Before selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), tricyclic antidepressants (tricyclics) were the first line of defense against depression. Today, tricyclics are a less popular choice than new generation antidepressants, but they're still important for a subset of people who don't respond to other types of antidepressants. Tricyclic antidepressants (TCAs) are also known as "heterocyclics" or "cyclics."

Common tricyclic antidepressants include:

• Amitriptyline (Elavil, Endep, Levate)
• Amoxapine (Asendin)
• Clomipramine (Anafranil)
• Desipramine (Norpramin, Pertofrane)
• Doxepin (Adapin, Silenor, Sinequan)
• Imipramine (Tofranil, Tofranil-PM)
• Maprotiline (Ludiomil)
• Nortryptyline (Aventyl, Pamelor)
• Protriptyline (Vivactil)
• Trimipramine (Surmontil, Trimip, Tripramine)

You can see a complete list of antidepressants here.

How Tricyclic Antidepressants Work

Tricyclic drugs work by increasing the brain's supply of norepinephrine and serotonin levels - chemicals that are often abnormally low in depressed patients. Unlike some other antidepressants, tricyclics do not act by stimulating the central nervous system or by blocking monoamine oxidase.

However, tricyclic medications interfere with a range of other neurotransmitter systems and a variety of brain cell receptors as well, affecting nerve cell communication all over the brain in the process. This increases the likelihood of side effects. For some people though, tricyclics work better than any other antidepressant drug available.

Who Shouldn't Take Tricyclic Antidepressants?

The first job for your doctor is to decide whether you're one of the people who shouldn't take tricyclic antidepressants. Obviously, your doctor won't prescribe them if you're allergic to this type of antidepressant. If you've taken an MAOI within the past two weeks, you'll want to wait two weeks before taking tricyclics, since the combination of these two can cause serious side effects.

Others who shouldn't take tricyclic medications include:

• If you have any kind of drinking problem
• People with schizophrenia
• People with bipolar disorder

Other conditions that may suggest avoiding certain tricyclics include:

• Bone marrow or blood cell disorders
• Seizures
• Adrenalin-producing tumors
• Serious heart disease
• Glaucoma

How to Use Tricyclics

If your doctor is considering one of the tricyclics to treat your depression, you may be asked to get a physical examination, an electrocardiogram (EKG), and routine blood tests first. These can help determine which type of drug will be safest for you.

If you don't respond to a tricyclic medication, it may mean your dose isn't high enough. Your doctor may order blood tests to find out how much of the tricyclic drug is actually circulating in your blood. If after increasing the tricyclic dose you still feel depressed after four or five weeks, your doctor will probably switch you to a different drug.

Some tricyclic antidepressants may require ongoing blood tests and monitoring.

Tricyclic Overdose

An overdose of a tricyclic antidepressant can be fatal. A tricyclic overdose may cause:

• Hallucinations
• Drowsiness
• Enlarged pupils
• Fever
• Irregular heartbeat
• Severe dizziness
• Severe muscle stiffness or weakness
• Restlessness or agitation
• Breathing problems, respiratory failure
• Vomiting
• Convulsions
• Coma

A TCA overdose can be very dangerous at only 10-15 times your normal dose.

Tricyclic Side Effects

On the whole, tricyclics are pretty safe and effective, falling somewhere between the monoamine oxidase inhibitors (MAOI), which have many side effects, and SSRIs, which have few. Even if you do run into some unpleasant side effects in the beginning of tricyclic treatment, chances are they will become less of a problem as time goes by.

Common side effects with tricyclics may include:

• Headache
• Unpleasant taste
• Sensitivity to sunlight / heat; excessive sweating
• Dry mouth
• Constipation, diarrhea
• Nausea, indigestion
• Fatigue, sedation
• Insomnia
• Weakness
• Anxiety, nervousness
• Weight gain

Some less-common tricyclic side effects include:

• Shakiness
• Dizziness, fainting
• Vomiting
• Abnormal dreams
• Eye pain, dry eyes, visual changes
• Diminished sex drive
• Inflamed tongue
• Jaundice
• Hair loss
• Joint pain, muscle aches, back pain
• Abdominal pain
• Palpitations, irregular heartbeat
• Fever, chills
• Rash
• Hiccups
• Nasal congestion
• Difficult and/or frequent urination

You'll find helpful information about antidepressant side effects and how to manage them here.

Potential Drug Interactions with Tricyclic Antidepressants

Many drugs can interact with tricyclic antidepressants. A doctor should be consulted before taking a prescription or over-the-counter medication. Some drugs that interact with tricyclics include:

• Alcohol
• Amphetamines, ephedrine
• Anesthetics (plus some dental anesthetics)
• Blood pressure medication
• Anticonvulsants
• Antihistamines
• Appetite suppressants
• Tranquilizers (barbiturates, benzodiazepines)
• Blood thinners
• Other psychiatric medication
• Heart medication
• Muscle relaxants
• Sinus medication

Tricyclics While Pregnant or Breastfeeding

Tricyclic antidepressants are considered to possibly risk a fetus or a breastfeeding newborn. If you're pregnant and seriously depressed, you and your doctor will have to weigh the risks of your untreated depression against possible damage to your fetus.

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Soon after scientists developed tricyclic antidepressants, another group of depression drugs rolled out of the laboratory -- the monoamine oxidase inhibitors (MAOI or MAO inhibitors). These new drugs affected the same neurotransmitters (serotonin and norepinephrine) that the tricyclics did, but they also affected dopamine.

What Are MAO Inhibitors? How do they Work?

Once the brain's three neurotransmitters, known as monoamines (serotonin, norepinephrine and dopamine), have played their part in sending messages in the brain, they get burned up by a protein in the brain called monoamine oxidase, a liver and brain enzyme.

MAO inhibitors work by blocking this cleanup activity, increasing the levels of monoamines in the brain.

Unfortunately, monoamine oxidase doesn't just destroy those neurotransmitters; it's also responsible for mopping up another amine called tyramine, a molecule that affects blood pressure. So when monoamine oxidase gets blocked, levels of tyramine begin to rise, too. Excess tyramine can cause a sudden, sometimes fatal increase in blood pressure so severe that it can burst blood vessels in the brain. In those who take MAOIs, excessive tyramine levels are controlled by dietary restrictions.

List of MAOI Drugs

• Isocarboxazid (Marplan)
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)

Who Takes MAOIs?

If you have atypical depression,

• you're sensitive to rejection
• overeat and oversleep
• feel anxious and react strongly to your environment

you may respond very well to MAOIs, which can reduce the sensitivity that causes you to feel so easily hurt or rejected. Others who tend to respond very well to MAOIs can feel quite depressed, but they're able to surface from the morass of their depression from time-to-time and experience pleasure before plunging into depression again.

Who Shouldn't Take MAOIs?

Because an MAOI can affect many chemicals in the brain, there are a number of contraindications. People who shouldn't take MAO inhibitors include those with:

• Serious heart problems
• Epilepsy
• Bronchitis
• Asthma
• High blood pressure
• An aversion to following a stringent diet

In addition, isocarboxazid (Marplan) may be too stimulating if you're hyperactive, agitated, or schizophrenic. Studies suggest that phenelzine (Nardil) may not be as effective if you are severely depressed.

Dietary Restrictions When Taking MAO Inhibitors

In order to control the amount of tyramine in the body while taking MAOIs, do not consume the following foods containing tyramine unless advised otherwise by a doctor:

• Aged or fermented foods
• Alcoholic beverages (especially Chianti, sherry, liqueurs, and beer)
• Alcohol-free or reduced-alcohol beer or wine
• Anchovies
• Bologna, pepperoni, salami, summer sausage or any fermented sausage
• Caviar
• Cheeses (especially strong or aged varieties), except for cottage and cream cheese
• Chicken livers
• Figs (canned)
• Fruit: raisins, bananas (or any overripe fruit)
• Meat prepared with tenderizers; unfresh meat; meat extracts
• Smoked or pickled meat, poultry or fish
• Soy sauce

While on MAOIs, these foods may be eaten in moderation:

• Avocados
• Caffeine (including chocolate, coffee, tea and cola)
• Chocolate
• Raspberries
• Sauerkraut
• Soup (canned or powdered)
• Sour cream
• Yogurt

Before Taking MAOIs

Your doctor will probably quiz you about a range of medical conditions before prescribing an MAO inhibitor. It's especially important to tell your doctor if you have:

Frequent headaches or chest pain

• Diabetes mellitus
• An alcohol problem
• Heart or blood-vessel disease
• Liver or kidney problems
• Parkinson's disease
• An overactive thyroid

MAOI Side Effects

The one thing you've got to watch out for with these drugs is that sudden spike in blood pressure called a "hypertensive crisis" (also called the "cheese reaction") that we discussed at the beginning of this article. As long as you note the MAOI foods to avoid, you can avoid this risk.

The symptoms of a severe spike in blood pressure due to tyramine and MAOIs include:

Severe headache radiating to the front of the head

• Stiff and/or sore neck
• Nausea and vomiting
• Sensitivity to light
• Dilated pupils
• Sweating (sometimes with fever or with cold, clammy skin)
• Chest pain or heart palpitations

A blood pressure rise usually occurs within several hours after taking the drug. Stop taking MAO inhibitors immediately if you get a severe headache or palpitations and then call your doctor.

Other MAOI side effects that should be checked by a doctor include:

• Severe dizziness or light-headedness, especially when arising from a sitting or lying position
• Diarrhea
• Pounding heart
• Swelling of feet and/or lower legs
• Unusual excitement or nervousness
• Dark urine
• Fever
• Skin rash
• Slurred speech
• Sore throat
• Staggering walk
• Yellow eyes and/or skin

You can learn more about how to manage antidepressant side effects here.

There is also a range of less serious MAOI side-effects. Like all antidepressants, the MAOIs are capable of inducing a manic state in people who have bipolar disorder and may cause memory problems.

Other possible side effects of MAOIs include:

• Feeling drugged and sluggish
• Fainting and/or dizziness, particularly on standing up
• Drowsiness
• Blood sugar levels changes, particularly a concern for diabetics
• Sexual problems such as delayed orgasm
• Weight gain

MAOI Interactions with Other Drugs

While aspirin, acetaminophen (Tylenol) (plain), ibuprofen (Motrin) or antibiotics are safe when combined with an MAOI, you should check with your doctor before taking any other medicine.

Alwaysbe sure to tell your doctor or dentist that you're taking MAO inhibitors before any kind of surgery, dental treatment or emergency treatment -- even if you stopped taking the drug up to two weeks prior. The anesthesia combined with the MAOI can cause a drop in blood pressure or other problems. You may want to carry an ID card noting that you're taking this medicine.

Other drugs that can cause potentially fatal MAOI interactions include:

• Other antidepressants
• Antipsychotics
• Cold, cough, sinus, allergy, antihistamine medications
• Weight-control pills
• Asthma drugs
• Blood pressure medication
• Pain medication
• Anticholinergic medication such as Ditropan
• Heart medications
• L-Dopa
• Flexeril
• Symmetrel
• Tryptophan
• Insulin
• Cocaine
• Amphetamines

MAOI Overdose

The MAO inhibitors are somewhat more dangerous drugs than other antidepressants when taken in excessive amounts -- far more so than newer drugs such as fluoxetine (Prozac). Symptoms of overdose include severe anxiety, confusion, convulsions or seizures, cool clammy skin, severe dizziness, severe drowsiness, fast and irregular pulse, fever, hallucinations, severe headache, high or low blood pressure, muscle stiffness, breathing problems, severe sleeping problems, or unusual irritability.

MAOIs and Pregnancy and/or Breast-feeding

As with most antidepressants, safe use of MAO inhibitors during pregnancy hasn't been established, but one limited study in humans did suggest an increased risk of birth defects when MAOIs are taken during the first trimester. MAOIs are considered risky to the fetus and should be avoided when possible; both when pregnant and when breastfeeding.

MAOIs and the Elderly

Older patients are usually more sensitive than younger adults to MAO inhibitors, and they may be more likely to experience dizziness or light-headedness. Because of the danger of an abrupt increase in high blood pressure (hypertensive crisis), the MAO inhibitors are often not prescribed for people over age 60, or for those with heart or blood vessel diseases.

article references

SNRI antidepressants help relieve the symptoms of depression and anxiety.

The three main neurotransmitters (or neuromodulators) involved in depression are dopamine, norepinephrine and serotonin (also known as 5-HT). While their effect on mood is not completely clear, we do know that modulating these brain chemicals produces an antidepressant effect.

Initially, drugs specifically modulating serotonin (selective serotonin reuptake inhibitors, SSRIs) were developed, but now an additional class of medications that affect both serotonin and norepinephrine are common. These antidepressants are known as serotonin norepinephrine reuptake inhibitors (SNRIs).

Depression drugs included in the SNRI antidepressants class include:

• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)
• Milnacipran (Savella)
• Venlafaxine (Effexor, Effexor XR)

SSRIs vs. SNRIs

Are there differences among the SSRIs and SNRIs in achieving remission in patients with major depression?

Remission of depression in the patient is the doctor's main goal. According to Dr. Jeffrey Kelsey, Medical Director, Georgia Institute of Mood and Anxiety Disorders, all of the antidepressants available in the U.S. market today, including SSRIs and SNRIs, are equally effective when it comes to response rates.

Dr. Kelsey explains SSRIs vs. SNRIs in depression treatment,

"However, when it comes to remission, the data shows that SNRIs, dual-acting antidepressants, will, in some patients, confer an advantage. And the tricky part is going into it, we don't know which patients will benefit from one approach to the other.

SSRIs are very effective treatments but some patients are going to get more benefit from a dual-acting antidepressant."

Indications for Using SNRI Antidepressants

Serotonin-norepinephrine reuptake inhibitors are FDA-approved for treating major depressive disorder (MDD). SNRI drugs with additional FDA-approved uses include:

• Duloxetine (Cymbalta) – approved for the treatment of anxiety, diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain
• Milnacipran (Savella) – approved for the treatment of fibromyalgia
• Venlafaxine (Effexor, Effexor XR) – approved for the treatment of generalized anxiety, social anxiety, and panic disorder

Which SNRI Antidepressant is Best?

It is believed all antidepressants have approximately the same efficacy although in some cases, SNRIs have been shown more effective than SSRI antidepressants. Moreover, if a patient does not respond to an initial treatment of an SSRI antidepressant, switching them to another class of antidepressant, such as an SNRI, is more effective than treating with another SSRI.¹ (read more about switching antidepressants)

Desvenlafaxine (Pristiq) is the active metabolite in venlafaxine (Effexor). This means that when taking venlafaxine (Effexor) the body breaks it down into desvenlafaxine (Pristiq) and other components. Because of this similarity, both SNRIs have similar response rates and similar side effects although desvenlafaxine (Pristiq) may have fewer drug interactions.

Common side effects of SNRIs venlafaxine (Effexor) and desvenlafaxine (Pristiq) include:

• Nausea
• Tiredness
• Dry Mouth
• Sweating

Studies have also found the SNRIs duloxetine (Cymbalta) and venlafaxine extended-release (Effexor XR) comparable in effectiveness. Duloxetine (Cymbalta) was associated with more nausea, but a few patients taking venlafaxine (Effexor XR) experienced increases in blood pressure. Venlafaxine extended-release (Effexor XR) may also be associated with more sexual side effects than some other classes of antidepressants.

As for specific SNRI venlafaxine extended-release (Effexor XR) efficacy, an analysis of over 40 studies that involved about 4,000 patients found taking this SNRI medication was associated with a higher success rate than other types of antidepressants. In the analysis, 73.7% of patients taking venlafaxine extended-release (Effexor XR) were considered to be successful, as compared with 61.1% of those taking a selected serotonin reuptake inhibitor (SSRI) and 57.9% taking a tricyclic antidepressant (TCA). In addition, fewer patients taking venlafaxine extended-release (Effexor XR) stopped taking medication before their studies were scheduled to end.

SNRI Side Effects

The most common side effects shared by SNRIs venlafaxine extended-release (Effexor XR) and duloxetine (Cymbalta) include:

• Nausea
• Dizziness
• Fatigue or Sleepiness
• Insomnia
• Dry Mouth
• Loss of Appetite
• Nervousness
• Sweating
• Abnormal Vision
• Abnormal Ejaculation
• Constipation

There's more information about antidepressant side effects and how to manage them here.

Before Taking an SNRI

Just as with other antidepressants, be sure to tell your doctor if you've ever had allergies to any antidepressants, foods, preservatives or dyes. Other important facts to tell a doctor before taking an SNRI include:

• A history of bipolar disorder, convulsions or seizures
• Liver disease – mayraise blood levels of any antidepressant, which can increase the risk of side effects
• A recent heart attack - you may not be able to take antidepressant medication

It's important to be aware that young people being treated with SNRI antidepressants may have increased suicidal thoughts and behaviors. In 2004, the FDA issued the following warning on all antidepressants:

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [drug name] or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need.

Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older.

Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.

Generally, the risk is higher in first month or so and then appears to decrease as the body adjusts to the SNRI medication. However, depressed individuals may be more likely to attempt or commit suicide whether or not they are taking SNRI antidepressants.

Possible Important SNRI Side Effects, Adverse Reactions

As with all antidepressants, you should talk to your doctor before taking any other drugs, including non-prescription medications.

SNRIs may cause the following side effects, also known as adverse reactions:

• Increase blood pressure –bloodpressure should be controlled before starting treatment and should be monitored regularly
• Increase heart rate, especially at higher doses –usewith caution if you've recently had a heart attack, suffer from heart failure or have an overactive thyroid gland
• Increase cholesterol levels, especially at higher doses – often in those who take an SNRI for 3 months or longer
• Mydriasis (prolonged dilation of the pupil of the eye) – notify your physician if you have a history of glaucoma or increased eye pressure

SNRI Overdose

An overdose of an SNRI medication, combined with other drugs or alcohol, can be fatal. If you suspect an overdose, seek medical attention immediately.

Published retrospective studies report that a venlafaxine (Effexor) overdose may be associated with an increased risk of fatal outcome compared to that observed with SSRI antidepressants, but lower than that for tricyclic antidepressants. This may be due to the greater severity of depression typically suffered by those prescribed SNRIs, however.

Symptoms an SNRI overdose may include:

• Sleepiness
• Vertigo
• Rapid or slow heartbeat
• Low blood pressure
• Seizures
• Coma
• Serotonin syndrome
• Vomiting

SNRIs and Pregnancy / Breast-Feeding

If you want to get pregnant while you're on any antidepressant, including an SNRI, you're going to have to weigh the risks to your baby against the risks to you if you don't take the drug. What we know about antidepressant activity in pregnant women is mostly obtained from animal studies, not from large-scale studies in humans.

SNRIs are considered category C drugs with regards to pregnancy. This indicates SNRIs should be avoided whenever possible. SNRIs are also excreted in breast milk so their use during breastfeeding should also be avoided. SSRI antidepressants may be considered a safer alternative during pregnancy.

SNRI Use with the Elderly

If you're over age 60, you're more likely to be sensitive to all antidepressants, including SNRIs. This means your depression will probably respond to lower doses of medication. It also means you are at higher risk for developing side effects such as fluid retention.

article references

Selective serotonin reuptake inhibitors (SSRIs) are a frontline antidepressant due to their low risk of side effects and overdose, as well as their efficacy. SSRI antidepressants are chosen over all other classes in the treatment of depression and anxiety in children, teens and the elderly.

This doesn't mean that SSRIs are the only worthwhile antidepressant, of course. Research has shown the older antidepressant medications (tricyclics) are just as effective as SSRIs but, on the whole, the newer ones seem to have fewer side-effects.

Researchers also note that the SSRI medications don't work for up to 50% of the depressed or anxious people who try them -- the same failure rate as for the older antidepressants.

Which is the Best SSRI?

No single SSRI is best, although escitalopram (Lexapro) has been shown to have superior efficacy in cases of severe depression. Each SSRI has a certain profile of its own particular side effects often including common SSRI side effects like nausea and headache. Of course, none of the SSRIs are any sort of wonder drug.

See also (no particular order of effectiveness):

1. Citalopram (Celexa)
2. Fluoxetine (Prozac, Prozac Weekly, Selfemra, Sarafem)
3. Fluvoxamine (Faverin, Luvox, Luvox CR)
4. Paroxetine (Paxil, Paxil CR, Pexeva)
5. Viibryd (Vilazodone)

Cost of Selective Serotonin Reuptake Inhibitors

One of the biggest problems with some newer SSRIs is their cost. The branded versions are much more expensive than the generic versions of older drugs like some of the SSRIs, MAOIs or tricyclic antidepressants. Generic versions of the older antidepressants are available because their patents have expired.

Even if you find the best SSRI for you, if you can't afford it, it's not going to do you much good. The high cost of the SSRIs can be a real hardship for someone with no insurance, or whose insurance doesn't cover drugs. With some SSRI antidepressants costing $4 - $11 per pill, the pharmacy bill can be overwhelming.

SSRI Antidepressants, Suicidal Feelings and Young People

Young people taking SSRIs may have increased suicidal thoughts and behaviors. In fact, in 2004, the FDA ordered the strongest safety warning possible known as a black box warning on SSRI and other antidepressants:

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [drug name] or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need.

Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older.

Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.

SSRI Medical Cautions

Severe kidney or liver disease could result in higher-than-normal blood levels of SSRIs. In addition, SSRIs shouldn't be used in the treatment of patients with mania.SSRIs may not be the best treatment in those with a history of seizures or bipolar disorder.

SSRI Side Effects

SSRI side effects are usually mild and manageable, although once in a while a sensitive person gets a severe reaction. There have been reports of episodes of aggression, although these are rare.

Common SSRI side effects include:

• Nausea (may be improved by taking SSRI with food)
• Dizziness
• Headache
• Anxiety
• Dry mouth
• Insomnia
• A variety of sexual dysfunctions
• Menstrual changes

The list of SSRI side effects looks worrying - there is even more information about these on the leaflets that come with SSRI medication. However, most people get a small number of mild side-effects (if any). More serious SSRI side effects - problems with urinating, difficulty in remembering, falls, confusion - are uncommon in healthy, younger or middle-aged people. You can learn more about antidepressant side effects and how to manage them here.

Side effects of SSRIs usually wear off over a couple of weeks as your body gets used to the medication. It is important to have the whole SSRI side effect list, though, so you can recognize side effects if they happen and discuss them with your doctor.

It is common, if you are depressed, to think of harming or killing yourself. Tell your doctor - suicidal thoughts should pass once the depression starts to lift.

Drug Interactions with SSRI Medications

SSRI medications are fairly safe, but like all other medications, interactions can occur. Some drugs that can interact with SSRIs include:

• Tryptophan
• Blood-thinners like Warfarin or Aspirin
• Alcohol
• Other antidepressants, including MAOIs
• Other medications that increase serotonin levels causing a serious illness called serotonin syndrome.

Taking an SSRI medication within two weeks of an MAOI may cause serious side effects. You should wait at least two weeks between stopping MAOIs and starting an SSRI, or at least five weeks after stopping an SSRI and starting an MAOI. Learn more about switching antidepressants here.

SSRIs and Pregnancy / Breast-Feeding

It is always best to take as little as possible in the way of medication during pregnancy. However, some mothers have to take SSRI antidepressants during pregnancy. Most SSRIs in pregnancy are considered category C drugs which are to be used with caution and only when the benefits outweigh the risks.

Most SSRIs, however, haven't been studied in nursing mothers or pregnant women. Animal studies have suggested taking SSRIs during pregnancy can pose a risk to the fetus. SSRI medication is present in breast milk and the use of SSRIs during breastfeeding should be avoided if possible.

Paroxetine (Paxil) should not be taken during pregnancy as it may produce some birth defects.

(also read: Antidepressants for PMS Symptoms)

Other Disorders Treated by SSRI Antidepressant Medications

SSRIs can be an effective treatment in medical and psychiatric disorders besides depression. Some SSRIs have been approved for treating various disorders such as:

• Anxiety disorders including panic attacks, obsessive-compulsive disorder, post-traumatic stress and social anxiety disorder
• Eating disorders
• Chronic pain
• Premenstrual dysphoric disorder

SSRI Withdrawal

SSRI antidepressant medications don't cause the addictions that you get with tranquilizers, alcohol or nicotine, in the sense that:

• You don't need to keep increasing the dose to get the same effect
• You won't find yourself craving them if you stop taking them

However, in spite of not having the symptoms of addiction described above, some people who stop SSRIs have withdrawal symptoms; sometimes referred to as antidepressant discontinuation syndrome. SSRI withdrawal is more common for people who have taken medication for longer than six weeks.

SSRI withdrawal symptoms may include:

• Irritability
• Anxiety
• Insomnia
• Headaches
• Dizziness
• Fatigue
• Nausea

In most people, these withdrawal effects are mild, but for a small number of people they can be quite severe. SSRI withdrawal is most likely seen with paroxetine (Paxil). It is generally best to taper off the dose of any antidepressant rather than stop it suddenly.

Some people have reported that, after taking an SSRI for several months, they have difficulty managing once the drug has been stopped. This is most likely the symptoms of the original disorder (depression, anxiety) returning.

The Committee of Safety of Medicines in the UK reviewed the evidence in 2004 and concluded,

"There is no clear evidence that the SSRIs and related antidepressants have a significant dependence liability or show development of a dependence syndrome according to internationally accepted criteria."

article references

There is a long list of antidepressants from which your doctor will choose the right one for you. This antidepressant medications list covers the different types of antidepressant medications for depression.

Antidepressant List: List of Medications for Depression by Category

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Monoamine oxidase inhibitors (MAOIs)
• Tricyclics
• Other types

The following are lists of medications for depression grouped by type of antidepressant.¹

SSRI List

SSRIs are the most common type of antidepressant medication. An SSRI antidepressants list includes well-known drugs like fluoxetine (Prozac) and sertraline (Zoloft). The following SSRI list is in alphabetical order by generic name:

1. Citalopram (Celexa)
2. Escitalopram (Lexapro)
3. Fluoxetine (Prozac, Prozac Weekly, Selfemra, Sarafem)
4. Fluvoxamine (Faverin, Luvox, Luvox CR)
5. Paroxetine (Paxil, Paxil CR, Pexeva)
6. Sertraline (Zoloft)
7. Viibryd (Vilazodone)

Read about SSRI antidepressants.

SNRI List

Similar to SSRIs are SNRIs which modulate norepinephrine as well as serotonin. There are fewer drugs on this antidepressants list and the medications are newer. The following is the SNRI list:

1. Desvenlafaxine (Pristiq)
2. Duloxetine (Cymbalta)
3. Milnacipran (Savella)²
4. Venlafaxine (Effexor, Effexor XR )

Read about SNRI antidepressants.

MAOI List

MAOIs are an older class of antidepressants and alter more chemicals in the brain than either SSRI or SNRIs. The medications on this list of antidepressants may have dietary restrictions associated with them. The following is the MAOI list:

1. Isocarboxazid (Marplan)
2. Phenelzine (Nardil)
3. Tranylcypromine (Parnate)

Read about MOAI antidepressants.

List of Tricyclic Antidepressants

Tricyclic antidepressants are another older class of antidepressant. Antidepressants on this list are not generally chosen as first-line treatments as their risk of side effects is higher than some other types. The following is a list of tricyclic antidepressants:

1. Amitriptyline (Elavil, Endep, Levate)
2. Amoxapine (Asendin)
3. Clomipramine (Anafranil)
4. Desipramine (Norpramin, Pertofrane)
5. Doxepin (Adapin, Silenor, Sinequan)
6. Imipramine (Tofranil, Tofranil-PM)
7. Maprotiline (Ludiomil)
8. Nortryptyline (Aventyl, Pamelor)
9. Protriptyline (Vivactil)
10. Trimipramine (Surmontil, Trimip, Tripramine)

Read about tricyclic antidepressants.

Other Antidepressant Medications List

In addition to the above, there is a long list of antidepressants that don't fit neatly into any category. Those on the following list of medications for depression have unique ways of acting on the brain:

1. Bupropion (Alpenzin, Budeprion SR, Budeprion XL, Buproban, Wellbutrin, Wellbutrin SR, Wellbutrin XR, Zyban)
2. Buspirone (Buspar)
3. Maprotiline (Ludiomil)
4. Mirtazapine (Remeron, RemeronSolTab)
5. Reboxetine (Edronax, Vestra)
6. Trazodone (Desyrel, DesyrelDividose, Oleptro, Trazodone D)
7. Vilazodone (Viibryd)

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What is the best treatment for depression? The best treatment for depression is the one that works for you. It sounds trite, but each person's mind and body is different and your experience with depression and depression treatments may be slightly or hugely different than the next person's experience. That's why, unfortunately, most people have to try several different antidepressant medications before finding the best depression treatment for them.

Depending on the type of depression, some don't need antidepressants at all and can get by on psychotherapy alone. For those with moderate to severe depression, the National Institute of Mental Health states that research shows a combination of antidepressant medication and psychotherapy is the best depression treatment.

But what it really takes to effectively treat and manage depression symptoms is a comprehensive plan. Julie Fast, an award-winning author of many books and articles on depression, spells out in plain English, what it takes to recover from depression in a special HealthyPlace.com section entitled: "The Gold Standard for Treating Depression." We highly recommend you read it. We think you'll find it enlightening and it may change your thoughts about how to find the best help for depression.

What Types of Depression Treatments Are Best?

There are many different types of treatments for depression. Listed below are sections with in-depth articles on the various ways of treating your depression. Each section includes the benefits as well as problems you may encounter in using that specific treatment to help you better find the best depression treatment for you.

1. Antidepressant Medications (medications for depression)
2. Psychotherapy for Depression
3. Electroconvulsive Therapy (ECT, shock therapy)
4. Natural Depression Treatment
5. Eye Movement Desensitization and Reprocessing (EMDR)
6. Self-Help for Depression
7. Transcranial Magnetic Stimulation (TMS)
8. Vagus Nerve Stimulation (VNS therapy)

If you reached this page first and you need some background information, start here with "What is Depression?" and then come back here for comprehensive information on best depression treatment. We also have specific information for women with depression.

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There are several approaches to depression therapy including:

• Cognitive-behavioral therapy
• Interpersonal therapy
• Psychodynamic therapy
• Other kinds of talk therapy

Each of the depression therapies can help patients recover. Psychotherapy for depression provides tools for people to use to ascertain the causes of pain and sadness in their lives. There might be psychological, behavioral, interpersonal and situational factors contributing to their depression. If you're not presently in depression therapy, this article on "How to Find A Therapist to Treat Your Depression" should be very helpful.

What Can Depression Therapy Do?

Therapy professionals, like licensed psychologists, can work with depressed patients to:

• Identify distorted thinking patterns. These may be unreasonably negative thoughts that dominate everyday life. They may also be thoughts that are "black" or "white," where everything is characterized as either "bad" or "good." Therapy for depression helps nurture a more positive outlook on life.
• Understand everyday circumstances and events that may be contributing to their depression. Depression therapy focuses on how to lessen these contributing factors by taking positive steps to improve the situations.
• Explore learned behaviors that might contribute to a low mood. For example, therapy for depression can help improve the way people socially interact with each other.
• Regain a sense of control and pleasure in life. Psychotherapy for depression helps people see choices as well as gradually incorporate enjoyable, fulfilling activities back into their lives.

Therapy for Depression Reduces Future Risk

Having one episode of depression greatly increases the risk of having another episode. Additionally, the more episodes of depression a person has, the more likely future episodes will be more severe. However, there is good news. New research suggests that ongoing depression psychotherapy may lessen the chances of future depression or reduce its intensity. Through depression therapy, people can learn skills to avoid unnecessary suffering from later bouts of depression.

Role of Family and Friends in Depression Therapy

It can be extremely difficult and stressful to live with, or be around, a person with depression. Loved ones feel helpless and often feel a loss for the person the depressed patient used to be. They may even feel angry at the person with depression, even though they are aware it is a mental illness and not something being done on purpose.

This is where family or couple’s depression therapy can help. Left alone, the feelings of helplessness and anger can get worse, but depression psychotherapy can help relieve these tensions. Therapy for depression can increase understanding and awareness of the condition, as well as teach ways to help cope with the depression symptoms. That way, all loved ones can practice healthy coping techniques together and encourage wellness and the continuation of depression therapy.

This participation by family and friends in depression psychotherapy can be critical to its success. Loved ones then become part of the support network for the person with depression and can help them move forward through treatment.

Antidepressants and Depression Therapy

Antidepressant medications can be very helpful for reducing the symptoms of depression in some people, particularly in cases of moderate-to-severe depression. Many healthcare providers treating depression may favor using a combination of depression psychotherapy and medications. Given the possibility of medication side effects, any use of medication requires close monitoring by the prescribing physician.

Antidepressants may also stabilize a person enough to make them more successful at depression therapy. For people who too depressed, psychotherapy may not be useful on its own. By conducting a thorough assessment, a mental health professional can make recommendations about an effective depression treatment plan.

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Scientists, patients and loved ones are all looking for a cure for depression. Everyone would like a medication or a therapeutic technique that would stop depression for good. Unfortunately, depression can't be cured, but it can be treated for the vast majority of people. However, lifetime remission could be thought of as cured depression.

One of the biggest barriers to stopping depression is getting adequate treatment – up to two-thirds of people don't realize they have a treatable illness. Society's stigma around depression and the treatments used to help "cure" depression also stop people from getting depression help.

It's important to remember though, while a cure for depression may not be available, depression treatment enables 70% - 80% of people to achieve a significant reduction in depression symptoms.¹

How to Stop Depression

How to stop depression is different for each individual. For some people, psychotherapy offers the best depression cure while for others, medication is necessary to stop their depression. Depression may be treated using:

• Medication (info on: depression medications)
• Psychotherapy (info on depression therapy)
• Lifestyle changes for depression (such as diet and exercise)
• Other therapies (such as light therapy or electroconvulsive therapy)

Most doctors agree a combination of medication and psychotherapy give people the best chance at a long-lasting depression cure, particularly in cases of severe depression. In cases of mild-to-moderate depression, psychotherapy and lifestyle changes alone may stop depression.

Depression Remission

Rather than a depression cure, most doctors talk about depression remission. Depression remission indicates a cessation or dramatic reduction of depression symptoms. Complete remission, where the patient no longer experiences any impact from depression in day-to-day life and has little to no depression symptoms, is the objective of treatment. It's possible to have partial remission where only some of the depression symptoms go away, but stopping depression completely is always the goal.

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ECT problems are nothing new. Electroconvulsive therapy, once known as shock therapy, has historically been plagued with problems. Electricity was used to invoke seizures long before electricity and the brain were understood. While modern machines and procedures are now used, electroconvulsive therapy (ECT) problems still exist.

As with any medical procedure involving general anesthesia, death is a possibility during ECT. This ECT problem is considered minor, however, as the risk is equal to that of any minor surgery, approximately 1 in 10,000 patients.¹

The ECT problems of greatest concern are cognitive in nature. Possible cognitive problems include:

• Short or long-term memory loss
• Disorientation and confusion
• Slowing of information processing speed
• Very rarely, delirium

Cognitive ECT problems tend to fade over time but some, like memory loss, may be permanent. (more info on ECT side effects)

ECT problems may also include nausea, headache, muscle pain and soreness right after treatment. Rarely, patients with co-occurring disorders may be at higher risk for other difficulties such as: asystole (heart stoppage), prolonged seizures and prolonged apnea.

A Personal Story of the Problems with ECT

Bipolar blogger Liz Spikol talks about the ECT problems she experienced. While a psychiatric nurse tells Spikol ECT is easy, the adult diaper and mouth guard given to Spikol for the procedure suggest otherwise. Spikol outlines what she calls traumatic treatments and the long-lasting memory effects.

 

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These ECT videos provide information on the benefits of ECT treatment as well as negative side effects of ECT. Plus these ECT videos include personal ECT stories.

Electroconvulsive therapy (ECT), once known as shock therapy, is primarily used in treating severe treatment-resistant depression. While ECT is the most controversial practice in psychiatry, over 100,000 people receive ECT each year in the United States. The benefits of ECT treatment have been well documented and for many, are worth the risks.¹

Watch these ECT videos.

ECT Video – A Personal Story

This treatment can be a positive experience, as seen in this ECT video. Carol Kivler, our guest on the HealthyPlace Mental Health TV Show, talks about how she experienced the benefits of ECT treatment. Kivler suffers from periodic acute bouts of medication-resistant depression, responsive only to ECT.

Carol is a 59-year-old corporate trainer; she is also an executive coach, keynote speaker and founder of Kivler Communications. Carol also is the author of Will I Ever Be the Same Again? Transforming the Face of ECT (Shock Therapy). In this video, Carol talks about her experiences with shock therapy as a treatment for clinical depression, as well as the model she created to help those suffering from clinical depression to stay in recovery for longer periods of time.

Medical ECT Videos

ECT is no longer practiced with patients wide awake and is not used to control or subdue patients. Psychiatrist Dr. Harry Croft, Medical Director at HealthyPlace.com, dispels this and other myths in this ECT video.

 

ECT is used to treat several conditions. In this ECT therapy video, Dr. Croft outlines why a patient would consider ECT treatment and the possible side effects of ECT.

However, not everything about ECT is good though. Some patients experience ECT problems.

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