Drug Treatment for Depression

Everybody's different -- and everyone's depression is different, too. So if you and your doctor decide to try medicine to help treat it, you’ll work together to find one that helps.

Prescription drugs that lift your mood are called antidepressants. It may take some trial and error until you find one that's a good fit for your symptoms.

Keep in mind that depression treatment tends to have the best results when you also get counseling (“talk therapy”) and make lifestyle changes, like regular exercise. You and your doctor should talk about that. What you need may depend in part on how depressed you are.

If you don’t have a counselor, ask your doctor for a referral. Your friends and family may also have recommendations.

Types of Antidepressants

Antidepressants are drugs that treat depression. They help lift your mood and ease the sadness and hopelessness you might feel. They are also sometimes prescribed for physical pain, to treat symptoms of ADHD.

The major types of antidepressants are:

  • SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed type of antidepressant. SSRIs improve how brain circuits use serotonin. They include Citalopram (Celexa); Escitalopram (Lexapro); Fluoxetine (Prozac); Fluvoxamine (Luvox); and Sertraline (Zoloft). 
  • SNRIs (serotonin and norepinephrine reuptake inhibitors) affect brain circuits that use both serotonin and norepinephrine. They include         Duloxetine (Cymbalta); Venlaxafine (Effexor); Desvenlafaxine (Pristiq); and Levomilnacipran (Fetzima). 
  • Tricyclic antidepressants (TCAs) have been used since the 1950s to treat depression. They cause more side effects then newer drugs used to treat depression. TCAs include amitriptyline (Elavil); amoxapine (Asendin); desipramine (Norpramin); doxepin (Sinequan); imipramine (Tofranil); nortriptyline (Aventyl, Pamelor); protriptyline (Vivactil); and trimipramine (Surmontil).
  • MAOIs (monoamine oxidase inhibitors) are early antidepressants. They include Isocarboxazid (Marplan); Phenelzine (Nardil ); andSelegiline(Emsam).

Atypical Antipsychotics

Some drugs that were first used to treat schizophrenia, called atypical antipsychotics, may also help certain kinds of depression, either alone or in combination with more traditional antidepressants. 

Some examples are:

  • Aripiprazole (Abilify)
  • Brexpiprazole (Rexulti)
  • Lurasidone (Latuda)
  • Olanzapine-fluoxetine combination (Symbyax)
  • Quetiapine (Seroquel)

What to Consider

If you and your doctor decide that it’s time to try a medicine, you’ll want to talk about things like:

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What are the side effects? All medications have them. But which ones are more serious and which are you more likely to be OK with?

SSRIs, for example, can cause dry mouth, nausea, nervousness, insomnia, low sexual desire, and headache. Some atypical antidepressants, on the other hand, can raise or lower your appetite and cause insomnia or drowsiness but are less likely to cause sexual problems.

What are your other symptoms? If you have depression with anxiety or insomnia, for example, your doctor might prescribe a drug with a sedating effect. If you have pain or fatigue, a different medication might be best.

What are your other health conditions? Some antidepressants aren't safe for people with certain illnesses. The drugs could cause a bad interaction with your other prescriptions or directly worsen your medical problem.

How much does it cost? The cheapest prescriptions are generics, but not all medications come in this form.

Your insurance company may have a few "preferred" brands that cost more than generics but less than other name brands.

The most expensive drugs are those on your insurance plan's “non-preferred” list. If you can't afford them, you might want to try less costly antidepressants first. If they’re not effective or if they have side effects that bother you, your plan may then cover these more expensive drugs.

What Else to Keep in Mind

Antidepressants might also ease other symptoms, like anxiety, that can come with depression. But your doctor might think it's best to make a separate plan for these other problems.

The first antidepressant that you try might not work. But stick with it long enough to find out. It could take at least 4 weeks to feel the effects. If the prescription doesn't help, talk with your doctor about trying something new.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on April 06, 2019

Sources

SOURCES:

Andrew Leuchter, MD, professor of psychiatry; director, Laboratory of Brain, Behavior, and Pharmacology (LBBP); senior research scientist, Semel Institute for Neuroscience and Human Behavior and the Brain Research Institute, University of California, Los Angeles.

Agency for Health Care Research and Quality: "Medicines for treating depression -- A review of the research for adults."

National Institutes of Health: "Spotlight on SSRIs."

Family Doctor: "Depression -- Types of antidepressants."

Lin, S. Journal of the American Board of Family Medicine, February 2014.

Centers for Medicare and Medicaid Services: "Your guide to Medicare Prescription Drug Coverage."

WebMD: "Common Treatment Options for Clinical Depression."

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