Depression Drugs and Medication
These include imipramine, amitriptyline, nortriptyline, clomipramine, protriptyline, doxepin, trimipramine, dothiepin and lofepramine. Each has its own specific characteristics and differs in some ways from the others. The TCAs were developed in 1958.
TCAs can take anything from a week to several weeks to work and length of treatment varies. They work by correcting a deficiency of monoamines in the brain. These are chemical transmitters and their levels become reduced during depression. Because they are cheap, TCAs are often the first drug prescribed. However, they have some unpleasant side effects and so may not be your doctor’s first choice. But if you are one of the people who does not respond to other drugs, they may prove effective. Side effects may include difficulty urinating, constipation, rapid heartbeat, feeling faint, drowsiness and confusion. If they are prescribed, your doctor will supervise their use.
There are few withdrawal symptoms, although there may be a relapse into depression a few weeks later.
Monoamine oxidase inhibitors
MAOIs include phenelzine, tranylcypromine and moclobemide. They are so called because they slow down the removal of monoamines by the enzyme monoamine oxidase. Each drug has its own specific characteristics and no two are identical. They were developed in the late 1950s/early 1960s. The first was actually a treatment for tuberculosis, which was then found to improve mood – a happy, accidental discovery.
They can take a few weeks to work and the length of treatment varies. There is no doubt that they work, but they have many side effects, including lowered blood pressure leading to dizziness and fainting, headaches and sleep problems. Some of this family of drugs may interact adversely with foods such as mature cheese and pickled fish, so make sure your doctor advises you about which foods to avoid.
Selective serotonin reuptake inhibitors
The best-known SSRIs are fluoxetine (under the brand name Prozac) and paroxetine (Seroxat in the UK and Paxil in the USA). Others are citalopram, fluvoxamine, paroxetine (Seroxat) and sertraline. Each drug in the SSRI family has its own characteristics and no two are identical. For example, Seroxat is usually more effective than Prozac in treating depression accompanied by an element of obsessive-compulsive disorder.
SSRIs are so called because they raise serotonin levels in the brain. These levels are lower than normal in people with depression. The length of treatment varies from person to person. Many people suffering from depression have found them very helpful. They are just as effective as the TCAs, but without the worrying side effects of the older drugs.
Nevertheless, you may be unlucky enough to experience nausea, insomnia and general agitation or anxiety. Some people lose their sex drive.
Lithium carbonate (often simply called lithium) is a mood regulator and the drug your doctor will usually choose if you are suffering from mania and manic depression. Other drugs he might prescribe include carbamazepine and sodium valproate.
It may take several months before it is fully effective. Your doctor will arrange regular tests to monitor the amount of lithium in your blood because the level required for the treatment to work is not much below the toxic level. Since you might experience some unpleasant side effects, such as reduced thyroid function, thirst, trembling, nausea and diarrhea, your doctor will supervise its use. Lithium is sometimes prescribed in combination with TCAs. Carbamazepine and sodium valproate also may have serious side effects.
Insomnia and waking in the early hours of the morning, both common signs of depression, can be treated with sleeping tablets. If you take them for only a short time while you are completely exhausted, they can be very helpful. However, most of these drugs are addictive, so you should not take them for more than two weeks. Think of them as a short-term remedies for depression.
Anxiety is a very common feature of depression and your doctor may prescribe anti-anxiety drugs, or tranquillizers, to help you in the weeks that it can take for anti-depressant medication to become effective. Some anxiolytics are addictive, so, as with sleeping tablets, your doctor will prescribe them for short-term use only.