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Depression Medications

Some of the most commonly prescribed medicines in the United States.

Prozac (chemical name: fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), Lexapro (escitalopram) are among the most commonly prescribed depression medications.

These drugs are frequently used to treat a number of problems in addition to depression, including anxiety and panic attacks. Prozac and Zoloft are available in generic form.

Common daily dosage:
Prozac, 20-60 mg.
Zoloft, 50-200 mg.
Paxil, 20-40 mg.
Celexa, 20-60 mg.
Lexapro, 10-20mg.

Major side-effects include: Nausea, sleepiness, trouble falling asleep, headache. These all tend to fade away after a week or two. A decrease in interest in sex, difficulty in getting an erection or becoming aroused and difficulty having an ejaculation or orgasm can be more persistent side-effects for many people. There are potential remedies for these sexual side effects.


Effexor (venlafaxine) is a depression medication that may be more effective for people with severe symptoms. It is also used to treat anxiety and social phobia. Extended release forms of the drug allow for less frequent dosing.

Common daily dosage:
Range from 150 mg to
375 mg or more

 

Major side-effect include: Insomnia, nervousness, nausea. These generally decrease over time. A small percentage of patients may experience sustained increases in blood pressure. This is more common in those taking doses over 225 mg per day. Effexor can cause the same sexual side effects as the depression medicines previously discussed.


Remeron (mirtazapine)
is a depression medication that is useful for patients with anxiety, insomnia and severe depression.

Common daily dosage:
7.5-30 mg.

 

Major side-effects include: This drug causes no gastrointestinal problems, sexual dysfunction, or insomnia over the long term. Sleepiness for the first few days can be a problem, however sleepiness may be less of a problem at higher doses. Increased appetite and weight gain are common.


Wellbutrin (bupropion
)
is a depression medication that can be especially useful for depressed patients who feel fatigued and lethargic. It is also used to help people stop smoking (Zyban). Controlled-release forms are available, which decreases the number of times a day the drug has to be taken.


Common daily dosage:
150-450 mg.

 

Major side-effect include: Causes no weight gain and, for most people, does not cause sexual difficulties. It can produce nervousness and insomnia. It can increase the risk of seizures at higher doses. It should not be used by patients with eating disorders.


Cymbalta (duloxetine)
is the newest depression medication. It is supposed to be effective in treating both the emotional and the physical symptoms such as backache and muscle tenderness that often accompany depression
.

Common daily dosage:
20-30 mg twice a day, although taking 60 mg once per day is okay.

Major side effects include: The most common side effect is nausea, which usually goes away in a week or two. Other common side effects include: dry mouth, constipation, decreased appetite, fatigue, sleepiness, and increased sweating. Some people have an increase in blood pressure.

Call Dr. Quinn to get a consultation if your depression is not getting better.


Warning
: Have you taken a depression medication and had any of the following reactions?

  • A sudden increase in energy, enthusiasm, decreased need for sleep, and the ability to get a lot done.
  • Improvement followed by repeated recurrence of depression after several dose increases or use of different depression medicines.
  • Increased irritability or explosive temper.
  • Depression that is not getting better in spite of having tried 3 or more depression medications.

If you have had any of these reactions to depression medications, you may have bipolar depression – a type of depression that should generally not be treated initially with antidepressant medication.

Some concerns people have about using depression medication:

Can depression medication cause someone to become suicidal?

Children, adolescents and young adults who are depressed but also have symptoms such as extreme agitation, explosive temper, racing thoughts, or a decreased need for sleep can respond to standard depression medications with the development or worsening of their agitation and suicidal thinking. Many of these individuals have a bipolar type depression that was mistakenly diagnosed as simple depression. Roughly one-half of children with symptoms of depression may go on to develop bipolar disorder. Prescribers of medication need to be very cautious in administering depression medication to kids, teens and young adults. This is especially the case if the child, teen or young adult is angry and agitated or if there is a family history of bipolar illness.

I want to learn to deal with my problems and its root causes on my own. Aren’t depression medications just a crutch?

Not at all. This concern is based on a couple of incorrect assumptions. The first one is that depression is due primarily to deep-seated problems that depression medications somehow just smooth over or cover up. The second one is that people can pull themselves out of depression if they have the guts or will-power to do so. It seems to me that many depressed people actually have more guts than the average person! If they didn’t, they wouldn’t be able to keep going the way they do. As to the first objection, there is no scientific evidence that depression is caused by deep-seated problems, so there really is nothing to cover-up. Depression medications do not interfere with or eliminate the need to learn new ways of thinking, behaving, or dealing with feelings in therapy. In fact, by relieving unnecessary psychic pain, they often make learning possible.

Other concerns people have about using depression medications that are addressed in The Depression Sourcebook, 2nd edition:

- Will depression medication change my personality or make me not feel like myself?
- How long do I have to take a depression medicine for?
- Are depression medications addictive?
- Are there natural alternatives to these drugs?
- Can psychotherapy work as well as depression medicines?

For more information on depression visit my depression resources page, call me at my Huntington, NY office or read "The Depression Sourcebook".

 
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