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    Understanding Depression -- Diagnosis and Treatment

    Medication for Depression

    The group of antidepressants most frequently prescribed today consists of drugs that regulate the chemical serotonin. Known as selective serotonin reuptake inhibitors (SSRIs), the group includes Paxil, Prozac, Celexa, Lexapro, and Zoloft. Serotonin norepinephrine reuptake inhibitors (SNRIs) including Effexor, Khedezla, Pristiq, Fetzima, and Cymbalta, also act on serotonin and norepinephrine but in a different way than SSRIs. The drugs Brintellix and Viibryd affect the serotonin receptor (like SSRIs) but also affect other receptors related to serotonin function. Other antidepressants include Wellbutrin, a drug that appears to affect dopamine and norepinephrine regulation, and Remeron, which increases levels of serotonin and norepinephrine by a different mechanism than SNRIs. For children and adolescents, the SSRIs are among the best-studied and therefore often the drugs of choice.

    The tricyclic antidepressants (TCAs), which have been used to treat depression since the 1950s, are another option, although they are apt to have more side effects than the SSRIs. Like all antidepressant drugs, you must take them for a while before they take effect. TCAs include Amitriptyline, Amoxapine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, and Trimipramine.

    Because adolescents do not tolerate side effects well and tend to stop taking their medication, TCAs are not recommended for them as first-line treatments. In addition, heart rhythm problems have been seen in children and adolescents taking desipramine, a TCA, so caution should be taken when this medication is prescribed to this population.

    The third group of antidepressants, the monoamine oxidase inhibitors (MAOIs), like Parnate, Nardil, and the skin patch EMSAM, have also proved effective. MAOIs may sometimes work more quickly than the TCAs, but they require avoiding certain foods (such as aged meats and cheeses) and certain other medicines that can also affect serotonin or raise blood pressure. MAOIs are usually prescribed only if the SSRIs and the TCAs or other depression medicines that can be simpler to take fail to bring improvement.

    Lithium carbonate, which is a drug commonly used for manic depression, is also sometimes used to treat depression in combination with an antidepressant. Today, atypical antipsychotics have become the most widely prescribed class of medications that are added on to an antidepressant after an incomplete initial response. Two in particular, Seroquel XR and Abilify, are FDA-approved as add-on therapy for antidepressants, regardless of the presence or absence of psychosis (delusions or hallucinations). However, atypical antipsychotics can have many possible side effects, including weight gain, changes in blood sugar and cholesterol, sedation, and abnormal movements.

    Your health care provider can recommend the best medicine for you.

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