Carl R. Darnall Army Medical Center - Health Library

Medications for Depression

Here are the basics about each of the medicines below. Only the most common reactions are listed. Ask your doctor if you need to take any special steps. Use each of these drugs as advised by your doctor or the booklet they came with. If you have any questions, call your doctor.

There are many types of antidepressants. It may take some time to find the one that works best for you. Sometimes, you may only need to have the dose changed. In most cases, it can take 4-6 weeks for the full effect of the medicine to be in place.

Don't stop taking these on your own, even if you feel better. When you feel better, you may think you no longer need medicine, but this isn't true. If the medicine isn't working as expected, talk to your doctor. Some of these need to be tapered down to avoid withdrawal symptoms. You and your doctor will decide how long you need to take them. It's different for each person.

Prescription Medications

Selective serotonin reuptake inhibitors (SSRIs)

  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
  • Escitalopram

Tricyclic antidepressants

  • Doxepin
  • Clomipramine
  • Nortriptyline
  • Amitriptyline
  • Imipramine
  • Maprotiline
  • Desipramine
  • Trimipramine
  • Protriptyline

Monoamine oxidase inhibitors (MAOIs)

  • Isocarboxid
  • Phenelzine
  • Tranylcypromine
  • Selegiline patch

Serotonin/norepinephrine reuptake inhibitors (SNRIs)

  • Venlafaxine
  • Duloxetine
  • Desvenlafaxine

Other antidepressants

  • Trazodone
  • Nefazodone
  • Bupropion
  • Mirtazapine
 

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Citalopram
  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline
  • Escitalopram

SSRIs help with serotonin, a brain chemical that plays a role in depression. These may be the first choice if you need to try medicine.

Don't drink alcohol while taking an SSRI. Don't take SSRIs if you've taken a monoamine oxidase inhibitor (MAOI) in recent weeks.

Some problems are:

  • Risk of severe changes in your mood and behavior. This may also include self-harm or trying to take your own life:
    • Children and young adults (mainly under age 25)
    • The risk is greatest in the first few weeks of starting these
  • Nausea
  • Stomach irritation
  • Diarrhea
  • Insomnia
  • Less hunger than normal or weight loss
  • More hunger than normal or weight gain
  • Nervousness
  • Lightheadedness
  • Problems with sex—can be with arousal, erectile dysfunction (ED), and delayed time to or lack of orgasm
  • Serotonin syndrome—happens when there is too much serotonin, which can be serious
 

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)

  • Venlafaxine
  • Duloxetine
  • Desvenlafaxine

SNRIs help with serotonin and norepinephrine. They work as well as SSRIs.

Some problems are:

  • Dry mouth
  • Constipation
  • Nausea
  • Fatigue
  • Drowsiness
  • Excessive sweating
  • Higher heart rate
  • High blood pressure—venlafaxine
  • Lightheadedness
  • Low blood pressure
  • Diarrhea
  • More hunger than normal or weight gain
  • Nervousness
  • Problems with sex—can be with arousal, ED, and delayed time to or lack of orgasm
  • Serotonin syndrome—happens when there is too much serotonin, which can be serious
  • Risk of severe changes in your mood and behavior. This may also include self-harm or trying to take your own life:
    • Young adults may be at a higher risk
    • The risk is greatest in the first few weeks of starting these
 

Tricyclic Antidepressants

  • Doxepin
  • Clomipramine
  • Nortriptyline
  • Amitriptyline
  • Imipramine
  • Maprotiline
  • Desipramine
  • Trimipramine
  • Protriptyline

These work on more than one chemical in your brain. But, they are toxic if taken in large doses. They're not used for people who think about taking their own life. Tricyclics don't cause addiction.

Some problems are:

  • Lightheadedness
  • Dry mouth
  • Constipation
  • Problems passing urine
  • Low blood pressure
  • Irregular or rapid heartbeat
  • Drowsiness
  • Nausea
  • Diarrhea
  • More hunger than normal or weight gain
  • Nervousness
  • Vision problems
  • Problems with sex—can be with arousal, ED, and delayed time to or lack of orgasm
  • Serotonin syndrome—happens when there is too much serotonin, which can be serious
  • Risk of severe changes in your mood and behavior. This may also include self-harm or trying to take your own life:
    • Young adults may be at a higher risk
    • The risk is greatest in the first few weeks of starting these
 

Monoamine Oxidase Inhibitors (MAOIs)

Common names include:

  • Isocarboxid
  • Phenelzine
  • Tranylcypromine
  • Selegiline patch

MAOIs will keep brain chemicals from being broken down. These may help people who haven't had success with other types of medicine.

If you take MAOI, you will need to make changes in how you eat to keep a certain substance called tyramine from building up in your body. Not doing so can cause a hypertensive crisis, which can lead to death.

You will have to avoid:

  • Alcohol
  • Certain types of cheeses
  • Overripe or spoiled fruits
  • Chicken and beef liver
  • Dried meats
  • Certain kinds of beans
  • Monosodium glutamate (MSG)

Some other problems are:

  • Lightheadedness, sleepiness, blurred vision, problems thinking clearly
  • Headache
  • Constipation
  • Insomnia
  • Skin irritation—selegiline patch
  • Problems with sex—can be with arousal, ED, and delayed time to or lack of orgasm
  • Serotonin syndrome—happens when there is too much serotonin, which can be serious
  • Risk of severe changes in your mood and behavior. This may also include self-harm or trying to take your own life:
    • Young adults may be at a higher risk
    • The risk is greatest in the first few weeks of starting these
  • High blood pressure—rare

MAOIs can cause problems when mixed with many other types of drugs, even other antidepressants. Ask your doctor about what you will need to avoid.

 

Other Antidepressants

  • Trazodone
  • Nefazodone
  • Bupropion
  • Mirtazapine

There are many other types that work in different ways. These change the levels of brain chemicals that keep your moods level.

Nefazodone has been associated with reports of life-threatening liver failure. People with liver disease shouldn't take it. Those who are taking nefazodone are advised to report liver problems right away. These may be jaundice, loss of hunger, feeling ill, and problems with your gastrointestinal system.

Some problems are:

  • Lightheadedness
  • Dry mouth
  • Constipation
  • Problems passing urine
  • Low blood pressure
  • Sedation
  • Nausea
  • Diarrhea
  • More hunger than normal or weight gain
  • Less hunger than normal or weight loss
  • Nervousness
  • Vision problems
  • Problems with sex—can be with arousal, ED, and delayed time to or lack of orgasm
  • Serotonin syndrome—happens when there is too much serotonin, which can be serious
  • Risk of severe changes in your mood and behavior. This may also include self-harm or trying to take your own life:
    • Young adults may be at a higher risk
    • The risk is greatest in the first few weeks of starting these

Special Considerations

If you are taking medicines:

  • Take the medicine as directed. Don’t change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Don’t share your prescription medicine.
  • Medicines can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medicine. This includes over-the-counter products and supplements.
  • Plan for refills as needed.

When to Contact Your Doctor

Contact your doctor if you:

  • Have any questions about your medicines
  • Have problems with side effects
  • Feel like the medicine isn't working as it should

Get help right away if you have thoughts of hurting yourself or others.

REFERENCES:

Antidepressant medication and suicide risk. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T921684/Antidepressant-medication-and-suicide-risk. Updated March 27, 2018. Accessed October 9, 2018.

Antidepressant medication overview. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T113820/Antidepressant-medication-overview. Updated April 2, 2018. Accessed October 9, 2018.

Bailly D. Antidepressant use in children and adolescents. Arch Pediatr. 2009;16(10):1415-1418.

Brent DA. The treatment of SSRI-resistant depression in adolescents (TORDIA): in search of the best next step. Depress Anxiety. 2009;26(10):871-874.

Depression. National Institute of Mental Health website. Available at: https://www.nimh.nih.gov/health/topics/depression/index.shtml. Updated February 2018. Accessed October 9, 2018.

Depressive disorders. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/psychiatric-disorders/mood-disorders/depressive-disorders. Updated May 2018. Accessed October 9, 2018.

Low tyramine diet. UW Health website. Available at: https://www.uwhealth.org/healthfacts/nutrition/154.pdf. Accessed October 9, 2018.

Major depressive disorder (MDD). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116638/Major-depressive-disorder-MDD. Updated August 23, 2018. Accessed October 9, 2018.

Price J, Cole V, Goodwin GM. Emotional side-effects of selective serotonin reuptake inhibitors: qualitative study. Br J Psychiatry. 2009;195(3):211-217.

Suicidality in children and adolescents being treated with antidepressant medications. US Food & Drug Administration website. Available at: https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm161679.htm. Updated February 5, 2018. Accessed October 9, 2018.

7/28/2014 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T921684/Antidepressant-medication-and-suicide-risk: Miller M, Swanson SA, Azrael D, Pate V, Stürmer T. Antidepressant dose, age, and the risk of deliberate self-harm. JAMA Intern Med. 2014;174(6):899-909.

7/28/2014 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113820/Antidepressant-medication-overview: Barbui C, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ. 2009;180(3):291-297.

Last reviewed September 2018 by EBSCO Medical Review Board Adrian Preda, MD  Last Updated: 10/9/2018