Medication for Depression

Explore the medication options for treating depression...

medication for depression

Treating depression with medication takes skill, patience, and a great deal of understanding and knowledge, but once practitioners help their patients find the right medications at the right dosages, a large number of individuals report dramatic differences in their lives.

Doctors and mental health professionals who treat individuals with these medications must know how these drugs work for every type of depression, and for the severity of specific symptoms. In addition, gauging how perniciously depression affects the everyday functioning of patients also plays a major role in prescribing the most efficacious medication.

The following types of medications are used to treat mood disorders – a category of disorders that includes all types of depression and bipolar disorder:

  • Tricyclic antidepressants
  • Monoamine Oxidase Inhibitors
  • Serotonin Specific Reuptake Inhibitors (SSRIs)
  • Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
  • Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)
  • Bipolar medications

How do these medications work?

The brain transfers thoughts, emotions, moods, knowledge, memories, sensory and motor instructions – virtually all mind and body functions – through networks of brain cells called neurons. The brain’s neurons don’t actually touch, but send these messages electrochemically across small gaps between the cells called synapses.

Special molecules called neurotransmitters allow this transmission of information to take place. These chemicals enable messages - or nerve impulses – to travel between neurons, through the synapses, to the next neuron. There are pre-synaptic neurons, or those sending the messages, and post-synaptic neurons, or those receiving the messages.

During this message transmission, neurotransmitters are released into the synapse in order to conduct the impulse – or message - to the next neuron. At the end of this process, some of the neurotransmitters travel into the post-synaptic neuron, while some are reabsorbed back into the pre-synaptic neuron – called reuptake. The remaining neurotransmitter molecules linger in the synapse only to get destroyed by enzymes called monoamine oxidase enzymes.

Scientists have identified what they believe to be the main neurotransmitters involved with the transmission of information between neurons and also associated with depression. They are serotonin, norepinephrine, and dopamine, and for a number of reasons not yet fully understood, individuals with depression have unusually low amounts of these neurotransmitters.

Medications currently on the market to treat depression increase one, two, or all of these neurotransmitters, or target and destroy the monoamine oxidase enzyme that kills these important neurotransmitters.

Tricyclic antidepressants

Tricyclics are the oldest types of antidepressants, and are still used today in many cases of major depressive disorder (MDD), or for the most severe, trenchant type of depression. (see article on Types of Depression.)

Tricyclic antidepressants work by increasing either serotonin, or norepinephrine, or both.

Because of their side effects, however, they are not prescribed unless other, newer forms of antidepressants have been tried unsuccessfully.

Side effects include dry mouth, weight gain, sexual dysfunction, sleepiness, constipation, dizziness, low blood pressure, and nervousness. Overdosing on a tricyclic can result in death.

In some cases, practitioners will prescribe a tricyclic in combination with another type of medication, such as a selective serotonin reuptake inhibitor, to target especially problematic depressive symptoms.

Some of the more common tricyclics are:

  • Anafranil®
  • Elavil® (Amitriptyline)
  • Norpramin®
  • Pamelor® (Nortriptyline)
  • Sumontil®
  • Tofranil®
  • Vivactil®
  • Asendin®
  • Ludiomil®

Monoamine Oxidase Inhibitors (MAOIs)

Monamine oxidase inhibitors, also called MAOIs, are medications that destroy the monamine oxidase enzyme in order to prevent these enzymes from destroying neurotransmitters that are already in short supply.

Because of their severe side effects, these medications are used only sparingly, and only as a final attempt at treating severe depression when all other medications have failed.

These medications require individuals to monitor their food and beverage intake because these drugs react adversely with certain foods and drinks, and also have potentially fatal consequences if mixed with certain other types of medications, including some over-the-counter medications.

Side effects include drowsiness, sleep disturbances, twitching muscles, dry mouth, stomach discomfort, difficulty with urination, dizziness, and sexual dysfunction.

MAOIs include:

  • Nardil®
  • Pamate®
  • Marplan®

Selective Serotonin Reuptake Inhibitors (SSRIs)

These are the some of the newest antidepressants on the market, and have the fewest side effects of any other class of antidepressants. For that reason, practitioners will usually start pharmacological treatment for depression with one of these medications.

Reuptake refers to neurotransmitters such as serotonin getting reabsorbed by the pre-synaptic neuron after a message transmission takes place. Reuptake inhibitors prevent reabsorption by attaching barriers on the membrane of the pre-synaptic neuron.

Serotonin is intricately linked to mood, so the process of preventing reuptake from occurring increases the probability that more serotonin will remain in the brain.

Although not as potentially harmful as other types of antidepressants, side effects do exist for some individuals when taking SSRIs. The most common are sexual dysfunction, or the inability of women to achieve orgasm, or delayed ejaculation in men.

Other side effects reported are nausea, sleep disturbances, agitation, and withdrawal symptoms if stopped abruptly.

SSRIs include:

  • Celexa®
  • Lexapro®
  • Prozac®
  • Luvox®
  • Paxil®
  • Zoloft®

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

Similar to SSRIs, these reuptake inhibitors prevent both serotonin and norepinephrine from getting reabsorbed back into pre-synaptic neurons. For some individuals, the increased amount of both of these neurotransmitters more effectively manages their depression.

Side effects are sexual dysfunction, nausea, dizziness, anxiety, sleep disturbances, and withdrawal symptoms if stopped abruptly.

SNRIs include:

  • Effexor®
  • Effexor XR®
  • Cymbalta®

Norepinephrine and Dopamine Reuptake Inhibitor (NDRI)

One antidepressant medication, bupropion, also called by its brand name Wellbutrin® prevents the reuptake of norepinephrine and dopamine into the pre-synaptic neuron.

Many individuals prefer this medication because it has the fewest sexual side effects of any of the antidepressant medications. However, this drug can cause seizures so if a history of previous seizures exists or there is a family history of seizures, this drug should be avoided.

Other types of antidepressants

Other antidepressants that don’t fit neatly into the above categories, working differently, yet still targeting neurotransmitters, include:

  • Desyrel® (Trazodone)
  • Serzone®
  • Remeron®

These medications also have similar side effects to the antidepressants listed above. Trazodone is known especially for its sedating effects, so if a patient has trouble sleeping, it’s often used also as a sleep aid and prescribed at bedtime.

Bipolar Medications

Treating bipolar disorder (see Bipolar Disorder) is more complicated than treating one of the pure depressive disorders. Its characteristics of extreme highs (mania) and lows (depression) often require a type of drug known as a mood stabilizer. In many cases, antidepressants are avoided because they are known to trigger extreme mania. However some individuals are able to combine an antidepressant with a mood stabilizer but under the strict guidance and care of a physician.

Typically what works for one patient does not work for another, so a trial-and-error period usually takes place when starting individuals on these medications. And often during the course of an individual’s life, a physician or practitioner will have to change the medications.

In most cases of bipolar disorder, individuals need to stay on medicine for the long-term. Studies have shown that going on and off the medications might worsen either the mania or depression, or both.

Lithium is one of the most widely used mood stabilizers, and has been used for over 50 years, but scientists still aren’t sure exactly how it works in the brain. The website livestrong.com states that the drug might alter electrolytes, neurotransmitters or enzymes, or all three. Many scientists strongly favor the “enzyme” focus, according to the website. Citing the textbook “Basic and Clinical Pharmacology,” the website speculates that lithium blocks the action of certain enzymes responsible for forming phosphates, a blockage that sets off a number of chemical reactions in the brain.

Mood stabilizing drugs for bipolar disorder include:

  • Lithium. (Lithionate,® Lithotabs,® Lithobid,® Eskalith®) Depending on the drug, side effects include weight gain, fatigue, feeling “dulled,” digestive problems, dehydration, diarrhea, and dry mouth.
  • Anticonvulsants. (Depakote® and Lamictal®) These mood stabilizing drugs often are used to help control mixed episodes of mania and depression. Depending on the drug, side effects include weight gain, nausea, decrease in blood platelets, rash, and pancreatitis. Rarely, they can cause blood disorders, liver problems, or polycystic ovary syndrome.
  • Antipsychotics. (Zyprexa,® Risperdal,® Seroquel®) For those not helped by lithium or an anticonvulsant, physicians often try antipsychotic medications as mood stabilizers. Depending the drug, side effects include weight gain, drowsiness, tremors, shaking, dry mouth, blurred vision, restlessness, low blood pressure, and sexual side effects.
  • Symbyax. This medication combines the antidepressant Prozac® with the antipsychotic Zyprexa.® For those who can tolerate this combination, it works as both an antidepressant, and as a mood stabilizer for mania. Side effects can include weight gain, dizziness, drowsiness, dry mouth, dehydration, headache, nausea, sweating, and some sexual dysfunction.

If you want to work as a psychologist treating patients who suffer with depression or bipolar disorder, a PhD in clinical psychology is required. For more information on starting a program that will qualify you for this degree, or the requirements to enter an advanced degree program, contact schools offering degrees in psychology.

For more details on how to become a therapist, request information from the schools offering degree programs in psychology, mental health counseling, or a related counseling degree programs.

* This website does not endorse any specific medications or brand names, nor the taking of any medications without the care and guidance of a qualified physician or mental health provider.