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Depression Medication Management

If you are being diagnosed with depression, your doctor will come up with a treatment plan that may include prescribing a depression medication known as antidepressants.

Developed in 1950 by accident by chemists tasked to find a cure for tuberculosis,
antidepressants have been formally prescribed for 70 years, and the science behind them is continuously evolving on a daily basis.

Antidepressants alter the brain’s chemistry by introducing chemicals to the body that people with depression can’t produce in adequate amounts. These chemicals include serotonin, dopamine, and norepinephrine.

Although antidepressants may not cure depression, they can reduce symptoms. The development of antidepressants has enabled millions of individuals to reclaim their lives from the shadows and find solutions to cope with unavoidable conditions.

What Is Antidepressant Medication Management?

Antidepressant Medication Management (AMM) supports adults, children and adolescents living with depression by helping individuals manage their symptoms. Medication for depression is frequently prescribed alongside counseling or psychotherapy, and different types of antidepressants can cater to people’s unique needs and health requirements. Knowing which to choose will ensure you have maximum success with your treatment.

Which Types of Depression Can Benefit From Antidepressant Treatment?

Many types of depression can benefit from antidepressant treatment, from moderate cases to persistent depressive disorder to major depressive disorder, but evidence suggests they are less effective in mild cases of depression. Studies show that the benefit generally depends on the severity of the depression: The more severe the depression, the greater the benefits will be. In other words, antidepressants are effective against chronic, moderate, and severe depression. Antidepressants are also used to treat cases of anxiety, as well as anxiety and depression when diagnosed together.

Main Types of Antidepressants

Several types of antidepressants are prescribed to patients according to their symptoms and requirements. This antidepressants list outlines the properties of six of the most common types of medication for depression:

Selective Serotonin Reuptake Inhibitors (SSRIs)

The most commonly prescribed type of antidepressant, SSRIs mainly work by encouraging serotonin to act for longer in the brain and body by obstructing the serotonin reuptake into the nerve cell that released it.

Common SSRIs include fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine.

Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)

SNRIs are often the preferred choice for treating severe depression and anxiety. They work in a similar way to SSRIs. But they affect your noradrenaline reuptake as well as your serotonin reuptake for a more powerful impact overall.

Common SNRIs include duloxetine and venlafaxine.

Tricyclic Antidepressants (TCAs)

Named due to their chemical structure of three rings, tricyclics such as amitriptyline, amoxapine, and desipramine (Norpramin) boost your body’s noradrenaline and serotonin reuptake, creating a longer-lasting effect on your brain and body. As they can affect some other chemicals, they can cause increased unpleasant side effects.

Common SNRIs include duloxetine and venlafaxine.

Noradrenaline and Specific Serotonergic Antidepressants (NaSSAs)

For people who cannot take SSRIs, NaSSAs may be an effective solution, although the side effects are similar. NaSSAs are shown to cause fewer sexual problems but may cause increased drowsiness at first. They may be used for sleep and appetite.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs are an older type of antidepressant not often used nowadays. They work by making it harder for an enzyme called monoamine oxidase to break down noradrenaline and serotonin, keeping it active for longer. As it can have dangerous interactions with other medications and food, you need to follow a careful diet if you are prescribed MAOIs—you are unlikely to be prescribed an MAOI unless all other types of antidepressants have been unsuccessful.

Common MAOIs include tranylcypromine, phenelzine, and isocarboxazid.

Serotonin Antagonists and Reuptake Inhibitors (SARIs)

SARIs work by inhibiting serotonin reuptake and blocking serotonin 5-HT2A and 5-HT2C receptors. These atypical antidepressants both inhibit serotonin reuptake and block adrenergic receptors. Although these medications are not usually the first choice of medication, they may be prescribed if other medication for depression has not worked. Trazodone is commonly prescribed for sleep.

Common SARIs include trazodone and nefazodone.

Choosing Depression Medication

Many types of antidepressants work for patients in slightly different ways with various side effects. When choosing the right antidepressant for you, it is important to consider your particular situation and symptoms, such as whether you are also experiencing insomnia or if you are breastfeeding.

Your first antidepressant pick may work, but if you’re like many others considering antidepressants for the first time, you may need to try a few before finding the proper fit. In the future, you may need to adjust your dosage or medications.

Starting with one antidepressant does not guarantee that you will stick with it. If you need to move from one antidepressant to another, a doctor will be there to help you.

Pharmacogenomic testing is receiving increased attention as a mechanism to personalize medication selection. Pharmacogenomic testing, also known as genetic testing or genetic screening, is a tool used to analyze an individual’s genetic makeup and how it may affect their response to certain medications. In the context of depression, pharmacogenomic testing can help identify genetic variations that may influence how a person metabolizes and responds to antidepressant medications.

For depression, pharmacogenomic testing can help identify genetic variants that may impact side effects of antidepressant medications. By understanding an individual’s genetic profile, healthcare providers can make more informed decisions when prescribing antidepressants, potentially improving treatment outcomes, and minimizing adverse reactions.

Common Side Effects of Antidepressants

The specific side effects depend on which antidepressant you choose to take, but common symptoms are usual side effects of antidepressants that include:

  • Nausea
  • Weight gain
  • Trouble sleeping
  • Dry mouth
  • Blurred vision
  • Dizziness
  • Anxiety
  • Headache
  • Diarrhea or constipation
  • Sexual problems
  • Fatigue
  • Tremors
  • Increased sweating

In some cases, antidepressant medication can cause serotonin syndrome, an uncommon but potentially serious side effect linked to SSRIs and SNRIs. This occurs when the levels of serotonin in your brain become too high and is usually triggered when you take an antidepressant in combination with another substance that also raises serotonin levels, such as another antidepressant or St. John’s wort, and/or prescription and OTC medications.

If you think you might have serotonin syndrome, contact an emergency health care practitioner, or visit the emergency room. Always discuss all medications and supplements taken with your doctor to prevent interactions and serotonin syndrome. Symptoms of serotonin syndrome include:

  • Confusion
  • Agitation
  • Muscle twitching
  • Sweating
  • Shivering
  • Diarrhea

Medications for Major Depressive Disorder (MDD)

Major Depression Disorder is one of the most common mental disorders in the United States.

Drug classes such as monoamine oxidase inhibitors, tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs) have been used for to treat MDD.

In 2019, the Food and Drug Administration (FDA) approved the first new medication for major depression in decades. The drug is a nasal spray called esketamine, derived from ketamine—an anesthetic that has made waves for its surprising antidepressant effect.

After a psychiatric evaluation, your assigned doctor or medical professional will prescribe you the antidepressant that best fits your specific requirements and symptoms.

Antidepressant Medications for Young Adults

Antidepressants are commonly prescribed as medication for young adults with depression, but extra caution is recommended for children and teenagers. While antidepressants are generally considered safe, there is a slight risk of increased suicidal thinking in some individuals under the age of 25.

For many children and teens, antidepressants are an effective way to treat depression, anxiety, obsessive-compulsive disorder, or other mental health conditions. If these conditions aren’t treated effectively, your child may not be able to lead a satisfying, fulfilled life or do everyday activities.

The FDA has approved certain antidepressants for use in children and teenagers for depression:

  • Escitalopram (Lexapro®) for 12 years and older for Major Depressive Disorder
  • Fluoxetine (Prozac®) for 10 years and older for Major Depressive Disorder
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Clinically Reviewed By:
Anthony Catullo, LPCC-S
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Anthony is trained in Cognitive Behavioral Therapy (CBT) and Dialectal Behavioral Therapy (DBT). His areas of specialty include adjustment disorder, anxiety, attention deficit-hyperactivity disorder (ADHD), autism spectrum disorder, depression, grief, relationship difficulties, social skills, stress management, and trauma.