1. Antidepressants: Selecting one that's right for you
Confused by the choice in antidepressants? With persistence, you and your
doctor should find one that works so that you can enjoy life more fully again.
Antidepressants are a popular treatment choice
for those with moderate or severe depression.
Although antidepressants may not cure
depression, they can reduce your symptoms. The
first antidepressant you try may work fine. But if it
doesn't relieve your symptoms, or it causes side
effects that bother you, you may need to try
another.
But don't give up. A number of antidepressants are available, and chances are
you'll be able to find one that works well for you.
Finding the right antidepressant
There are a number of antidepressants available that work in slightly different
ways and have different side effects. Most work equally well to relieve depression, so
choosing the right one generally involves subtle differences. When prescribing an
antidepressant that's likely to work well for you, your doctor may consider:
Your particular symptoms. Symptoms of depression can vary, and one antidepressant
may relieve certain symptoms better than another. For example, if your depression
symptoms include low energy, an antidepressant that's slightly stimulating may be the
best choice. On the other hand, if you have trouble sleeping, an antidepressant that's
slightly sedating may be a good option.
Possible side effects. Side effects of antidepressants vary from one medication to
another and from person to person. Bothersome side effects can make it difficult to
stick with treatment. Sexual side effects are a particularly common reason people stop
taking an antidepressant
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Whether it worked for a close relative. How a medication worked for a first-degree
relative, such as a parent or sibling, can indicate how well it might work for you.
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2. Interaction with other medications. Some antidepressants can cause dangerous
reactions when taken with other medications.
Whether you're pregnant or breast-feeding. Many antidepressants may not be safe for
your baby when taken during pregnancy or later when you're breast-feeding. Work
with your doctor to find the best way to manage your depression when you're
expecting.
Your other health conditions. Some antidepressants may cause problems if you have
certain mental or physical health conditions. On the other hand, certain
antidepressants may help treat other physical or mental health conditions along with
depression.
Cost and health insurance coverage. Some antidepressants can be very expensive,
especially if there's no generic version available.
Types of antidepressants
Certain brain chemicals called
neurotransmitters are associated with depression,
particularly the neurotransmitters serotonin (ser-
oh-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin)
and dopamine (DOE-puh-mene). Most
antidepressants relieve depression by affecting
these neurotransmitters. Each type (class) of
antidepressant affects these neurotransmitters in
slightly different ways.
Selective serotonin reuptake inhibitors (SSRIs).Many doctors start depression treatment
by prescribing an SSRI. SSRIs are safe and relieve depression for most people. However,
like many antidepressants, they can cause sexual side effects — most commonly failure
to achieve orgasm in women and delayed ejaculation in men. SSRIs include best
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Serotonin and norepinephrine reuptake inhibitors (SNRIs)SNRIs
include Cymbalta(Duloxetine). Duloxetine may help relieve physical
pain in addition to depression — but it isn't clear yet whether it works
better than other antidepressants for pain relief. Duloxetine can cause
a number of side effects. Nausea, dry mouth and constipation are
particularly common. You shouldn't take duloxetine if you're a heavy
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3. Atypical antidepressants.These medications are called "atypical" because they don't fit
neatly into other categories. Generally, atypical antidepressants cause fewer sexual
side effects than other antidepressants do.
Tricyclic and tetracyclic antidepressants.These older antidepressants are effective, but
are usually not a first-choice treatment for depression because of numerous side effects
such as dry mouth, constipation, difficulty urinating, sedation, weight gain and sexual
side effects. In some cases, a low dose of a cyclic antidepressant may be added to
another antidepressant, such as an SSRI, to increase the antidepressant effect.
Overdosing on a cyclic antidepressant can be deadly. These medications are not
usually given to older adults or people who have low blood pressure or certain heart
problems.
Monoamine oxidase inhibitors (MAOIs).Monoamine oxidase inhibitors are used as a last
resort because of numerous bothersome and potentially dangerous serious side effects.
However, MAOIs can be effective for some forms of depression when other
medications haven't worked. Side effects can include dizziness, dry mouth, upset
stomach, difficult urination, twitching muscles, sexual side effects, drowsiness and sleep
problems. MAOIs can cause potentially fatal high blood pressure when combined with
certain foods and beverages and certain other medications.
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Antidepressants and risk of suicide
Antidepressants are generally safe. However, in
some cases children, adolescents and young
adults ages 18 to 24 may have an increase in
suicidal thoughts or behavior when taking
antidepressants, especially in the first few weeks
after starting an antidepressant or changing a
dosage. Because of this risk, they must be closely
monitored by loved ones, caregivers and health
care providers while taking antidepressants. The
Food and Drug Administration (FDA) now requires that all antidepressant medications
carry a warning about suicide.
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4. Making antidepressants work for you
There are several steps you can take to get the best results:
Be patient. Once you and your doctor have selected an antidepressant, it may take six
or more weeks for it to be fully effective. And with some medications, you can take the
full dosage immediately. With others, you may need to gradually increase your dose.
Talk to your doctor or therapist about coping with depression symptoms as you wait for
medications to take effect.
See if the side effects improve. Many antidepressants cause side effects that improve
with time. For example, initial side effects when starting an SSRI can include nausea,
loose bowel movements, headache and insomnia, but these symptoms usually go
away as your body adjusts to the antidepressant. Sexual side effects may be eased by
adding or substituting bupropion.
If it doesn't work — try something else. If you have no significant improvement in your
symptoms after six weeks, talk to your doctor about trying a different antidepressant
(switching) or adding a second antidepressant or another medication (augmentation).
A medication combination may work better for you than does a single antidepressant.
Take your antidepressant consistently and at the correct dose. If your medication
doesn't seem to be working or is causing bothersome side effects, call your doctor
before making any changes.
Don't stop taking an antidepressant without talking to your doctor first. Some
antidepressants can cause significant withdrawal-like symptoms unless you slowly taper
off your dose.
Try psychotherapy. In many cases, combining an antidepressant with mental health
counseling (psychotherapy) is more effective than taking an antidepressant alone. It
can also help prevent your depression from returning once you're feeling better.
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