Psychiatric Database for Writers: Antidepressants

Antidepressants are used for the treatment of depression and other disorders, like anxiety, pain, and difficulty with attention.  The following is a very general overview of antidepressant groups.

Tricyclics Antidepressants (TCA) were the first group of medications to emerge on the market for depression.  They are used for depression, anxiety, obsessive compulsive disorder, chronic pain, sleep, bedwetting, and other problems.  Examples include Imipramine (Tofranil) and Amitriptyline (Elavil). These medications are often quite sedating.  They’re often used in depressed patients with insomnia.  Side effects can include dry mouth, blurred vision, constipation, urinary retention, forgetfulness, and less common, confusion, low blood pressure, heart problems, seizures.  They are very dangerous in overdose.

Like TCA’s, Monoamine Oxidase Inhibitors (MAOI) have been on the market for many years.  They are very effective medications for depression and anxiety but are rarely prescribed due to potential interactions with food and other medications.  Examples include Tranylcypromine (Parnate) and Phenelzine (Nardil).  Side effects include weight gain or loss, sleepiness, low blood pressure, high blood pressure, and rarely coma.  Most newer psychiatrists don’t have experience prescribing these antidepressants.

With the discovery of Prozac in the 1990’s, Selective Serotonin Reuptake Inhibitors (SSRIs) are perhaps the most-used antidepressant group on the market.  They are used for depression & anxiety/panic attacks, as well as obsessive-compulsive disorder, mood disorder related to menstruation, and many other conditions.  This group includes Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft. These medications are well-tolerated and are typically safe in overdose.Side effects can include slight tremor, stomach upset, diarrhea or nausea, problems sleeping, sleeping too much, and sexual problems. Individually, Prozac is perhaps the most activating.  Most cause weight loss except Luvox.  Paxil is particularly effective for panic attacks.  Celexa, Lexapro, and Zoloft are good choices for medically complicated or older patients, due to fewer medication interactions.

Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s) are similar to SSRI’s, except they influence both Serotonin and Norephinephrine, which means they’re a little more likely to cause high blood pressure than SSRI’s and are typically more effective for treatment of pain than medications like Prozac.  Examples include Venlafaxine (Effexor) and Duloxetine (Cymbalta).  They are used for depression, anxiety, and sometimes for pain conditions, like fibromyalgia.  Side effects are similar to SSRI’s, apart from blood pressure changes.  They are very rarely fatal in overdose.  Cymbalta is considered better for pain management than Effexor.

Buproprion (Wellbutrin) is a “novel” antidepressant, in that it’s very unusual.  While most antidepressants work on Serotonin and Norepinephrine, Bupropion affects a chemical called dopamine.  It is used for depression and concentration, as well as smoking cessation, but isn’t good for anxiety.  Major side effects include shakiness/anxiety, problems sleeping. It is rarely associated with visual hallucinations and (especially at high doses) seizures.

When it comes to depression in people with insomnia, doctors often turn to sedating antidepressants. Mirtazapine (Remeron) is moderately sedating and can promote appetite, which can be helpful in underweight patients.  Trazodone is a very sedating antidepressant, so sedating in fact that most people can’t take a high enough dose for the antidepressant effect to kick in.  Trazodone is used mostly for sleep.  Side effects can include daytime sleepiness or slowing, painful erection of the penis (rare), and dizziness; it doesn’t usually cause weight gain.  Nefazodone, also called Serzone, is a sedating antidepressant that can cause mild weight gain, sleepiness, and rarely liver disease.  It isn’t used all that often due to risk of liver problems.


Alex Natalian, Psychiatrist and Author     Alex Natalian is a pseudonym for psychiatrist KRR.

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