, trouble swallowing, or swelling of your lips. Contact your health professional immediately if you do experience any of these serious side effects.
- If your side effects are less serious but bothersome, talk with your health professional to see whether you should continue the medication or try another. There are many things you can do to reduce bothersome side effects of medications.
Antidepressant medications may need to be started at low doses and increased gradually, especially in most older adults. Medications should also be stopped gradually by decreasing the dose over a period of time. If certain antidepressant medications are stopped abruptly, you may suffer negative effects or the symptoms of depression may return.
Older adults or others who are depressed and taking several medications for other health conditions (not related to depression) need careful monitoring of their medications. People are more likely to have harmful side effects from taking many different medications.
FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:
- An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed. The FDA also advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania.
- A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.
For more information about side effects, see:
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| Author: | Jeannette Curtis Ralph Poore | Last Updated: March 21, 2007 |
| Medical Review: | Martin Gabica, MD - Family Medicine Lisa S. Weinstock, MD - Psychiatry | |
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