Managing Medications: Antidepressants

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Trying to sort through all the different medications available to treat depression can be overwhelming. Here, we’ve got a cheat sheet that covers some of the most widely used medications, how they work, their side effects and some patient anecdotes. Remember, side effects may go away within a few weeks of starting treatment, and it will likely take some trial and error to figure out which medications are best for each individual. Also, keep in mind that a medication’s effectiveness may decline over time.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Common medications: Zoloft, Celexa, Lexapro, Paxil, Prozac, Viibryd, Luvox

How they work: SSRIs are believed to balance out the brain’s serotonin.

Potential side effects: Nausea, agitation or nervousness, dizziness, decreased sexual function, headache, dry mouth, weight gain or loss, drowsiness, insomnia, vomiting, diarrhea.

User experience: “Zoloft made me tired, and Lexapro made me extremely tired. I’m on Prozac now, and it’s very helpful. I don’t have any suicidal thoughts, and I have a much better sense of normalcy.”
—Rick Hensel, 46, diagnosed at age 32.

“I liken depression to having a house with a hell cellar. What Zoloft did was keep me living in the main levels of the house again instead of keeping me locked in the cellar. It does have a numbing effect on emotion.”
—Jamie Morgan,* 39, diagnosed with postpartum depression at age 36.

Serotonin norepinephrine reuptake inhibitors (SNRIs)

Common medications: Effexor, Cymbalta, Fetzima, Pristiq

How they work: These medications are believed to balance serotonin and norepinephrine in the brain.

Potential side effects: Appetite changes, blurred vision, headaches, nausea, drowsiness, tremors, dry mouth, strange dreams, lightheadedness, fever or chills, constipation.

User experience: “I had night sweats with Effexor, which is, ironically, sometimes used to help women who have night sweats.”
—Laynie Morgenstein,* 37, diagnosed with postpartum depression at age 24.

“Once I started taking Cymbalta, I started making progress. The initial side effects I experienced are weird—clenching of teeth, muscle cramping, headaches, and trouble sleeping through the night, but those faded after the first few weeks or so.”
—Betsy Kennewick,* age 41, diagnosed at age 35.

“Cymbalta gave me erectile issues, but moving from a 90mg dose to 60mg solved the problem, so people with similar issues should ask their doctor for permission to experiment.”
—Jim Riske, 38, diagnosed at age 30.

“Cymbalta made me tired. I was on it several times. It worked very well at first, and the depression symptoms were much better. After about four weeks, things started to decline again. I felt tired and angry, and thoughts of suicide returned. It seems as if I built up a tolerance to the dosage.”
—Rick Hensel

“I had weird visual changes with Effexor, seeing lights in my peripheral vision. It didn’t resolve itself after a couple weeks, so my doctor switched me to something else.”
—Sarah Ludwig, 40, diagnosed at age 24.

Tricyclic antidepressants

Common medications: Anafranil, Elavil, Norpramin, Adapin, Tofranil, Pamelor, Vivactil, and Surmontil

How they work: Similar to SSRIs and SNRIs, but since they have more side effects, they are usually only prescribed when the others have failed to help.

Potential side effects: Sexual problems, twitching, fatigue, dry mouth, weight gain, dizziness, increased heart rate, drowsiness, bladder problems, constipation, blurred vision.

User experience: “I had to switch off both Elavil and Pamelor because my blood pressure would bottom out at random times and I’d collapse.”
—Jim Riske

Atypical antidepressants

Common medications: Remeron, Oleptro, Brintellix

How they work: These medications don’t really fit into any of the other categories, but they also help balance out neurotransmitters in the brain.

Potential side effects: Weight gain, drowsiness, fatigue, dry mouth, nausea, sweating, vomiting, bowel issues, headache, sexual difficulties, dizziness.

User experience: “Trazodone (Oleptro) was fantastic for sleep, but I found that I did things before bed that I had no memory of. There were a couple of points where decision-making was obviously compromised.”
—Jim Riske

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

Common medications: Wellbutrin, Aplenzin, Forfivo

How they work: These medications seem to balance the brain’s natural neurotransmitters.

Potential side effects: Dizziness, weight loss, restlessness, constipation, decreased appetite, tremor, anxiety, insomnia, diarrhea, dry mouth, seizures.

User experience: “Wellbutrin also gave me erectile issues.”
—Jim Riske

“Wellbutrin made me agitated, and I was shaky.”
—Rick Hensel

“I was on Wellbutrin for years, and then my hair started coming out in clumps, so my doctor switched me to something else. This is evidently a rare side effect because my doctor didn’t seem to believe me until he tried to put me back on it later and my hair immediately started coming out again. Otherwise, it worked great!”
—Sarah Ludwig

Monoamine Oxidase Inhibitors (MAOIs)

Common medications: Ensam, Marplan, Nardil, and Parnate

How they work: MAOIs stop the brain’s neurotransmitters from breaking down. They are not prescribed as often because of the interactions they tend to cause with other medications and the risk for high blood pressure.

Potential side effects: Insomnia, dizziness, dry mouth, appetite changes, high blood pressure and/or heart rhythm changes, weight gain, muscle twitching, decreased sexual function.

Bottom line:

“Have patience. Give the drugs time to kick in, but don’t hesitate to talk to your doctor about side effects. And don’t be embarrassed. You wouldn’t make fun of a diabetic for needing insulin, so why would you beat yourself up over this?”
—Jim Riske

“Keep a log or journal of the medications you take. During a depressive state, it’s hard to remember things and having the medication, the dosage, the dates taken, and how it’s worked or not is very important. Also, talk to your doctor honestly. Let him/her know how the medication is working and if you are having side effects. I especially speak to men on this point. If your medication decreases your libido or causes erectile dysfunction, let your doctor know.”
—Rick Hensel

* Name has been changed to protect privacy

SOURCES:

https://www.webmd.com/depression/symptoms-depressed-anxiety-12/antidepressants

https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273

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