Anti-depressant treatment options -
Most cases of increased risk of suicide were observed in adolescents and young people. One possible explanation is that it may be related to the increase in energy that comes early in treatment, before improvement in mood. In other words, antidepressants may give some people the energy to act on their suicidal thoughts.
Some antidepressants can also cause feelings of agitation, restlessness and detachment. These feelings may resemble symptoms of anxiety and may add to, rather than relieve, feelings of hopelessness and despair.
Some people may become suicidal or violent. This reaction to antidepressants is thought to occur in about four per cent of people who take them, with the risk being highest in the first few weeks of treatment.
Before starting treatment , prepare for the possibility of feeling worse before you feel better. Know what supports are available to you and who you can call.
When you begin treatment , monitor your thoughts and moods, and communicate any thoughts of hurting yourself or others with your doctor, a crisis line or the emergency department. If you experience an increase in suicidal thinking or anxiety, your doctor can help you decide if you should stop taking the medication or if you should try to be patient and give the medication a chance to work.
There are several classes of antidepressants; within each class there are many individual medications. While all antidepressants work well overall, no drug or type of drug works equally well for everyone who takes it.
You may be advised to try more than one type of antidepressant or to use a combination of antidepressants to seek relief from your distress. The different types of antidepressants are listed in the order in which they are most commonly prescribed.
Medications are referred to in two ways: by their generic name and by their brand or trade names. Brand names available in Canada appear in brackets. This group of drugs, including fluoxetine Prozac , paroxetine Paxil , fluvoxamine Luvox , citalopram Celexa , escitalopram Cipralex and sertraline Zoloft , is usually the first choice for treatment of depression and anxiety disorders.
These medications are known to have milder side-effects than some other antidepressants. Buspirone Buspar is similar to SSRIs and has been found to help with anxiety but not depression.
Common side-effects include nausea, vomiting, diarrhea, weight gain, dry mouth, headaches, anxiety, sedation and a decrease in sexual desire and response. This group of drugs may also cause a jittery or restless feeling and sleep difficulties, such as problems falling asleep, waking in the night, vivid dreams or nightmares.
This class of medications includes venlafaxine Effexor , duloxetine Cymbalta , levomilnacipran Fetzima and desvenlafaxine Pristiq. These drugs are used to treat depression, anxiety problems and chronic pain.
Common side-effects include nausea, drowsiness, dizziness, nervousness or anxiety, fatigue, loss of appetite and sexual problems. In higher dosage, these medications may increase blood pressure. The medication available in this class is bupropion Wellbutrin, Zyban. When used to treat depression, it is often given for its energizing effects, in combination with other antidepressants.
Mirtazapine Remeron , the medication available in this class, is the one of the most sedating antidepressants, making it a good choice for people who have insomnia or who are very anxious.
This medication also helps to stimulate appetite. This older group includes amitriptyline Elavil , , imipramine Tofranil , desipramine Norpramin , nortriptyline Aventyl , trimipramine Surmontil and clomipramine Anafranil. Because these drugs tend to have more side-effects than the newer drugs, they are not often a first choice for treatment.
However, when other drugs do not provide relief from severe depression, these drugs may help. Common side-effects include dry mouth, tremors, constipation, sedation, blurred vision, difficulty urinating, weight gain and dizziness.
Because cyclics may cause heart rhythm abnormalities, your doctor should order an electrocardiogram ECG before you take this medication. Monoamine oxidase inhibitors, or MAOIs, such as phenelzine Nardil and tranylcypromine Parnate were the first class of antidepressants.
MAOIs are effective, but they are not often used because people who take them must follow a special diet. A newer MAOI, moclobemide Manerix , can be used without dietary restrictions; however, it may not be as effective as other MAOIs.
Common side-effects include a change of blood pressure when moving from a sitting to a standing position orthostatic hypotension , insomnia, swelling and weight gain.
When you start a new antidepressant, the first step is to decide whether you can tolerate the side-effects; this should become clear within a few weeks. The next step is to decide whether the drug helps with your depression or anxiety.
Improvements should be seen in two to four weeks. Full remission is seen at six to twelve weeks. If the medication does work for you, your doctor will advise you to continue taking it for at least six to nine months after you start to feel its beneficial effects.
People who stop taking antidepressants too soon risk having the symptoms of their depression or anxiety problem return. Most people who take antidepressants need to take them for at least a year.
People who experience depression that keeps coming back may need to take them for a longer term. Drugs that are addictive produce a feeling of euphoria, a strong desire to continue using the drug, and a need to increase the amount used to achieve the same effect.
Antidepressants do not have these effects. Antidepressants do, however, have one thing in common with some addictive drugs—they can cause withdrawal effects when you stop taking them.
When you take antidepressants for months or years, your body adjusts to the presence of the drug. If you then stop using it, especially if you stop suddenly, you may experience withdrawal effects such as muscle aches, electric-shock-like sensations, dizziness, headache, nausea, chills and diarrhea.
These effects are most commonly reported with paroxetine Paxil and venlafaxine Effexor ; however, they can occur with any antidepressant. Some people find these effects distressing and have difficulty withdrawing from these drugs.
Whether you want to cut down your dose or stop taking a medication, the same rule applies: go slowly. Sudden changes in your dose can greatly increase your risk of having another mood episode or having withdrawal effects.
The first step is to ask yourself if this is the right time. Are you feeling well? Is the level of stress in your life manageable? Do you feel supported by your family and friends? If you are not satisfied with his or her reasons, you may want to see another doctor for a second opinion.
If your doctor does agree, he or she will advise you not to skip doses but to reduce your dose gradually—usually by about 10 per cent at a time—with at least two to three weeks between each reduction. This process of cutting back will take several months. Using a pill cutter can help you to cut your dose down in small amounts.
If you want to stop taking more than one medication, your doctor will usually suggest that you lower the dose of one drug at a time. As you cut down, if you start to feel unwell, let your doctor know. He or she can help you determine whether you are experiencing withdrawal effects or signs that symptoms are returning.
Find the dose that works best for you. Antidepressants may interact with some other types of medication, even over-the-counter medications, such as cold or allergy tablets or cough syrups, and some herbal remedies, such as St. Always ask your doctor, dentist or pharmacist about potential drug interactions with the medication you are taking before you take other medications.
Drinking alcohol can worsen symptoms of depression or anxiety. Alcohol can also worsen some side-effects of antidepressants, making you more sleepy, dizzy and lightheaded.
However, if you have been taking antidepressants for more than a few weeks, and you are feeling well, having a drink or two on occasion should be okay—but remember that one drink could have the effect of two or even three drinks.
The caffeine in coffee and other beverages can cause problems if you struggle with depression or anxiety. Depression disrupts sleep, and caffeine, a stimulant, can make the problem worse.
It is better to drink decaffeinated coffee and beverages or to decrease the amount you drink. You want to feel well. While street drugs such as marijuana or cocaine may have some effects that seem to make you feel better for a while, mixing the effects of these drugs may make your situation worse.
Street drugs may also interact with your medication, for example, by interfering with its effectiveness or by worsening side-effects. Depression itself can lead to fatigue and concentration problems, affecting your ability to drive.
Antidepressant medications may also cause drowsiness, especially in the early stages of treatment, before your body has adjusted to the medication. If you feel drowsy, do not drive a car or operate machinery. Alcohol, sedatives and antihistamines cold and hay fever medication will worsen the problem.
Antidepressants, especially those that increase serotonin activity, can also negatively affect sexual function. Sexual side-effects of antidepressants can include delayed ejaculation and the inability to experience an orgasm.
Many factors affect your sexuality. When antidepressants bring relief from the distress of depression or anxiety, this may help you to focus more on your partner and to feel more desire.
If you think your medication affects your sexual function, your doctor may be able to help by changing your dose, switching medication or adding other medications.
For any pregnant woman with a history of depression, the question of whether to take antidepressants during pregnancy usually comes down to a risk-benefit analysis.
When treatment with an antidepressant helps to avoid a relapse or to reduce distress, the benefits of continuing the medication may outweigh the risks. Antidepressants are relatively safe to use during pregnancy. When they are used close to delivery, newborns may be restless and irritable, and may have sleeping, feeding and breathing difficulties.
These problems resolve within three days to two weeks. Antidepressants do not increase risk for birth defects. The amount of antidepressant passed through breast milk is very small and is not considered to be a risk to the baby, especially when weighed against the benefits of breastfeeding.
In other words, taking an antidepressant over a long period of time successfully prevented a relapse in an average of 27 out of people. Like all medications, antidepressants can have side effects.
Over half of all people who take antidepressants have side effects. They usually occur during the first few weeks of treatment and are less common later on. Some of these side effects are believed to be a direct consequence of the medication's effect on the brain and are relatively similar among various drugs within the same group.
Examples include a dry mouth, headaches, dizziness, restlessness and sexual problems. These kinds of problems are often perceived to be side effects of the medications.
But some of them may be caused by the depression itself. Whether or not someone has side effects, which side effects they have, and how frequent they are will depend on the drug, the dose used, and whether they have just started taking it or have been taking it for some time. And everyone reacts slightly differently to drugs too.
The risk of side effects increases if you are also taking other medication. One of the drugs may make the side effects of the other worse. These kinds of drug interactions are common in older people and people with chronic illnesses who are taking several different kinds of medication.
For this reason, it's important to thoroughly discuss the pros and cons of the various medications with your doctor. The side effects of tricyclic antidepressants are often worse than those of SSRIs and SNRIs. More people tend to stop taking tricyclic antidepressants because of this: Studies found that about 15 out of people who were taking tricyclic antidepressants did so, compared to around 10 out of people who were taking SSRIs.
There's also a greater risk of severe side effects if an overdose of tricyclic antidepressants is taken. Antidepressants can cause dizziness and unsteadiness, increasing the risk of falls and bone fractures, especially in older people. Interactions with other medications can increase this risk.
A very small number of people have had heart problems, epileptic fits or liver damage while taking antidepressants. It is believed that these were rare side effects of antidepressants. Various studies suggest that teenagers are more likely to think about killing themselves committing suicide when taking SSRIs or SNRIs, and also actually attempt to take their own lives more often.
Because of this, teenagers should see their doctor or therapist more regularly at the beginning of treatment so that any risk of suicide can be identified early on.
Whether antidepressants are an option will depend on things like the severity of the symptoms. Other aspects can also play a role in the decision:. The question of side effects can also be key when choosing which drug to take: Some people might be more keen to avoid digestion problems.
Others might prefer to avoid dizziness, decreased sex drive or erection problems. It only makes sense to use antidepressants if the diagnosis is correct. Specialists believe that some people are prescribed antidepressants unnecessarily.
The fact that a lot more people take antidepressants nowadays suggests that this is true. They are sometimes already prescribed for milder symptoms, even though it's not clear whether they help in mild depression. But it's still important to make sure that severe depression is diagnosed and treated properly.
Antidepressants can be helpful here, and for some people may be the only way that they can get back into a daily routine or start going to psychotherapy.
IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services. Because IQWiG is a German institute, some of the information provided here is specific to the German health care system.
The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations. Our information is based on the results of good-quality studies.
It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.
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Show details Cologne, Germany: Institute for Quality and Efficiency in Health Care IQWiG ; Search term. Depression: How effective are antidepressants?
What antidepressants are available? This article is mainly about the most commonly used antidepressants: Tricyclic antidepressants TCAs. How do antidepressants work? What does the treatment involve? How effectively do antidepressants relieve the symptoms?
Studies involving adults with moderate or severe depression have shown the following: Without antidepressants: About 20 to 40 out of people who took a placebo noticed an improvement in their symptoms within six to eight weeks. With antidepressants: About 40 to 60 out of people who took an antidepressant noticed an improvement in their symptoms within six to eight weeks.
How well can antidepressants prevent relapses? Relapse prevention may be a good idea for people who have already had several relapses,.
have chronic depression. Without preventive treatment: About 50 out of people who took a placebo had a relapse within one to two years. With preventive treatment: About 23 out of people who took an antidepressant had a relapse within one to two years.
What are the side effects of antidepressants? Some side effects are more common with particular drugs: SSRIs are more likely than tricyclic antidepressants to cause diarrhea, headaches, sleep problems and nausea.
Compared to SSRIs, tricyclic antidepressants are more likely to cause vision problems, constipation, dizziness, a dry mouth, trembling and difficulty urinating peeing.
Severe side effects Antidepressants can cause dizziness and unsteadiness, increasing the risk of falls and bone fractures, especially in older people. What should you consider when deciding whether or not to take antidepressants?
Other aspects can also play a role in the decision: Are you going to psychotherapy or are you planning to? Sources Arroll B, Elley CR, Fishman T, Goodyear-Smith FA, Kenealy T, Blashki G et al.
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Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA ; 1 : Gartlehner G, Gaynes BN, Amick HR, Asher G, Morgan LC, Coker-Schwimmer E et al.
Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder. December Comparative Effectiveness Reviews; Volume Gartlehner G, Hansen RA, Morgan LC, Thaler K, Lux LJ, Noord M et al.
Second-generation antidepressants in the pharmacologic treatment of adult depression: an update of the comparative effectiveness review. AHRQ Comparative Effectiveness Reviews; Volume Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E et al.
Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet ; : Hetrick SE, McKenzie JE, Cox GR, Simmons MB, Merry SN. Newer generation antidepressants for depressive disorders in children and adolescents.
Antidepressant medications Diabetes management technology most commonly used to Anti-deprsssant relieve the Anti-depressant treatment options of depression or anxiety. They are also used to help with Anti-depresasnt conditions such as bulimia and chronic pain. Antidepressants help many people. However, they don't work for everyone. Even when they do work well, they can only do so much. They often work best when they are combined with talk therapy, support from family and friends and self-care e. Antidepressants can take up to several weeks to be fully effective.
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