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Depression Health Center

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Treatment-Resistant Depression

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Medications for Treatment-Resistant Depression continued...

  • Switching medicines. There are a number of different classes of antidepressants, including SSRIs (such as Celexa, Lexapro, Paxil, Prozac, and Zoloft) and SNRIs (such as Cymbalta, Effexor, Khedezla, Fetzima, and Pristiq). Newer antidepressant medicines that affect many different serotonin receptors in the brain include Brintellix and Viibryd. Older classes of antidepressants include tricyclics (like Adapin, Aventyl, Elavil, Pamelor, and Tofranil ); tetracyclics (like Asendin, Ludiomil, Mazanor, and Remeron). Some "novel" antidepressants, such as Wellbutrin or Remeron, are thought to affect the brain chemicals dopamine and norepinephrine through unique mechanisms, and are often combined with other antidepressants in order to take advantage of their combined effects. Another older class of antidepressants, called MAO inhibitors (such as Emsam, Marplan, Parnate, and Nardil) affect a special enzyme inside brain cells that can increase the functioning of several different neurotransmitters. Sometimes, switching from one class of antidepressant to another can make a difference.
    Another option is to switch from one drug to another in the same class. A person who wasn't helped by one SSRI could still benefit from a different one.
  • Adding a medicine. In other cases, your doctor might try adding a new medicine to the antidepressant you're already using. This can be especially helpful if your current drug is partly helping, but not completely relieving your symptoms.
    What medicines might he or she try? One option is to add a second antidepressant from a different class. This is called combination therapy.Another approach is called augmentation therapy: adding a medicine not typically used to treat depression, like lithium, an anticonvulsant, or an antipsychotic. Abilify and Seroquel are FDA approved as add-on therapies to an antidepressant for treatment-resistant depression. Symbyax is a combination drug that contains the active ingredients in Zyprexa and Prozac together in one tablet and is approved for the acute treatment of treatment-resistant depression. One drawback to this approach is that the more medicines you take, the greater potential for side effects.

    People have different reactions to the drugs used for treatment-resistant depression. The medicine that works best for one person might have no benefit for you. And unfortunately, it's hard for your doctor to know beforehand what drug or combination of drugs will work best. Arriving at the right treatment can take patience.

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