Depression is a serious medical illness. Also called “major depressive disorder,” or “unipolar depression,” it affects about 350 million people worldwide and is a leading cause of disability, according to the World Health Organization.
If you have depression, you may not recognize the symptoms or may think symptoms are due to a lack of sleep or a poor diet. Or you may realize you’re depressed but feel too tired or ashamed to seek help.
Not all depression requires treatment with medication. But medications approved for the treatment of depression by the U.S. Food and Drug Administration (referred to here as “antidepressants”) can help improve symptoms in some people.
Diagnosis—which should be from a health care professional—depends on the number, severity, and duration of depressive symptoms, which can include:
- depressed mood
- loss of interest or pleasure in almost all activities
- changes in appetite or weight
- disturbed sleep or sleeping too much
- slowed or restless movements
- fatigue or loss of energy
- feelings of worthlessness or excessive guilt
- trouble in thinking, concentrating, or making decisions
- thoughts of death or suicide
Doctors typically consider your history and review your behavior and mental status when evaluating a possible diagnosis of depression. Then, a doctor can evaluate symptoms, rule out physical causes of depression (such as thyroid disease or Parkinson’s disease), and decide if depression is an appropriate diagnosis.
Doctors should also screen you for bipolar disorder, a brain disorder that causes unusual shifts in mood, energy, and activity levels, as well as changes in your ability to do everyday tasks. If certain medications approved for treatment of depression are wrongly prescribed to a person with bipolar disorder, they can cause mania, a type of unusually elevated or excited mood. If mania is severe, a person can become psychotic. (Read this Consumer Update for more on bipolar disorder.)
Treatment with Medication
Antidepressants are medications that are thought to work by changing brain chemicals called neurotransmitters—primarily serotonin, norepinephrine, and dopamine—which are involved in regulating mood.
Some antidepressants have classifications:
- selective serotonin reuptake inhibitors (SSRIs); examples are Prozac (fluoxetine), Celexa (citalopram), and Paxil (paroxetine)
- serotonin norepinephrine reuptake inhibitors (SNRIs); examples are Effexor (venlafaxine) and Cymbalta (duloxetine)
- tricyclic antidepressants (TCAs); examples are Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline)
- monoamine oxidase inhibitors (MAOIs); examples are Nardil (phenelzine) and Parnate (tranylcypromine)
Other antidepressants include:
- Remeron (mirtazapine)
- Wellbutrin (bupropion)
Medications approved for treatment of depression affect different neurotransmitters in a variety of ways. For example, SSRIs increase the signaling of serotonin in the brain. And MAOIs block monoamine oxidase, an enzyme that breaks down neurotransmitters.
“Some evidence shows that the most effective way to treat many patients with depression is through both talk therapy and prescribed antidepressant medication,” adds Mitchell Mathis, M.D., director of the Division of Psychiatry Products at the FDA. Talk to your doctor about the best treatment for you.
In general, you must take regular doses of a prescribed antidepressant for several weeks before you’re likely to have the medication’s full effect.
You shouldn’t stop taking medication without talking with your doctor—even if you feel better. Stopping can result in withdrawal symptoms like anxiety and irritability. Or depression could return.
Note: A significant percentage of people may not respond to a prescribed antidepressant. In these cases, switching to a different medication or adding another medication can sometimes help treat symptoms. Some people may not respond to medication at all, Mathis notes. If you have concerns about antidepressants you are taking, talk with your doctor.
Common side effects of antidepressants can include:
- Nausea and vomiting
- Weight gain
- Sleep disturbances
- Sexual problems
It may take some time for your doctor to determine the medication that works best for you.
Some antidepressants can have serious risks. Discuss these risks with your doctor. Some of the relevant risks are listed below.
Suicidal thinking: In 2004, the FDA asked manufacturers to add a boxed warning to the labeling of all antidepressant medications. This labeling warns about the increased risk of suicidal thinking or suicidal behavior in children and adolescents taking antidepressants during initial treatment and with dose increases. In 2007, FDA requested that the warning be extended to include young adults through age 24.
If you or someone you know is having thoughts of suicide, you can immediately call your doctor; go to a hospital emergency room; or call the confidential and toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Birth defects: Some antidepressant medications might harm a fetus if taken during pregnancy. If you are considering an antidepressant medication and are pregnant, plan to become pregnant, or breastfeeding, talk to your doctor about benefits and risks.
High blood pressure: Those taking monoamine oxidase inhibitors must avoid certain foods that contain high levels of the chemical tyramine. This chemical is in many cheeses, wines and pickles, and some medications including decongestants. If you take MAOIs and consume this chemical, they may interact and cause a sharp increase in blood pressure, which could lead to a stroke or other complications. Talk to your doctor about the best diet for you.
Source: FDA Consumer Updates