Finding the right antidepressant can be a difficult process for most depressed people. Treating depression can be challenging. While citalopram (Brand Name: Celexa) certainly seems to be the most popular antidepressant on the market today, many patients are finding success with Zoloft, Lexapro, Wellbutrin orEffexor.
Many patients with chronic depression report that it took an average of about six months of trying various depression pills before they found the right drug for them.
There are many considerations that go into selecting the right antidepressant for you. The medication must correct your mood disorder with as few side effects as possible. Some people who are living with depression have to go off certain depression pills because the side effects become too much for them to handle. Another problem with some antidepressants is that they lose effectiveness after a while. A medication that has worked perfectly for you for over a year may suddenly stop working. Your depression may return with a vengeance and you will be back to square one. Then your doctor will have to start you on a new antidepressant until you find one that was as effective as the first one.
Around 50% of people with depression will respond to antidepressants. In rare cases, antidepressants can have a paradoxical effect and can actually worsen your depression and anxiety symptoms.
Many doctors will continue antidepressant therapy for a long time after the patient appears to feel better. Long term treatment with antidepressants can prevent the patient from relapsing after the depression drug is discontinued. After the patient is in remission, many doctors will continue to prescribe depression pills for an additional six to 12 months to increase the patient’s chances of a successful recovery. Half of the patients who respond to treatment will relapse within a year if treatment is discontinued.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Usually, your doctor will select a medication from the SSRI class of antidepressants when you first start treatment for chronic depression. SSRIs are known for their safety (in comparison to other classes of depression pills) and they work for about half of the people who take them.
Citalopram (Brand Name: Celexa) – Celexa, or citalopram, is approved by the FDA (Food and Drug Administration) to treat major depression. It is frequently prescribed for other medical conditions such as Obsessive Compulsive Disorder (OCD), premenstrual dysphoric disorder (PMDD), panic disorder, chronic depression and anxiety.
Many doctors love to start their patients on a low dose of citalopram and then go from there. Celexa is available in a generic form and it is very inexpensive. This makes citalopram an affordable antidepressant for people that are unemployed or uninsured. Citalopram is considered to be safer than many other depression pills and it is effective for most people with depression.
About half of the people who take Celexa show a substantial improvement in mood after the first month of treatment. Citalopram does have some side effects, but most of them are mild. Celexa users often experience sexual side effects. The sexual side effects associated with citalopram use will usually disappear after the drug is discontinued, but some patients have reported permanent sexual side effects. Celexa should not be given in dosages that exceed 40mg per day as researchers have recently found out that high amounts of citalopram can cause fatal changes in the heart. Citalopram should also not be given to patients who may have undiagnosed bipolar disorder.
Prozac is Frequently Prescribed for Chronic Depression
Fluoxetine (Brand Name: Prozac) – Prozac, discovered in 1974, first went on the market in 1988. Prozac, or fluoxetine, is approved by the Food and Drug Administration (FDA) to treat many conditions such as premenstrual dysphoric disorder (PMDD), panic disorder, major depression and bulimia nervosa. It has also been used to treat alcohol addiction.
Prozac is generally well-tolerated by most patients, but it also has been known to cause relatively severe sexual side effects. Prozac also commonly causes Akathisia, which is a feeling of tension, restlessness and inner anxiety. Akathisia, which can be very unpleasant, causes your feet and legs to constantly move. Akathisia can cause more anxiety. Prozac should not be taken with ibuprofen as it can cause serious intestinal bleeding. Another common side effect associated with fluoxetine is a skin rash. This rash was observed in 8% of patients. In many cases, the rash was serious enough to cause patients to discontinue Prozac antidepressant therapy.
There have been many violent acts and murders that have been blamed on the usage of Prozac. Joseph Wesbecker killed 8 people in 1989 while taking Prozac. In the resulting court case, the use of Prozac was linked to violent behavior.
However, the Federal Aviation Association (FAA) allows pilots to fly planes while taking Prozac. There are only 4 approved antidepressants for pilots under the FAA guidelines. Pilots are also allowed to fly while taking Celexa, Lexapro and Zoloft.
Sertraline (Zoloft) is Safe for Chronic Depression Patients with Heart Disease
Sertraline (Brand Name: Zoloft)- Zoloft is a very popular antidepressant. It works as well as some of the tricyclic antidepressants, but with much less side effects. Recent studies have provided documentation that Zoloft is more effective than Prozac for most types of depression. Around 30 million prescriptions for Zoloft are written every year in the United States.
Zoloft is used to treat Post Traumatic Stress Disorder (PSTD), major depression, chronic depression, OCD, premenstrual dysphoric disorder (PMDD), social anxiety disorder (social anxiety) and panic disorder. Zoloft is usually safe to take if a patient has heart disease. A generic version of Zoloft is available,
Paroxetine (Brand Name: Paxil)- Paxil went on the market in 1992 and is currently one of the top 5 prescribed antidepressants in the United States. Physicians in America write around 20 million prescriptions for Paxil every year. Paxil, or paroxetine, is used to treat major depression, chronic depression, panic disorder, social anxiety, Post Traumatic Stress Disorder (PSTD) and generalized anxiety disorder (GAD). Paxil has similar side effects to other SSRI antidepressants. Paxil usage can cause a significant weight gain in some patients.
Paxil has a particularly bad withdrawal period. Patients should not suddenly stop taking Paxil. Paxil withdrawal symptoms can be severe. Paxil needs to be tapered off slowly.
Paxil should be used cautiously in patients that also have bipolar disorder(manic depression) as it can induce severe episodes of mania. You should read about manic depression symptoms to make sure that you don’t have any of them before you start taking Paxil.
GlaxoSmithKline (GSK), the manufacturer of Paxil, was successfully sued in court because they misled the public about the severity of Paxil withdrawal symptoms associated with the discontinuation of paroxetine. GlaxoSmithKline marketed Paxil as a non-addictive or non-habit forming medication. Doctors found that these claims were not true; Paxil is very addictive.
Paxil withdrawal symptoms can be brutal: electric shocks throughout the body, constant crying, vivid nightmares, severe anxiety, insomnia, nausea, light headedness, dizziness and vertigo. Out of all of the SSRI depression pills, paroxetine has the most severe withdrawal symptoms. Patients need to consider the withdrawal symptoms when deciding whether or not to take the medication in the first place. You will eventually want to get off Paxil and you don’t want to experience a nightmarish withdrawal from the drug. If you are currently on Paxil, your doctor will be able to recommend a good taper schedule to lessen the paroxetine withdrawal symptoms.
Lexapro is Used to Treat Chronic Depression
Escitalopram (Brand Name: Lexapro)- Lexapro is marketed as a slightly improved and updated version of Celaxa, or citalopram. Lexapro is approved to treat major depressive disorder and generalized anxiety disorder. Lexapro entered the market soon after Lundbeck’s patent on Celexa expired. Lundback has been accused of releasing a nearly identical version of Celexa to continue making big profits after other pharmaceutical companies started producing generic versions of citalopram. Lexapro is prescribed to treat many of the same mental disorders that Celexa is prescribed for.
As of February 2012, there has been only one study that indicated that Lexapro may be superior to Celexa. This study was later determined to be biased as the study was conducted by a firm that had links to Lexapro’s manufacturer, Lundbeck. Many people ask, “Which is a better antidepressant? Lexapro or Celexa?” The answer to this question is that Lexapro and Celexa are almost identical in chemical composition. For this reason, many doctors prescribe citalopram to their patients based on its lower cost.
Fluvoxamine (Brand Name: Luvox) – Luvox, or fluvoxamine, is often confused with fluoxetine (Prozac) due to their similar sounding names. Luvox was originally approved in 1993, for the treatment of Obsessive Compulsive Disorder (OCD). It is often prescribed to treat major depressive disorder, panic disorder and Post Traumatic Stress Disorder (PSTD). Luvox works especially well for children who have obsessive compulsive disorder. It works better than other antidepressants for patients that require long-term therapy with depression pills. Luvox, or fluvoxamine, stays effective after taking it for a year or more.
Luvox has quite a few side effects; however, most of them are relatively mild.Luvox side effects include: nausea, anxiety, dry mouth, heartburn, headaches, sweating and rapid heartbeat. An advantage of Luvox is that the sexual side effects associated with most SSRIs are less pronounced. As sexual side effects can often be a deal breaker for many patients, Luvox is preferred by many depressed people for this reason.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
The most popularly prescribed SNRIs include:
Duloxetine (Brand Name: Cymbalta) – Cymbalta is an antidepressant that is known to be very effective for the treatment of major depression and generalized anxiety disorder (GAD). If you are suffering from severe depression, you should definitely talk to your doctor about a Cymbalta prescription. Cymbalta is also prescribed for certain types of painful conditions including fibromyalgia. Cymbalta is said to be very effective for lower back pain and osteoarthritis. Cymbalta is also currently being investigated to see if it will be helpful for any other medical conditions. Cymbalta has been very effective in treating severe depression in elderly patients. Elderly patients who were depressed improved their cognition and had lower pain levels while taking Cymbalta.
It is especially promising that Cymbalta has been proven to be an effective treatment for fibromyalgia. In clinical trials, women with fibromyalgia reported significantly lower pain levels when taking Cymbalta. Fibromyalgia is a hard disease to treat effectively. The FDA has approved Cymbalta, or duloxetine, for the treatment of fibromyalgia. Cymbalta may also be an effective treatment option for another disabling medical condition, Chronic Fatigue Syndrome (CFS). Cymbalta is proving to be a very versatile and well-tolerated medication that has the ability to treat many difficult-to-treat diseases in addition to its effectiveness in treating depression. Severe depression is often a consequence of disabling and chronic illnesses like Chronic Fatigue Syndrome and Fibromyalgia. Pain and depression often occur simultaneously so an antidepressant that can also relieve pain may be a miracle drug for some people.
Cymbalta side effects are generally mild. Cymbalta side effects can include nausea, dizziness and insomnia.
Venlafaxine (Brand Name: Effexor) – Effexor, or venlafaxine, is prescribed for the treatment of panic disorder, depression, general anxiety disorder and social phobia. Effexor is also used to treat Obsessive Compulsive Disorder (OCD). There are current studies that are investigating the possibility of Effexor being a good treatment for chronic pain.
Effexor is proven via multiple studies to be very effective in treating various forms of depression. Patients who have been prescribed Efflexor notice a similar result to some of the older tricyclic antidepressants. This is good news because tricyclic antidepressants are known for dangerous side effects. Patients that were prescribed larger doses of Effexor had better results and higher rates of remission from their depression.
Many doctors have begun prescribing Effexor for other conditions. Doctors have prescribed Effexor for the treatment of migraine headaches. Studies have also shown that Effexor can dramatically reduce the discomfort of hot flashes in women suffering from menopause. Effexor has also been used to treat the sleep disorder, narcolepsy.
Many people who are prescribed Effexor will lose weight. This can be helpful for depressed people who are suffering from a loss of self-esteem due to weight gain.
Effexor should not be used in patients that have bipolar depression. Effexor can increase the severity of mixed states and mania.
Effexor should be used with caution in patients with high blood pressure. Studies have shown that Effexor can cause a substantial increase in blood pressure. Effexor should not be taken with the herbal supplement St. John’s Wort. Patients should not consume alcohol while taking Effexor. Drinking and depression can be a dangerous combination. Alcohol doesn’t mix well with many depression medications.
Effexor side effects include sexual side effects. Some of the side effects of Effexor can be severe. Effexor side effects include yawning, blurry vision, vomiting, constipation, amnesia, dry mouth, dizziness, nausea, sweating, anxiety, insomnia and weight loss. Some of the more severe Effexor side effects include infections, headaches, chest pain, hypertension, hypotension, diarrhea, skin rash, rapid heartbeat, confusion, depersonalization, tinnitus, agitation and twitching.
Effexor withdrawal symptoms can also be severe. Patients commonly experience SSRI Discontinuation Syndrome when coming off Effexor. Effexor has a very short half-life compared to other depression pills. Therefore, if you miss even one Effexor dose, the withdrawal symptoms can start. Effexor withdrawal symptoms include severe headaches, extreme tiredness, disorientation and stomach pains. Effexor withdrawal symptoms can be so severe that your doctor may prescribe a different type of SSRI medication to help alleviate the discomfort of discontinuation. Some people may be unable to discontinue Effexor due to a condition called Serotonin toxicity or Serotonin Syndrome.
Effexor’s patent has expired and a generic version is now available at a much lower cost.
Desvenlafaxine (Brand Name: Pristiq)– Pristiq, or desvenlafaxine, is currently being heavily marketed. If you have been watching any television lately, you’ve probably noticed many advertisements for the new SNRI antidepressant, Pristiq. Pristiq is a synthetic form of venlafaxine (Effexor).
Pristiq is approved by the FDA as an antidepressant. Pristiq is also being targeted as a possible treatment for the unpleasant symptoms of menopause. Since Pristiq is a non-hormonal alternative to traditional menopause medications, it may turn out to be very promising. Many women have refused to take hormone pills for their menopause symptoms because of the cancer risks associated with hormone replacement therapy (HRT).
Common Pristiq side effects can include nausea, dizziness, constipation, insomnia, night terrors, appetite loss and anxiety. Pristiq has many of the same side effects of Effexor, including a risk of high blood pressure. There are also some serious Pristiq side effects including abnormal bleeding, hypertension, glaucoma, seizures and high cholesterol.
If you have been prescribed Pristiq, you should not consume alcohol.
Like Effexor, Pristiq withdrawal symptoms can be severe. Pristiq also has a very short half-life. Because of Pristiq’s short half-life, Pristiq withdrawal symptoms can start after missing just one dose. Some patients have stated that the severity of Pristiq withdrawal can be so bad that it is nearly impossible to get off this medication. Pristiq withdrawal symptoms include nausea, irritability, anxiety, dizziness, abnormal dreams and nightmares, insomnia and electric shock sensations throughout your entire body.
One of the major benefits of taking an atypical antidepressant is that they don’t usually cause the sexual side effects that other depression pills do.
Atypical Antidepressants include:
Trazodone (Brand Name: Oleptro) – Trazodone, or Oleptro, can be extremely sedating; some doctors like to prescribe it in smaller doses as a sleeping aid for this reason. Trazodone is an SARI antidepressant. SARI stands for Serotonin Antagonist and Reuptake Inhibitor. Trazodone is known for its hypnotic and anxiolytic effect. One of the benefits of taking trazodone is that it has less sexual side effects than tricyclic antidepressants.
Trazodone was originally developed in Italy in the 1960’s as an antidepressant medication. Trazodone is used to treat Bipolar depression, sleep disturbances, insomnia, nightmares and unipolar depression. Trazodone also is prescribed for many off label uses. Trazodone off label uses include panic disorder, fibromyalgia, bulimia nervosa, obsessive compulsive disorder (OCD), alcohol withdrawal, pain management, psychosis and schizophrenia.
Trazodone withdrawal symptoms can be significant. Even patients on very low dosages can experience serious Trazodone withdrawal symptoms such as suicidal thoughts, depression and emotional instability.
Trazodone can have many side effects, some serious and some not so serious. Minor trazodone side effects include headache, dry mouth, diarrhea, appetite changes, nausea, stomach pain, vomiting, fatigue, difficulty in concentration, nightmares, sweating, muscle pain, blurry vision, ringing in your ears and increased sexual drive. Serious Trazodone side effects include pounding heartbeat, irregular heartbeat, chest pains, shortness of breath, chills, infections, fever, hives, itchy skin rash, breathing difficulties, fainting, uncontrollable shaking, swollen face, swollen throat, swollen lips, swollen tongue and cardiac arrhythmia.
Trazodone is prescribed in dosages of 25mg to 150mg. If a doctor is prescribing trazodone as a sleeping aid, they will usually prescribe it in a 25mg dose.
Trazodone may cause mental or physical impairments. You should be careful if you are taking Trazodone and driving a vehicle.
You should not take trazodone if you are already taking barbiturates or other central nervous system depressants. Consuming alcohol with trazodone can cause extreme dizziness and tiredness. ECT or shock therapy should not be administered while a patient is taking trazodone.
Bupropion (Wellbutrin or Zyban)
Bupropion (Brand Name: Wellbutrin or Zyban) – Wellbutrin, currently the 4th most prescribed antidepressant in the United States, is a very versatile medication. Doctors write over 20 million prescriptions for Wellbutrin every year in America.
Wellbutrin is an atypical antidepressant that is also prescribed as a stop smoking aid. Wellbutrin treats both clinical and chronic depression. Wellbutrin is currently being studied to see if it will treat obesity. Wellbutrin has a stimulating effect on most people. Wellbutrin has been found to be effective for adult ADHD, social anxiety disorder and severe anxiety. There are studies that are currently being conducted to see if Wellbutrin would be an effective treatment for cocaine and methamphetamine abuse. Many doctors prescribe Wellbutrin for patients that suffer from Seasonal Affective Disorder (SAD). Wellbutrin may also be helpful for patients who suffer from psoriasis or Crohn’s Disease.
Wellbutrin is often prescribed in conjunction with another antidepressant. The combination of citalopram (Celexa) and Wellbutrin is a popularly prescribed and potent combination. The strategy of combining two different antidepressants is called augmentation.
Wellbutrin does not cause the sexual dysfunction that is often seen in other types of depression pills. In fact, Wellbutrin often causes an increase in sex drive. Wellbutrin does not cause patients to gain weight. People who are prescribed Wellbutrin have increased mood and motivation. Wellbutrin is especially helpful in providing a boost to patients who are suffering with depression fatigue. Taking stimulants for depression is often very helpful for patients who lack focus and energy.
Wellbutrin might sound like it is the perfect antidepressant and for many people, it is. However, there are some risks associated with taking Wellbutrin. Wellbutrin has been associated with a higher risk of seizures. Common Wellbutrin side effects include hypertension, dry mouth, insomnia, tinnitus, nausea, sweating and tremors. Rare Wellbutrin side effects include mania and psychotic symptoms.
Wellbutrin withdrawal symptoms include anxiety, irritability, mania, headaches, pains and aches. Your doctor will use dose tapering when you decide to stop taking Wellbutrin.
Do Anti-Depressants Cause People with Chronic Depression to Commit Suicide?
Anti-depressants carry a black box warning that there may be a suicide risk. The Food and Drug Administration (FDA) requires that all antidepressants and depression pills carry a warning about the risk of suicide. The suicide risk mainly affects younger patients such as children, adolescents and young adults between the ages of 18 and 24 years of age. In younger patients, antidepressants have caused an increased risk of suicide due to frequent thoughts of death and dying. Due to this risk, younger patients should be monitored more carefully when taking antidepressants by their loved ones and health care professionals. Suicide is always a huge concern for teenagers with depression.