What about antidepressants like Wellbutrin, Effexor, Remeron, and Desyrel that don't fit into the standard drug type classifications? This article can answer some of your questions about them.

"When I was depressed, it was like having a tight metal band around my head all the time. I felt like my cognitive processes couldn't run with the energy they should have. When I took Wellbutrin and my depression lifted, the band loosened and the relief was incredible."

-- Jim, 42

Jim was the son of two alcoholics, a brilliant but erratic man who blazed through his adolescence and early adulthood and crashed into a fog of depression in medical school. For the next 10 years, he was haunted by intermittent episodes of depression. But it was his inability to function at work that Jim, a drug company executive, found most troubling.

"The problems my depression was causing me at work were particularly devastating," he recalls today. "I was trying to build my ego late in life, which is fairly common among children of alcoholics. And my depression was getting in the way of my healthy functioning."

In a vain attempt at self-medication, Jim began using cocaine regularly. When he was finally given a prescription for Wellbutrin, he had given up hope that he would ever regain his ability to think clearly.

Within a week, he began to notice an effect. Within five or six weeks, his depression was gone. "Being able to focus again on work, instead of on myself and my problems, was initially the most uplifting effect," he recalls. Wellbutrin also helped him overcome his cocaine addiction.

Bupropion (Wellbutrin), trazodone (Desyrel), venlafaxine (Effexor), and mirtazapine (Remeron) are a group of structurally unrelated antidepressants that don't fit into any of the established antidepressant drug classes of MAOIs, tricyclics, or SSRIs.

These three are among a group of drugs that scientists have discovered as a result of fiddling with the biochemistry of antidepressants, looking for the perfect medication that's safe, nontoxic, and effective. Although all three are very effective antidepressants, each one affects a different neurotransmitter system: Wellbutrin affects dopamine, Desyrel affects serotonin, and Effexor affects norepinephrine, serotonin, and dopamine, while Remeron stimulates norepinephrine and serotonin release as it blocks certain receptors.

Pros and Cons

Wellbutrin, Effexor, Desyrel, and Remeron appear to cause fewer serious side effects than MAO inhibitors or tricyclics. But because these three drugs can cause a few unusual problems in some people, chances are your psychiatrist will be far more likely to choose an SSRI like Prozac or Zoloft at first.

The most common side effects shared by Wellbutrin, Effexor, and Desyrel include agitation, dry mouth, insomnia, headache, nausea and vomiting, constipation, and tremors.

But perhaps the most troubling problem with the newer drugs is that no one is sure just what their long-term effects might be. There are some new, troubling reports that Effexor may cause tardive dyskinesia, a movement disorder that may be permanent, involving writhing, wormlike movements of the body, lips, and tongue.

But many chronically depressed people say they don't care. They're willing to pay the price of future uncertainty to buy freedom from depression today.

"There are risks to these drugs," says Joan, whose training as a nurse makes her more aware than most of the possible hazards. "They just don't know what they do in the body. But after this many years of being depressed, it's worth the risk to me. I've spent half my life in hell, so taking a risk with antidepressants is well worth the effort. As more years have gone by, I see the years I was depressed as wasted. I don't want to waste any more."

Wellbutrin

The good news about Wellbutrin is that you probably won't have sexual problems, you won't gain weight (you may even lose a few pounds!), and you won't have a lot of annoying minor side effects. The bad news is that -- especially if you've had a head injury or you have epilepsy -- there's a higher risk of seizures.

"Wellbutrin is usually my second-choice antidepressant," says psychiatrist Andy Myerson. "I've had remarkable success with it, but many people are scared by the potential for seizures. It's tricky."

Because Wellbutrin blocks dopamine, this drug also can rarely produce movement disorders and changes in the endocrine system.

As mentioned above, the biggest problem associated with Wellbutrin is the fact that psychiatrists are nervous about a risk of seizure four times higher than with other antidepressants. Overdosing is a particular danger, since the chance of a seizure increases almost tenfold at twice the normal daily dose of 300 milligrams. Your biggest chance of developing a seizure appears to be if you've had a prior serious head injury or prior seizures, brain or spinal-cord tumors, if you take anti-seizure medication, or if you suddenly hike your dosage. You can lower the risk if you never abruptly increase your dosage, don't take more than 450 milligrams a day, and limit any single dose to no more than 150 milligrams.