Depression can be treated successfully with a variety of methods, including many new medications.  These new medications have been found to be effective in treating persons with depression, and may offer hope to depressed older adults who have not responded to other therapies. Medication descriptions are below, as well as Medication Assistance Information and General Medication Guidelines.

Living Well:  A Treatment Series
Antidepressant Medications
This free video is a part of a five part series entitled "Living Well:  A Treatment Series" found on the Fuqua E-Learning Center.  In this 20 minute video, physicians and nurses from the Fuqua Center review the pros and cons of different antidepressant medications.  The video also includes interviews with patients currently taking antidepressant medications.  You can view the video for free or download an order form to purchase a copy of the program.

Medications
The medications are grouped based on their chemical compositions.  Please click on the name to learn more.

Monoamine Oxidase Inhibitors (MAOI's)
Isocarboxazid (Marplan®)
Phenelzine (Nardil®)
Tranylcypromine (Parnate®)

Tricyclic Antidepressants (TCA's)
Amitriptyline (Elavil®)
Imipramine (Tofranil®)
Clomipramine (Anafranil®)
Trimipramine (Surmontil®)
Doxepin (Sinequan®)
Protriptyline (Vivactil®)
Desipramine (Norpramin®)
Nortriptyline (Pamelor®)

Heterocyclic Antidepressants
Amoxapine (Asendin®)
Maprotiline (Ludiomil®)

Unicyclic Aminoketone
Bupropion (Wellbutrin®)

Piperazine Antidepressants
Trazodone (Desryel®)
Nefazodone (Serzone®)

Serotonin Selective Reuptake Inhibitors (SSRI's)
Fluoxetine (Prozac®)
Sertraline (Zoloft®)
Paroxetine (Paxil®)
Fluvoxamine (Luvox®)
Citalopram (Celexa®)
Escitalopram (Lexapro®)

Serotonin and Norepinephrine Reuptake Modulators
Venlafaxine (Effexor®)
Mirtrazapine (Remeron®)

Monamine Oxidase Inhibitors (MAOIs):
Isocarboxazid (Marplan®)
Phenelzine (Nardil®)
Tranylcypromine (Parnate®)

Pros :  They are very effective medications in treating depression and have been in use longer than any other antidepressants.

Cons:  They have strong and potentially dangerous side effects.

Side Effects:  Dry mouth, constipation, weight gain, sexual dysfunction and sedation.  Some of the medications lead to liver problems or may lower blood pressure.  In extreme cases there can be a dangerous hypertensive reaction (high blood pressure) when mixed with certain foods or other medications.

Bottom Line:  Although highly effective, MAOI medications are rarely prescribed in the United States except in cases where other methodications have failed. 

Tricylic Antidepressants (TCAs):
Amitriptyline (Elavil®)
Imipramine (Tofranil®)
Clomipramine (Anafranil®)
Trimipramine (Surmontil®)
Doxepin (Sinequan®)
Protriptyline (Vivactil®)
Desipramine (Norpramin®)
Nortriptyline (Pamelor®)

Pros:  They are very effective and generally safe.  TCAs can be measured reliably in the bloodstream to assure an adequate dosage.  And, as generic drugs, they may be less expensive than other medications.

Cons:  They require additional tests prior to beginning treatment. TCAs have more side effects than some other classes of antidepressants.  As a result, patients may have difficulty staying on the medication long enough for it to be effective.  In some cases, a low initial dose of the medication may have such a strong effect that it may mask the need for a higher, more sustained dosage.

Side Effects:  Depending on the type of TCA taken, the severity of the side effects may differ but include dry mouth, constipation, difficulty urinating, weight gain, sedation, blurred vision, decreased blood pressure, and sexual dysfunction have been reported.  There are also effects on the heart (specifically effects on the cardiac conduction system) that need to be monitored while a patient is on these medications.

Bottom Line:  Doctors can usually control side effects of TCAs by starting with a low dose and increasing it slowly.  However, depending on the patient, there may be more effective antidepressants available with fewer side effects.

Heterocyclic Antidepressants:
Amoxapine (Asendin®)
Maprotiline (Ludiomil®)

Pros:  In certain cases, these were successful alternatives for patients who could not tolerate the side effects of some other antidepressants. 

Cons:  Potentially dangerous side effects.  

Side Effects: One of these medications, amoxapine, has been linked to a condition that causes symptoms similar to those of Parkinson's disease.  And another, maprotiline, can cause seizures.

Bottom Line: There are newer, equally effective medications that do not have the potentially serious side effects.  For that reason, the heterocyclic antidepressants are now obsolete medications.

Unicyclic Aminoketone
Bupropion (Wellbutrin®)

Pros:  Unlike some antidepressant medications, they do not cause weight gain or sedation and are not harmful to the heart.  Patients report only a low incidence of sexual dysfunction.

Cons:   They have been linked to seizures in patients who have not been carefully monitored to assure the proper dosage.  They also are not advised for patients with bulimia.

Side Effects: In addition to the serious conditions listed above, there are rare occurrences of headaches, anxiety, agitation, and sleep disturbance.

Bottom Line:  These medications may be appropriate for patients whose dosage can be closely supervised, and if administered within the recommended guidelines, do not cause seizures more than other antidepressants. The newer longer acting bupropion SR is associated with a lower risk of seizures than other antidepressants.

Piperazine Antidepressants
Trazodone (Desryel®)
Nefazodone (Serzone®)

Pros:    They do not cause many of the side effects associated with other antidepressants such as constipation or more serious conditions such as aggravated glaucoma, urinary tract difficulties, sexual dysfunction and heart problems.

Cons:  These medications may not be as effective in the treatment of depression.  In fact they are only effective in fairly high doses and their side effects (particularly sedation) may limit their use in the elderly.

Side Effects:  They tend to cause sedation, and doctors use them as a sleeping pill.  In addition,  trazodone, can cause dizziness because of abrupt drops in blood pressure.  Nefazodone, is one of the few antidepressants that have a low incidence of sexual side effects and is less sedating than trazodone.   .

Bottom Line:  The sedative effect of these medications may prove a problem for elderly patients who need to be maintained on fairly large dosages to achieve a therapeutic effect.

Serotonin Selective Reuptake Inhibitors (SSRIs)
Fluoxetine (Prozac®)
Sertraline (Zoloft®)
Paroxetine (Paxil®)
Fluvoxamine (Luvox®)
Citalopram (Celexa®)
Escitalopram (Lexapro®)

Pros:  They are as effective as other antidepressants but have only a few minor side effects.  Weight gain, a common side effect of most antidepressants, is not a problem. And, there are no serious effects on the heart or blood pressure.

Cons: These medications are expensive but financial assistance may be available.  Please visit our site for Medication Assistance Information, or ask your doctor about patient prescription assistance information.

Side Effects:  One in 10 patients may report diarrhea, nausea, headaches or rashes, agitation, sedation,  and a feeling of apathy.  Four in ten may report sexual side effects, usually a lack of desire.

Bottom Line:  Although comparatively expensive, SSRIs have been a significant development in the treatment of depression because of their effectiveness and relatively benign side effects.  The cost of these medications is offset by  their improved side effect profile.

Serotonin and Norepinephrine Modulators
Venlafaxine (Effexor®)
Mirtrazapine (Remeron®)

Pros:   Similar in side effects to the SSRI class medications, they have minor side effects, but because they work therapeutically on both neurotransmitters affected by depression (norepinephrine and serotonin) medications in  this class may be more effective on pateints who failed SSRIs.

Cons:  A minority of patients develop high blood pressure on venlafaxine depending on the dose they are taking.   Some patients experience weight gain and sedation on mirtazapine.

Side Effects:  Nausea, headaches, agitation, insomnia and sexual side effects  are occasionally reported with some of the medications.

Bottom Line:  These medications are very effective, with few side effects.  More serious problems with increased blood pressure or sedation can be controlled by modifications to the dosage.

Medication Assistance Information

The Medicine Program

NeedyMeds.com

Directory of Patient Assistance Programs

GeorgiaCares Program

General Medication Guidelines

Patient research conducted with the above antidepressant medications has shown that:

• All appear to have been effective in treating depressed patients.
• 65-80% of patients responded to the medications in 4-6 weeks, with the majority showing a full response.

What you should know about antidepressant medications:

• They are non-addictive.
• The newer antidepressants seem to have fewer side effects than traditional medications.
• Some side effects may be felt in the first few days of taking the medication.
• A full, effective response to the medications takes about 4-6 weeks.
• You must stay on the medication as directed to ensure the full benefit.
• These antidepressants may cause reactions with other medications you might be taking, including over-the-counter products, such as ginko biloba or
  St. John's Wort.

What you should let your doctor know before taking antidepressant medications:

• Provide a list of all medications you are taking. You can ask your pharmacist for help. 
• Let your doctor know about previous treatments you have had for depression, including any medications you have taken.
• Talk openly about concerns you have about the cost of the medication. There may be special plans available to help patients with restricted incomes.

Remember to continue to take the medication as directed and to complete the prescribed dosage.

• If you are feeling better, it means the medication is working, not that you no longer need it.
• To prevent a reccurrence, you must stay on your medication at least 6 months to a year or as directed by your doctor.