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Other Antidepressants for Depression

There are other antidepressant medicines available to treat depression. All these antidepressants are pills taken by mouth. These antidepressants are newer (second generation) antidepressants. This means that they tend to have fewer side effects than older (first generation) antidepressants such tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs). Serotonin reuptake inhibitors (SSRIs) also are second generation antidepressants.

Examples

Generic name

Brand name

bupropion

Wellbutrin

desvenlafaxine

Pristiq

duloxetine

Cymbalta

mirtazapine

Remeron

trazodone

Desyrel, Oleptro

venlafaxine

Effexor

How they work

Bupropion, duloxetine, mirtazapine, trazodone, and venlafaxine balance certain brain chemicals (neurotransmitters) that are important to your mood. When these brain chemicals are balanced, it helps the symptoms of depression.

Why they are used

These drugs have been approved by the FDA for treating depression in adults. These medicines have not been approved for use in children ages 18 and younger. You can take these medicines alone or you can take them with another medicine.

Your healthcare provider may suggest these medicines when other antidepressants don’t work or have side effects that you can’t tolerate. For example:

  • Some antidepressants cause problems with sexual function. Bupropion may be used instead in these cases. It is less likely to cause sexual problems.

  • Some antidepressants can cause insomnia or feelings of agitation. Mirtazapine may help in these cases.

  • Some SSRIs can cause sleep problems. Trazodone may be used in small amounts to help with this.

Make sure your healthcare provider knows all your medical history. Tell them about all the health problems you have. Also tell your healthcare provider about all the medicines you are taking.

How well they work

These antidepressants work to treat depression. Some of these medicines are used to treat anxiety disorders, and some are used to treat obsessive-compulsive personality disorder.

Bupropion, desvenlafaxine, duloxetine, mirtazapine, trazodone, and venlafaxine have been approved by the FDA for treating depression in adults.

Side effects

These medicines have different side effects from first generation antidepressants. They also have different side effects from SSRIs.

Trazodone has numerous side effects. In rare cases, some can be severe. Some of the most common side effects of each of these medicines are listed below.

Some possible side effects of bupropion include:

  • Weight loss of more than 5 lbs

  • Agitation

  • Confusion

  • Anxiety

  • Insomnia

Other side effects are rare, but can include:

  • Allergic reactions

  • Dry mouth

  • Headaches

  • Heart palpitations

Bupropion may trigger seizures in some people. Talk with your healthcare provider before taking this medicine if you have a history of seizures. Also tell your healthcare provider if you have a history of eating disorders.

Some possible side effects of desvenlafaxine include:

  • Constipation

  • Not feeling hungry

  • Dry mouth

  • Blurred vision

  • Fatigue

  • Odd dreams

Some possible side effects of duloxetine include:

  • Nausea

  • Dry mouth

  • Constipation

  • Decreased appetite

  • Fatigue

  • Sleepiness

  • Increased sweating

  • Sexual dysfunction

More serious side effects are rare, but can include:

  • Liver problems

  • Increased blood pressure

  • Mania or hypomania

  • Seizures

  • Mydriasis (pupil dilation), which can cause problems for people with narrow-angle glaucoma

When you stop using duloxetine, withdrawal effects can include:

  • Dizziness

  • Nausea

  • Headache

  • Abnormal touch sensation or tingling (paresthesia)

  • Vomiting

  • Irritability

  • Nightmares

Some possible side effects of mirtazapine include:

  • Drowsiness

  • Increased appetite or weight gain

  • Increased cholesterol levels

  • Dizziness

  • Dry mouth

  • Constipation

More serious side effects are rare, but can include:

  • Agranulocytosis (insufficient white blood cell count)

  • Allergic reactions

  • Liver or pancreas problems

Some possible side effects of trazodone include:

  • Drowsiness

  • Dizziness or lightheadedness

  • Blurred vision

  • Weight gain

  • Dry mouth

  • Constipation

  • Headache

  • Nausea

This medicine can also cause priapism. This is a painful condition in which the penis stays erect. If this happens and you have an erection that lasts longer than three or four hours, call your healthcare provider right away.

Some possible side effects of venlafaxine include:

  • Constipation

  • Weight loss

  • Dry mouth

  • Slight increase in cholesterol

  • Hypertension

  • Sexual dysfunction

  • Enlarged (dilated) pupils

When you stop using venlafaxine, withdrawal effects can include:

  • Dizziness

  • Nausea

  • Headache

  • Abnormal touch sensation or tingling (paresthesia)

  • Vomiting

  • Irritability

  • Nightmares

Venlafaxine makes bleeding more likely in the stomach and esophagus. Taking NSAIDs (such as Aleve or Advil) while using this medicine can make bleeding even more likely. Taking a medicine to control acid in the stomach may help reduce this risk.

FDA advisories:

  • The FDA has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

  • The FDA recommends that people at risk for glaucoma are watched for signs of pupil dilation (mydriasis) when taking venlafaxine.

What to think about

Each antidepressant medicine works in its own way. No antidepressant works better than any another, but they can each work better or worse for different people. The side effects of one medicine may lead you to choose another. Tell your healthcare provider about any side effects you may have.

You may have to try several medicines, or you may need to take more than one, to help your symptoms. Most people find a medicine that works within a few tries. Other people take longer to find the right one or they may need to take an antidepressant with another type of medicine.

Your healthcare provider may ask if you have ever been on an antidepressant that worked. Or if a family member has ever gotten better from an antidepressant. This will help your healthcare provider figure out the right medicine for you.

Take your antidepressant exactly as your healthcare provider says. Don't stop taking your medicine without talking with your healthcare provider. If you stop suddenly, this can cause withdrawal effects. These may include dizziness, anxiety, fatigue, and headache. If you and your healthcare provider decide you can stop using medicine, you may need to reduce your dose slowly over time.

You may start to feel better within 1 to 3 weeks of taking one of these medicines. But it can take as many as 6 to 8 weeks to feel the full effects. If you don’t notice any change in your symptoms by 3 weeks, talk with your healthcare provider.

Like with other antidepressants, these should not be used at the same time as MAOIs. This can cause serious and sometimes fatal reactions to occur. To avoid serious problems, wait at least 14 days after stopping an MAOI before taking any of these medicines.

Taking medicines for depression while you are pregnant may make certain birth defects more likely. Let your healthcare provider know right away if you do become pregnant while taking medicine. Untreated depression can also have a negative impact on the baby or mother’s health, so you may need to keep taking the medicine if your depression is severe. You and your healthcare provider will weigh the risks of taking a medicine against the risks of not treating your depression.

These medicines must be used very carefully in people who have bipolar disorder. This is because the medicines may trigger a manic episode. If you have bipolar disorder, your healthcare provider may prescribe a mood stabilizer to take at the same time.

If you have any questions or concerns about your medicines, talk with your healthcare provider.

Do you have thoughts about suicide?

If you or a loved one has thoughts about death or suicide, call 911 or the Veterans Crisis Line at 800-273-TALK (800-273-8255) and press 1, or use other emergency services. Or you can chat with a trained counselor online at www.VeteransCrisisLine.net.

Author: StayWell Custom Communications
Last Annual Review Date: 9/1/2018
Copyright © The StayWell Company, LLC. except where otherwise noted.
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