Depression Treatment: Treatment - Commonly Used Medications

SSRIs and SNRIs are the most commonly used medications for depression, largely because they are safer and have fewer side effects than some other types of medication used to treat depression. However, in cases where a person is not helped by SSRIS or SNRIs, other types of medications are sometimes used. The major classes of alternative depression medications are Monoamine-Oxidase Inhibitors, Tricyclic Antidepressants and Antipsychotic medications. 
 
Monoamine Oxidase Inhibitors
Monoamine-Oxidase Inhibitors (MAOIs) can be effective for depression and were one of the first classes of antidepressant medication developed. However, they have largely been replaced by SSRIs and SNRIs, which are safer and tend to have fewer side effects. One of the most problematic issues with MAOIs is the potential to develop dangerously high blood pressure when the medications are taken in combination with certain foods or other medications. For these reasons, people taking MAOIs have certain important dietary restrictions. Similar to other types of antidepressant medications, MAOIs are believed to work by altering communication between chemical messengers in the brain. They may need to be taken daily for several weeks before a person will notice an antidepressant effect.
 
What are the different types of MAOIs and what are their characteristics?  The Federal Drug Administration has approved several types of MAOIs for treating depression.  Each is listed in the table below along with important characteristics such as names, doses, and side effects.
 
Brand Name Generic Name Usual Dosage Range Side Effects
Marplan Isocarboxazid 40-60mg Dizziness, headache, drowsiness, nausea
Nardil Phenelzine 45-75 mg Dizziness, headache, drowsiness, sleep problems, fatigue, constipation, stomach upset, dry mouth, nausea, weight gain, sexual dysfunction
Emsam Selegiline 6-12 mg transdermal; 30-60 mg oral Dizziness, headache, drowsiness, sleep problems, fatigue constipation, stomach upset, dry mouth
Parnate Tranylcypromine
30 mg Headaches, drowsiness, sleep problems, constipation, stomach upset, dry mouth, chills, vision problems, sensitivity to light, restlessness
 
Tricyclic Antidepressants 
Tricyclic Antidepressants (TCAs) are an older type of antidepressant medication. They can be effective but are often only tried if SSRIs and SSNIs have not been effective because they tend to cause more severe side effects than those medications. Among people with depression that includes difficulty falling asleep, certain TCAs are sometimes prescribed to be taken at bedtime because they have a sedating effect. Similar to other types of antidepressant medications, TCAs are believed to work by altering communication between chemical messengers in the brain. They may need to be taken daily for several weeks before a person will notice an antidepressant effect.
 
What are the different types of TCAs and what are their characteristics?  The Federal Drug Administration has approved several types of TCAs for treating depression.  Each is listed in the table below along with important characteristics such as names, doses, and side effects.
 
Brand Name Generic Name Usual Dosage Range Side Effects
Elavil, Levate Amitriptyline 50-150 Drowsiness, dizziness, weight gain, constipation, blurred vision, 
Asendin, Asendis, Defanyl, Demolox Amoxapine 200-300 mg Drowsiness, headache, dizziness, agitation, weight gain, constipation, dry mouth, sleep problems
Norpramin Desipramine 100-200 mg Headaches, nausea, dizziness, agitation, weight gain, constipation, dry mouth
Deptran, Sinequan Doxepin
75-150 mg Headaches, drowsiness, sleep problems, constipation, stomach upset, dry mouth, chills, vision problems, sensitivity to light, restlessness
Tofranil Imipramine
50-150 mg Nausea, stomach upset, blurred vision, tingling, sexual dysfunction, breast swelling (men and women)
Pamelor Nortriptyline
75-150 mg Blurred vision, rapid heart rate, dizziness, tingling, nausea, breast swelling (men and women)
Vivactil Protriptyline
15-40 mg Drowsiness, stomach upset, headache, constipation, weakness, dizziness, fatigue, sleep problems 
Surmontil Trimipramine
50-150 mg Drowsiness, headache, vision changes, sleep problems, stomach upset, breast swelling (men and women), sexual dysfunction
 
Antipsychotics
 
Antipsychotic medications are commonly used to treat Schizophrenia and Bipolar Disorder. They are also sometimes used as an “augmentation” treatment for depression, meaning in addition to SSRIs or SNRIs. This is typically considered when SSRIs and SNRIs alone are not effective and/or when other treatments have not worked. Antipsychotic medications have some drawbacks. They can be expensive and using them over time can lead to a serious side effect called Tardive Dyskinesia, which involves involuntary twitching in the face and body. In addition, antipsychotic medications can cause substantial weight gain and raise a person’s risk of developing Type II Diabetes. 
 
What are the different types of Antipsychotic medications and what are their characteristics?  The Federal Drug Administration has approved several types of Antipsychotic medications for treating depression.  Each is listed in the table below along with important characteristics such as names, doses, and side effects.
 
Brand Name Generic Name Usual Dosage Range Side Effects
Abilify Aripiprazole 2-10 mg Restlessness, insomnia, fatigue, blurred vision, constipation
Zyprexa Olanzapine 6-12 mg Dizziness, restlessness, weight gain, constipation
Seroquel XR Quetiapine 50-300 mg Constipation, upset stomach, dizziness, headache, weight gain, sleep problems