Depression Health Center

Understanding Depression -- Diagnosis and Treatment

Medication for Depression continued...

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. 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 work more quickly than the TCAs, but they have more severe side effects and require a change in diet; severe high blood pressure can occur if patients on MAOIs eat foods containing tyramine, such as cheese, many beans, some medications, and various alcoholic beverages. MAOIs are usually prescribed only if the SSRIs and the TCAs fail to bring improvement.

Lithium carbonate, which is the drug commonly used for manic depression, is used to treat depression as well by adding it to 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, regardless of the presence or absence of 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, making it important to discuss their pro's and con's relative to other treatment options with your doctor.  

Other Treatments for Depression

Electroconvulsive therapy (ECT) involves the application of an electric current through electrodes on the head. These are not felt by the patient, who is asleep under general anesthesia. Although doctors are still uncertain exactly how ECT works, it is thought that by producing a brief seizure, a course of ECT over several treatments can bring about relief from depression.  Its techniques have been refined in the past 20 years in order to minimize side effects such as memory loss, and today ECT is considered to be as safe or even safer than many drugs used to treat depression -- and in some cases more effective. Although ECT is usually considered only after a number of other options have been considered -- because it may require hospitalization and general anesthesia -- or if rapid results are vital, as with suicidal patients or those who refuse to eat or drink, it should not be thought of as a "last resort;" ECT is extremely effective and may work before other treatments have been tried and failed.  Usually given three times a week for two to four weeks, treatments generally don't extend beyond six to 12 sessions.