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Decision Assist

Depression medications

Introduction

The purpose of this tool is to help you decide whether depression medication is right for you. When making a decision like this, you must balance:

  • The reasons for taking the medication
  • The potential health risks, side effects, or limitations of the medication
  • Whether there are alternative treatments that may be more appropriate
  • Cost

This tool is not a substitute for professional medical care and advice. Work with your doctor to help you make this decision. A second opinion from another doctor may be valuable. Medication always has potential side effects, and you should be fully informed about the risks and benefits of this type of medication. There is usually no exact “right” or “wrong” answer.

Your physician may make certain recommendations to you. However, the final decision about whether to use this medication rests with you.

What is the medication?

Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. But true clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life.

Depression is a treatable illness, with many therapeutic options available. Increasingly, professionals are viewing major depression as a chronic illness, meaning the condition often returns when treatment is stopped. Therefore, medical intervention and help must be ongoing.

Another type of chronic depression called dysthymia is usually milder.

Forms of depression

Patients with chronic depression have several options, including psychotherapy, medications called antidepressants, or both. In general, the treatment choice depends on the degree and type of depression and other accompanying conditions. It also may depend on age, pregnancy status, or other individual factors.

Several studies have supported a combination of cognitive behavioral therapy (CBT) plus antidepressant medications. These drugs can include:

  • Selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Zoloft, Paxil, Celexa, or Lexapro
  • Drugs that inhibit norepinephrine uptake, such as Venlafaxine (Effexor), Duloxetine (Cymbalta), or Mirtazapine (Remeron)
  • Dopamine reuptake inhibitors (bupropion, also known as Wellbutrin)
  • Older antidepressants, most often a tricyclic antidepressant such as nortriptyline

Many of these newer antidepressants are effective and have very moderate side effects. Some may be beneficial in treating anxiety. They may also help treat disorders that have not responded to previous drug treatment, including premenstrual dysphoric disorder, seasonal affective disorder, atypical depression, and recurrent, brief bouts of depression.

Key points

  • Certain types of talk therapy (for example, cognitive behavioral therapy) may be at least as effective as medications.
  • The combination of talk therapy and medication may the best way to treat depression, especially if it is severe.
  • Patients should start antidepressant medications at a low dose, which may be increased over a period of 5 - 10 days.
  • Some experts recommend that patients see their doctor every 1 - 2 weeks until substantial improvement occurs. It may, however, take 4 - 8 weeks before a patient experiences improvements brought on by taking an antidepressant.
  • Some antidepressants are associated wtih an increased chance of suicide at the beginning of treatment or when dosage is changed.
  • Other side effects can include weight gain, sexual dysfunction, an increase in dental problems (due to dry mouth caused by taking antidepressants), and potentially dangerous interactions with other drugs.
  • Side effects usually diminish in 1 - 4 weeks. (Exceptions may be weight gain and sexual dysfunction.)
  • In general, patients should continue taking antidepressants for at least 6 months after symptom relief to help prevent relapse. (Patients who improve within 2 weeks of taking medications may not require lengthy treatment.)
  • If you are pregnant and have been taking antidepressants, you should talk to your doctor before stopping your medication.

How much time this decision tool will take

  • 5 - 10 minutes

What this tool will provide

  • A personalized list of factors for you to weigh
  • Questions to ask your doctor
  • Alternatives to this medication
  • Recommended reading

Review Date: 9/19/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Previously reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. (6/6/2008).

References:
  • Gijsman HJ. Geddes JR, Rendell JM, Nolen WA, Goodwin GM. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. American Journal of Psychiatry. September 2004;161(9):1537-47.
  • Gunnell D, Ashby D. Antidepressants and suicide: what is the balance of benefit and harm. BMJ. July 3, 2004;329(7456):34-8.
  • Hughes J, Stead L, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews. 2004;(4):CD000031.
  • Institute for Clinical Systems Improvement. Health Care Guideline: Major Depression in Adults in Primary Care. 13th ed. May 2010. Accessed September 18, 2010.
  • Mann JJ. The medical management of depression. New England Journal of Medicine. October 27, 2005;353(17):1819-34.
  • Rohan KJ, Roecklein KA, Tierney Lindsey K, et al. A randomized controlled trial of cognitive-behavioral therapy, light therapy, and their combination for seasonal affective disorder. J Consult Clin Psychol. Jun 2007;75(3):489-500.
  • Zuckerbrot RA, Cheung AH, Jensen PS, Stein RE, Laraque D; GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics. Nov 2007;120(5):e1299-312.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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