Antidepressants: How to Choose the Right Antidepressant Medication
A 2006 study by the National Institutes of Health found that only 30 percent of depression
patients responded fully to their first prescribed antidepressant. Those that responded quickly were more likely to have been taking a higher dose of antidepressant medication, and taking it for longer. Some antidepressant medications are more effective than others depending on the individual, and it's not uncommon for patients to try several antidepressant drugs before they find the best one for them. Some people do best on a combination of antidepressants.
Your doctor or psychiatrist will work closely with you to determine which antidepressant drug or drugs to prescribe, taking your symptoms and situation into consideration. For example, if you are having trouble sleeping or your depression is accompanied by nervousness, you may be prescribed an antidepressant that has a calming effect. If you are overly tired or withdrawn you may be prescribed an antidepressant medication with a stimulating effect. One antidepressant, Celexa, seems to work better for women than for men. Your doctor will also consider any other medical conditions you may have, and any other prescription and over-the-counter medications you are taking.
Most antidepressant medicines are believed to work by increasing the activity of chemicals in the brain called neurotransmitters, in particular serotonin, dopamine and norepinephrine. Today's most frequently prescribed antidepressants are the selective serotonin reuptake inhibitors or SSRIs (such as Celexa, Prozac and Zoloft), and the newer serotonin and norepinephrine reuptake inhibitors or SNRIs (such as Effexor and Cymbalta). Another new class, norepinephrine-dopamine reuptake inhibitors or NDRIs (Wellbutrin and Zyban), is being increasingly prescribed.
All three have fewer adverse side effects than the older classes of antidepressant medications, such as tricyclics and monoamine oxidase inhibitors (MAOIs). The most frequent antidepressant side effects are upset stomach, dry mouth, sleep disturbances, weight gain, anxiety, and impaired sexual function. Wellbutrin is not associated with weight gain or sexual impairment, and is frequently prescribed along with an SSRI for added effect. Marketed as
Wellbutrin sustained release (SR) and Wellbutrin extended release (XL), it is also prescribed for seasonal effective disorder and as an aid to quit smoking. Talk to your doctor about any unpleasant antidepressant side effects you may experience, as he or she may be able to suggest a way to minimize them. Remember that most side effects ease as you continue treatment.
It's important to stay on your antidepressant medication long enough for it to become effective, without skipping doses. It usually takes at least two weeks until patients begin to feel the benefits of their antidepressants, and it can take up to eight weeks for antidepressant drugs to reach full effectiveness. It's also important not to stop taking your antidepressant medication suddenly. You will likely need to reduce the dose gradually to avoid unpleasant withdrawal symptoms like headaches, nausea and dizziness, and to avoid a possible increase in your depression. Most people who take antidepressant medication need to stay on it for six to nine months. Some patients will need to take an antidepressant indefinitely.
Antidepressant medication has been associated with suicidal thoughts in youth and young adults during initial treatment, and the FDA has issued a safety warning regarding their use in this population. Americans' use of
depression medications doubled over the decade between 1996 to 2005, and is continuing to rise. Antidepressants have greatly improved the quality of life for many adults. Statistics show that suicide rates, which had held steady for 15 years, dropped with the introduction of the SSRI Prozac, and continued to drop over the next 14 years as Prozac sales rose, especially among women. The most effective depression treatment is a combination of medication and psychological counseling.
Antidepressants: How to Choose the Right Antidepressant Medication
By: Lynn Woods
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