A Guide to Depression Medication: Everything you Need to Know About Antidepressants

According to the National Institute of Mental Health (NIMH), an estimated 21 million adults in the US had depression in 2021 [17]. Depression can have a significant impact on individuals, leading to ongoing feelings of sadness, hopelessness, and worthlessness. It can also disrupt sleep, appetite, and energy levels, significantly affecting daily functioning and overall quality of life.

Thankfully, various depression medications can help with symptoms and improve quality of life and well-being, as well as other treatment options like Transcranial Magnetic Stimulation (TMS) and psychotherapy. In this article, we explore medications and treatment options, shedding light on how they work, their potential side effects, and when they may be recommended to help you navigate your mental health journey and make informed choices.

What is Depression

Depression, also known as major depressive disorder, is a common and serious medical condition that affects how you feel, think, and act. People with depression may lose interest in activities they once enjoyed, experience changes in appetite and sleep patterns, and feel tired or lack energy. They may also struggle with feelings of worthlessness or guilt, have difficulty concentrating, and, in severe cases, think about death or suicide. Getting help from healthcare professionals is essential for diagnosis and treatment [1].

Related: What is Depression? From Diagnosis to Treatment

Purpose of Depression Medication

Depression medicines help manage symptoms of depression by balancing chemicals in the brain. These medications can improve mood, increase energy levels, and help individuals function better in their daily lives. They are often necessary for treating severe or persistent depression, where other methods, like therapy alone, may not be enough. By stabilizing mood and reducing symptoms, these medications allow people to engage more effectively in different treatments and activities that support recovery [12].

Conditions Treated by Depression Medications

Antidepressants are commonly prescribed to treat depression and various mood disorders; these include [8]:

• Clinical depression (major depressive disorder)
• Bipolar depression
• Persistent depressive disorder (PDD)
• Premenstrual dysphoric disorder (PMDD)
• Atypical depression
• Seasonal depression (seasonal affective disorder)

Other Mental Health Conditions:

In addition to alleviating depression, they are also effective for several other conditions, such as [8]:

• Bulimia: An eating disorder that causes binge eating followed by purging.
• Generalized anxiety disorder (GAD): A condition involving persistent and excessive worry about various aspects of life.
• Obsessive-compulsive disorder (OCD): A disorder where individuals have recurring, unwanted thoughts (obsessions) and behaviors (compulsions) that they feel driven to repeat.
• Panic disorder: A condition that causes sudden and repeated episodes of intense fear accompanied by physical symptoms.
• Post-traumatic stress disorder (PTSD): A condition that develops after experiencing or witnessing a traumatic event, leading to severe anxiety, flashbacks, and other symptoms.
• Social anxiety disorder (social phobia): Involves intense fear and avoidance of social situations.

Antidepressant Types

Antidepressants are prescription medications that help manage the symptoms of depression by influencing certain brain chemicals called neurotransmitters. There are several types of antidepressants, each working in different ways and having various side effects.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are often the first choice for treating depression because they generally have fewer side effects than other antidepressants. They work by increasing serotonin levels in the brain [9, 13-14].

Common side effects:

Common side effects include:

• Dry mouth
• Nausea
• Diarrhea
• Headache
• Insomnia
• Drowsiness
• Fatigue
• Sexual dysfunction
• Weight gain
• Increased appetite

Generic and Brand Names

SSRIs are available in many different generic and brand names; these include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Sertraline (Zoloft)
• Paroxetine (Paxil, Pexeva)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Vilazodone (Viibryd)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs affect the neurotransmission involving both serotonin and norepinephrine, helping to better regulate mood and behavior.

Common Side Effects

Common side effects include [8, 13-14]:

• Nausea
• Increased appetite
• Weight gain
• Fatigue
• Drowsiness
• Insomnia
• Dry mouth
• Dizziness
• Sweating
• Increased blood pressure

Generic and Brand Names

SNRIs are available in many different generic and brand names; these include:

• Duloxetine (Cymbalta, Drizalma Sprinkle)
• Venlafaxine (Effexor XR)
• Desvenlafaxine (Pristiq)
• Levomilnacipran (Fetzima)

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs affect the brain’s use of several neurotransmitters, including serotonin, norepinephrine, and dopamine. They require dietary modifications to avoid hypertensive reactions caused by interactions with certain foods.

Common Side Effects

Common side effects may include [8, 13-14]:

• Dry mouth
• Nausea
• Diarrhea
• Constipation
• Headache
• Drowsiness
• Insomnia
• Increased appetite
• Weight gain
• Fatigue
• Insomnia
• Sexual side effects
• Heart-related effects

Risks and Considerations

MAOIs require strict dietary restrictions to prevent high blood pressure and the risk of hypertensive reactions.

Generic and Brand Names

MAOIs are available in many different generic and brand names; these include:

• Tranylcypromine (Parnate)
• Phenelzine (Nardil)
• Isocarboxazid (Marplan)
• Selegiline (Emsam) – patch form

Atypical Antidepressants

Atypical antidepressants work in various ways to alter brain neurotransmitter activity, but they don’t fit into the other specific categories of antidepressants.

Potential side effects include [8, 13-14]:

• Nausea
• Increased appetite
• Weight gain
• Fatigue
• Drowsiness
• Insomnia
• Dry mouth
• Sexual side effects

Generic and Brand Names

Atypical Antidepressants are available in many different generic and brand names; these include:

• Trazodone
• Mirtazapine (Remeron)
• Vortioxetine (Trintellix)
• Vilazodone (Viibryd)
• Bupropion (Forfivo XL, Wellbutrin SR, others)

Tricyclic Antidepressants (TCAs)

TCAs affect the brain’s use of serotonin and norepinephrine but are often reserved when other medications don’t work for treatment-resistant cases due to their higher rate of side effects.

Potential Side Effects

Potential side effects include [13]:  

• Nausea
• Increased appetite
• Weight gain
• Fatigue
• Drowsiness
• Insomnia
• Dry mouth
• Constipation
• Dizziness
• Sexual side effects

Other possible side effects may include:

• Heart rhythm issues
• Low blood pressure
• Rigid muscles
• Mental confusion
• Coma (in case of overdose)

Generic and Brand Names

Tricyclic antidepressants are available in many different generic and brand names; these include:

• Imipramine
• Nortriptyline (Pamelor)
• Amitriptyline
• Doxepin
• Desipramine (Norpramin)

NMDA Antagonists

NMDA (N-methyl-D-aspartate) antagonists interact with the NMDA receptors in the brain, crucial for processes like learning, memory, and mood regulation [20]. Drugs such as ketamine and its derivatives, like arketamine, block these receptors, reducing glutamate activity—a neurotransmitter that excites nerve cells and influences pain perception and mood [20].

Medications like ketamine and esketamine, both NMDA antagonists, primarily affect brain communication between nerve cells. Widely used in psychiatry, they can rapidly alter mental states, from mild euphoria to hallucinations and more severe disturbances [16].  

Side Effects

Like all medications, NMDA antagonists can cause side effects. Common ones include [5, 18, 20]:

• Dissociation (feeling disconnected from oneself or surroundings)
• Hallucinations
• Dizziness
• Nausea
• Vertigo
• Anxiety
• Sedation

Changes in blood pressure and heart rate

Esketamine (Spravato) and Auvelity are two NMDA Antagonist medications that may be used to treat depression, and each is slightly different.

Esketamine (Spravato)

Spravato, also known as esketamine, is a form of ketamine that is designed to have antidepressant effects. The FDA has approved it for intranasal delivery. It is used to treat treatment-resistant depression and major depressive disorder in patients with acute suicidal thoughts or behavior [5].

Unlike traditional antidepressants that target serotonin or norepinephrine, esketamine works by blocking N-methyl-D-aspartate (NMDA) receptors, which enhances glutamatergic neurotransmission and is believed to lead to rapid antidepressant effects [5, 18]. Due to its potential side effects, Spravato should only be administered under direct healthcare supervision, with patients being monitored for at least two hours after receiving the dose.

While it provides a new option for treatment-resistant depression, Spravato should be used alongside an oral antidepressant and under careful medical oversight due to its risks and side effects [5, 18]. Clinical trials have shown significant improvement in depressive symptoms within 24 hours of administration.

Auvelity (Brand Name)

Auvelity, a medication approved by the FDA in 2022 for treating major depressive disorder in adults, is one of the newest antidepressants on the market. It is a combination of dextromethorphan and bupropion [6]. Since it’s a new product, a generic version won’t be available until the patent expires in 2034 [10]. 

Dextromethorphan hydrobromide, commonly used in cough suppressants, enhances the antidepressant effects of Auvelity by affecting certain brain chemicals involved in regulating mood and emotions. Bupropion hydrochloride, an antidepressant, works by increasing dopamine and norepinephrine levels in the brain. These are crucial for maintaining mental balance, which is often disrupted in individuals with depression.

These two components in Auvelity alleviate depression symptoms by targeting multiple brain pathways involved in mood regulation. Clinical studies have shown that this combination effectively reduces the severity of depressive symptoms, as measured by standardized scales like the Montgomery-Asberg Depression Rating Scale (MADRS) [3].

Side Effects

Common side effects include [4]:

• Dizziness
• Headache
• Diarrhea
• Sleepiness
• Dry mouth
• Sexual problems
• Excessive sweating

Severe Side Effects:

Auvelity can lead to severe adverse reactions. These include [3]:

• Seizures: there is a risk of experiencing seizures, especially in individuals who misuse alcohol or abruptly stop using certain medications such as benzodiazepines.
• Increased Blood Pressure: This medication may cause elevated blood pressure and hypertension, which can worsen when combined with certain medications or substances like MAOIs.
• Neuropsychiatric Effects: Some users may experience changes in mood, including symptoms like hallucinations, paranoia, or confusion. These reactions can be severe and require immediate medical attention.
• Serotonin Syndrome: This condition can occur, particularly when this medication is used alongside other antidepressants such as SSRIs or tricyclic antidepressants, leading to symptoms such as agitation, hallucinations, rapid heartbeat, and unconsciousness.

Who Should Avoid Auvelity:

Certain individuals should not take Auvelity or should use it with caution under medical supervision [3]:

• Pregnant or Nursing Women: Due to potential risks to the fetus or infant, pregnant women or those breastfeeding should avoid using this medication.
• People with Seizure Disorders: Individuals with a history of seizures or conditions that lower the seizure threshold should avoid this medication.
• Those with Hypersensitivity Reactions: Individuals who have experienced severe allergic reactions or hypersensitivity to any component of this medication should not use it.
• Patients with Glaucoma: This medication can cause pupillary dilation, which may lead to acute angle-closure glaucoma in susceptible individuals.

Antidepressant Withdrawal

Antidepressant withdrawal syndrome, also known as antidepressant discontinuation syndrome, is a common occurrence affecting about 20% of patients who abruptly stop or significantly reduce their antidepressant medication after taking it continuously for at least a month.

Symptoms typically emerge within two to four days after stopping the medication and can last for one to two weeks, though in some cases, they may persist for up to a year.

Side effects can vary from person to person, including [11]:

• Flu-like symptoms
• Headaches
• Sweating
• Sleep problems such as insomnia or intense dreams
• Nausea
• Vomiting
• Dizziness
• Vertigo
• Tingling or burning sensations
• Anxiety
• Irritability or aggression

Patients should not stop taking antidepressants without first consulting with their healthcare provider. If a medication isn’t working or produces uncomfortable side effects, a physician may switch the patient to another medication. If the decision is made to stop a medication, the physician can help instruct how to discontinue it safely and prevent side effects. 

Alternative Treatments

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS) is a noninvasive brain stimulation technique used to treat depression [15, 19]. TMS uses magnetic fields to stimulate parts of the brain that affect mood regulation. It works by delivering repeated magnetic pulses to the dorsolateral prefrontal cortex, a region of the brain involved in mood control.

Psychotherapy

Psychotherapy involves a collaborative process between a psychologist, therapist, and patient to address mental health challenges. The patient plays an active role in setting goals and participating in treatment discussions. The therapist provides support and guidance to help patients better understand their emotions, behaviors, and thoughts to improve their overall well-being and quality of life.

Talk therapy can help treat depression by teaching new problem-solving skills and coping strategies that can be applied to real-life situations.

There are several types of therapy, but two that are commonly used to treat depression include:  

• Cognitive-behavioral therapy (CBT): CBT helps change negative thought patterns and behaviors.
• Interpersonal therapy (IPT): IPT aims to enhance relationships and communication abilities.

These therapies for depression aim to alleviate symptoms and prevent depression relapse [2].

Combination of treatments

When addressing depression, a combination of psychotherapy and medication is often recommended for its comprehensive benefits. This approach leverages the therapeutic tools of psychotherapy to manage symptoms and tackle underlying issues, complemented by the supportive effects of antidepressant medications. For cases where symptoms persist despite medication, integrating Transcranial Magnetic Stimulation (TMS) alongside antidepressants has demonstrated notable efficacy. This combined strategy aims to enhance treatment outcomes by targeting mood-regulating brain regions and offering a holistic approach to managing depression.

Psychotherapy with Antidepressant Medications:

In managing depression, a combined approach involving psychotherapy and medication is often considered the most effective. Psychotherapy alone can be beneficial for mild to moderate cases, offering tools to cope with symptoms and address underlying issues.

However, for severe depression or when individuals find it challenging to engage in therapy fully, adding medication can provide additional support. This dual approach aims to alleviate symptoms comprehensively, enhancing the overall effectiveness of treatment strategies for depression [2].

Antidepressant Medications with TMS:

Combining Transcranial Magnetic Stimulation (TMS) with antidepressants has shown promising results in treating depression. Studies have indicated that the combination can significantly improve response rates compared to antidepressants alone. For instance, research published in the American Journal of Psychiatry found that patients who received TMS in addition to medication experienced a response rate of 58%, compared to 37% with medication alone [7].

This approach not only enhances the overall effectiveness of treatment but also offers a viable option for individuals who may not fully respond to antidepressants alone. TMS targets specific brain regions involved in mood regulation, potentially addressing treatment-resistant symptoms and providing a more holistic approach to managing depression.  

Integrating psychotherapy with medications or combining antidepressants with TMS offers comprehensive approaches to managing depression, ensuring tailored care to meet varying patient needs and treatment responses.

Find out if Depression Medication is Right for You

Understanding depression medications empowers individuals to make informed choices for their mental health. Each medication and treatment type offers unique benefits and considerations, from SSRIs to innovative treatments like TMS.

Although mood and anxiety disorders are highly treatable, many people struggling with their mental health go a long time between developing symptoms and receiving appropriate treatment and support. Early intervention can make a big difference by saving a person and their loved ones from stress, developing more serious symptoms, and reducing the likelihood of problems with work, family, school, and substance misuse. If you think you may need antidepressants, it’s important to speak with a psychiatrist or other mental health professional.

If you or a loved one is experiencing depression, don’t wait to seek help. Contact Neuro Wellness Spa today and take the first step towards feeling better. We offer a range of depression treatment options, including medication management if our psychiatrists think depression medication is right for you, talk therapy that incorporates a wide range of therapeutic modalities that have been proven to be effective for treating and managing depression, and TMS therapy which targets specific regions of the brain that have been affected by depression. Our dedicated team of caring professionals is here to support you on your journey to recovery. Reach out now to discover the best treatment plan for you.

Frequently Asked Questions

What is the most used medication for depression?

The most commonly used medications for depression are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Examples include fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro) as SSRIs, and venlafaxine (Effexor), duloxetine (Cymbalta) as SNRIs. These medications are often prescribed due to their effectiveness and relatively fewer side effects compared to older antidepressant classes.

How do I know if I need an antidepressant?

If you experience any of the following, it is a good idea to discuss these with your physician or healthcare provider, who can help determine if starting or adjusting an antidepressant treatment is appropriate for managing your depression [14]:

• Persistent Symptoms: If you have ongoing symptoms of depression that haven’t improved with other treatments or lifestyle changes, an antidepressant may be considered.
• Side Effects: If previous treatments have caused intolerable side effects or haven’t relieved your symptoms effectively, switching to or adding an antidepressant could be beneficial.
• Family History: The effectiveness of antidepressants in close relatives can explain their potential effectiveness for you.
• Co-existing Conditions: If you have other conditions like anxiety or chronic pain alongside depression, an antidepressant that addresses multiple symptoms may be suitable.
• Pregnancy/Breastfeeding: If you’re pregnant, planning to become pregnant, or breastfeeding, balancing the risks and benefits of antidepressant use is important.

What is the safest antidepressant?

There is no single antidepressant that is considered the “safest.” The safety and effectiveness of antidepressants can vary from person to person. Like with any medication, there are risks with any antidepressant. What antidepressant is chosen should be decided based on individual factors, including potential side effects, interactions with other medicines, and each person’s specific symptoms.

How long do I need to take antidepressants for?

The length of time you need to take antidepressants will vary depending on your individual situation. Some people may only need to take them for a few weeks, while others may need to take them for several months or longer.

References:

1. American Psychiatric Association. Depression. Retrieved from https://www.psychiatry.org/patients-families/depression
2. American Psychological Association. (2023, December 12). Understanding psychotherapy and how it works. Retrieved from https://www.apa.org/topics/psychotherapy/understanding
3. Auvelity (dextromethorphan hydrobromide and bupropion hydrochloride) extended-release tablets, for oral use. (2022). Retrieved from https://www.axsome.com/auvelity-prescribing-information.pdf
4. Auvelity. What are some of the possible side effects? Retrieved from https://www.auvelity.com/side-effects
5. Bahr, R., Lopez, A., & Rey, J. A. (2019). Intranasal Esketamine (SpravatoTM) for Use in Treatment-Resistant Depression In Conjunction With an Oral Antidepressant. P & T: A Peer-Reviewed Journal for Formulary Management, 44(6), 340–375.
6. BioSpace. Axsome Therapeutics Announces FDA Approval of AUVELITY™, the First and Only Oral NMDA Receptor Antagonist for the Treatment of Major Depressive Disorder in Adults. August 19, 2022. Retrieved from https://www.biospace.com/article/releases/axsome-therapeutics-announces-fda-approval-of-auvelity-the-first-and-only-oral-nmda-receptor-antagonist-for-the-treatment-of-major-depressive-disorder-in-adults/
7. Brainsway. Medication vs. TMS Therapy for Depression. Retrieved from https://www.brainsway.com/knowledge-center/depression-medication-vs-tms-therapy/
8. Cleveland Clinic. Antidepressants. Retrieved from https://my.clevelandclinic.org/health/treatments/9301-antidepressants-depression-medication
9. Cleveland Clinic. SSRIs. Retrieved from https://my.clevelandclinic.org/health/treatments/24795-ssri
10. Drugs.com. Generic Auvelity Availability. Retrieved from https://www.drugs.com/availability/generic-auvelity.html
11. Gabriel, M., & Sharma, V. (2017). Antidepressant discontinuation syndrome. CMAJ: Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 189(21), E747. https://doi.org/10.1503/cmaj.160991
12. Kovich, H., Kim, W., & Quaste, A. M. (2023). Pharmacologic Treatment of Depression. American Family Physician, 107(2), 173–181.
13. Mayo Clinic. Antidepressants: Get tips to cope with side effects. Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20049305
14. Mayo Clinic. Antidepressants: Selecting one that’s right for you. Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273
15. Mayo Clinic. Transcranial magnetic Stimulation. Retrieved from https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
16. Moore, T. J., Alami, A., Alexander, G. C., & Mattison, D. R. (2022). Safety and effectiveness of NMDA receptor antagonists for depression: A multidisciplinary review. Pharmacotherapy, 42(7), 567–579. https://doi.org/10.1002/phar.2707
17. National Institute of Mental Health. Major Depression. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression
18. National Institute of Mental Health. Mental Health Matters Podcast: Depression: The Case for Ketamine. October 3, 2023. Retrieved from https://www.nimh.nih.gov/news/media/2023/depression-the-case-for-ketamine
19. Stern, A. P. (2020, October 27). Transcranial magnetic stimulation (TMMS): Hope for stubborn depression. Retrieved from https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335
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