The Ultimate Guide to Depression Medication

Depression is one of the most common mental illnesses in America and around the world. With even a single episode of depression having a high prevalence rate, it is important to know and have access to the best ways to treat depression. Medication, psychotherapy, and brain stimulation therapies are a few of the best modalities to treat depression. Medications tend to be the one of the first options to treat depression with severe symptoms, so let’s explore this type of treatment.

W. Nate Upshaw, MD

W. Nate Upshaw, MD

Dr. William Nathan Upshaw is the Medical Director of NeuroSpa TMS®. Since receiving training from the inventor of TMS Therapy nearly a decade ago, Dr. Upshaw has been a pioneer, champion and outspoken advocate of TMS Therapy. Dr. Upshaw’s holistic experience in the field has transformed him into Florida’s leading advocate for widespread accessibility to TMS Therapy.

About Dr. Upshaw

What is Depression?

Before diving into what can treat depression, understanding what depression is can be helpful. Depression presents through numerous symptom variations. Depression often consists of low mood, feelings of sadness, hopelessness, potential thoughts of suicide, and social isolation among other symptoms. Depression also can be present in the form of many physical symptoms. In order to be diagnosed with Major Depressive Disorder, symptoms have to be present for at least two full weeks. You must have at least two of these specific symptoms:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

There are other mood disorders that have depression as a symptom or part of their presentation. These include Bipolar Disorder, Postpartum Depression, and Dysthymia. Persistent Depressive Disorder, more commonly known as Dysthymia, presents as a low mood but with less severe symptoms as Major Depressive Disorder, for as long as two years. Depression can be clinically significant in your life, but not necessarily meet criteria for a diagnosis; if this is the case, know that it can still be treated and may be given an “unspecified” mood disorder diagnosis.

Treating Depression With Medication

Oral medications are a common and well researched treatment for depression. Oral medications are often a frontline treatment, in addition to various forms of psychotherapy for depression. SSRIs and SNRIs are the type of medications most likely to be prescribed early on during treatment of depression. Other medication classes include MAOIs and tricyclic medications.

SSRIs, or selective serotonin reuptake inhibitors, are the most commonly prescribed antidepressants. They are prescribed to reduce symptoms of moderate to severe depression, are relatively safe and typically cause fewer side effects than other types of antidepressants. They reduce depressive symptoms by increasing levels of serotonin in the brain, and block the reabsorption of serotonin into neurons. This makes more serotonin available to improve transmission of messages between neurons. The term “selective” is used in the name of this class of medication because they mainly affect serotonin and not other neurotransmitters. SSRIs are also used to treat other conditions, such as anxiety disorders.

Serotonin and norepinephrine reuptake inhibitors, or SNRIs, are another class of medications used to treat depression and other conditions, such as anxiety disorders and chronic pain. Like SSRIs, SNRIs impact neurotransmitters, but block the reabsorption of serotonin and norepinephrine, not just serotonin.

MAOIs, or monoamine oxidase inhibitors, were the first type of antidepressant ever developed. They’re effective, but have largely been replaced by other medications that are safer and cause fewer side effects. The use of MAOIs typically requires diet restrictions and avoidance of some medications because of their risk of dangerously high blood pressure when taken with certain foods or medications. This medication blocks the enzyme (monoamine oxidase) which is involved in the removal of the neurotransmitters norepinephrine, serotonin and dopamine from the brain. This results in more of them being available in the brain, which can improve mood. MAOIs are sometimes used to treat conditions such as Parkinson’s disease. Tricyclic medications were also one of the first medications used in the treatment of depression, but similarly to MAOIs, are often overlooked for SSRIs or SNRIs.

Medication Breakdown

There are numerous types and classes of medications that are used in the treatment of depression and other mental illnesses. It’s important to consult with your medical or mental health care provider which medications may be a good fit for your specific situation and diagnosis, as each patient is unique. Here is an in-depth breakdown of some of those medications.

Prozac®

What is Prozac®?

Prozac® is an FDA-approved medication to treat depression, panic attacks, Obsessive Compulsive Disorder (OCD), Bulimia Nervosa, other eating disorders and a severe form of premenstrual syndrome (premenstrual dysphoric disorder). It was created in 1987.

Prozac® Drug Class

SSRI

Generic Name

Fluoxetine

Similar Brands to Prozac®

Sarafem

Side Effects of Prozac®

Nausea, anxiety, dizziness, drowsiness, trouble sleeping, tiredness, loss of appetite, sweating, or yawning. 

Adverse Effects of Prozac®

Severe mood changes (i.e. agitation, unusual excitement, thoughts of suicide), easy bruising, muscle weakness, muscle spasm, shakiness, decreased libido, changes in sexual ability and unusual weight loss. 

Precautions

Contact your doctor if you have any allergies, or if you think you may be allergic to Prozac® as well as if you have liver problems, diabetes, low sodium in the blood (may occur while taking diuretics), severe dehydration, seizures or stomach/intestinal ulcers, and personal/family history of Bipolar Disorder, suicide attempts, and glaucoma (angle-closure type).

Related Drugs to Prozac® 

Paxil®, Pexeva®, Zoloft®, Celexa®, and Lexapro®

 

Prozac®’s Molecular Formula

C17H19ClF3NO

Prozac® Drug Interactions

Monoamine Oxidase Inhibitors (MAOIs) with an increased risk of serotonin syndrome, CNS Acting Drugs, Serotonergic Drugs, Drugs that interfere with hemostasis (e.g., NSAIDS, Aspirin, Warfarin), and Electroconvulsive Therapy (ECT).

Pregnancy and Breastfeeding

Tell your doctor if you are pregnant or planning to become pregnant. There’s an increased risk for neonatal complications later in pregnancy. 

Prozac® Treatment Period

The usual treatment period is from 6 months to 1 year if depression symptoms decrease. It’s safe to use for long periods of time. Can be used in patients 8 years and older. 

Prozac® Overdose

Although overdose is possible, it’s rare. 

Prozac® and Insurance

Prozac® is covered by most insurance plans and Medicare.

Ingredients in Prozac®

Fluoxetine hydrochloride equivalent to 10 mg (32.3 μmol), 20 mg (64.7 μmol), or 40 mg (129.3 μmol) of fluoxetine.

Other Clinical Uses

Alcoholism, Attention-Deficit Disorder (ADD), Borderline Personality Disorder, sleep disorders, headaches, Post Traumatic Stress Disorder (PTSD), Tourette’s syndrome, sexual problems, and phobias. 

Prozac® Dosage 

Capsules at 10, 20,or 40mg, tablets at 10, 20, or 60mg, delayed release capsules at 90mg, or an oral solution at 20mg/5mL. 

Celexa®

What is Celexa®?

Celexa® is an FDA-approved drug to treat depression. It was created in 1972. 

Celexa® Drug Class

SSRI

Generic Name

Citalopram

Similar Brands to Celexa®

Cipramil®

Celexa® Side Effects

Nausea, loss of appetite, sweating, dry mouth, drowsiness, blurred vision, tiredness, and yawning. 

Adverse Effects of Celexa® 

Fainting, irregular heartbeat, vomit that looks like coffee grounds, seizures, black stools, eye pain, eye swelling, eye redness, widened pupils, and vision changes.

Precautions

Tell your doctor/pharmacist if you’re allergic to Celexa® (or to escitalopram), or if you have any other allergies, liver disease, seizures, low sodium in the blood, intestinal ulcers/bleeding (peptic ulcer disease), bleeding problems, or a personal/family history of Bipolar Disorder, suicide attempts, and glaucoma (angle-closure type).

Related Drugs to Celexa®

Zoloft®, Paxil®, and Prozac®

Celexa®’s Molecular Formula 

C20H21FN2O

Celexa® Drug Interactions

Celexa® interacts with Buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), methylene blue injection, tryptophan, St. John’s wort, amphetamines, or some pain or migraine medicines (eg, rizatriptan, sumatriptan, tramadol, Frova®, Imitrex®, Maxalt®, Relpax®, Ultram®, Zomig®).

Pregnancy and Breastfeeding

If used while pregnant, it is recommended for use with caution if the benefits outweigh the risks. 

Celexa® Treatment Period

Usual treatment duration with Celexa® is 6 months. 

Celexa® Overdose

Overdose of Celexa® is rare, as this is a mild medication. 

Celexa® and Insurance

Celexa® is covered by most insurance plans and Medicare.

Ingredients in Celexa®

Copovidone, corn starch, croscarmellose sodium, glycerin, lactose monohydrate, magnesium stearate, hypromellose, microcrystalline cellulose, polyethylene glycol, and titanium dioxide.

Other Clinical Uses for Celexa®

Can be used to treat eating disorders, alcoholism, panic disorder, premenstrual dysphoric disorder, and social phobia.Recommended for use in people 18 years or older, but under special circumstances, it can be prescribed by a doctor for patients younger than 18. 

Celexa® Dosage

Tablets at 10/20/40 mg or an oral solution at 10mg/5mL.

Luvox®

What is Luvox®?

Luvox® is an antidepressant medication approved by the FDA to treat obsessive compulsive disorder (OCD). It was created in 1994 and can be prescribed to people 8 years and older. 

Luvox® Drug Class

SSRI

Generic Name

Fluvoxamine

Similar Brands to Luvox®

Luvox CR® and Faverin®

Side Effects of Luvox®

Nausea, weakness, drowsiness, loss of appetite, vomiting, trouble sleeping, dizziness, and sweating. 

Adverse Effects of Luvox®

Fainting, vomit, seizures, black stools, eye pain, eye redness, eye swelling, widened pupils, and vision changes.

Precautions

Contact your doctor if you may be allergic, if you have any other allergies, liver problems, diabetes, low sodium in the blood (may occur while taking diuretics), severe loss of body water (dehydration), seizures, stomach/intestinal ulcers, or a personal/family history of Bipolar Disorder, suicide attempts, and glaucoma (angle-closure type).

Related Drugs to Luvox® 

Celexa®, Lexapro®, Prozac®, Paxil®, Zoloft®, and Anafranil®

Luvox® Dosage 

Tablets at 25/50/100mg, and capsules or extended release capsules at 100/150mg. 

 

Luvox®’s Molecular Formula

C15H21F3N2O2

Ingredients in Luvox®

Active ingredients in Luvox® are fluvoxamine maleate. Inactive ingredients are carnauba wax, hydroxypropyl methylcellulose, mannitol, polyethylene glycol, polysorbate 80, pregelatinized starch (potato), silicon dioxide, sodium stearyl fumarate, starch (corn), and titanium dioxide.

Luvox® Drug Interactions

Luvox® interacts with other drugs that can cause bleeding or bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, “blood thinners” such as warfarin).

Pregnancy and Breastfeeding

During pregnancy, it’s recommended to use with caution if the benefits outweigh the risks. 

Luvox® Treatment Period

Treatment usually lasts 6-8 weeks, which is when symptoms typically improve. 

Luvox® Overdose

Overdose risk is low.

Luvox® and Insurance

Luvox® is covered by most insurance plans and Medicare.

Other Clinical Uses

Luvox® is also used to treat Panic Disorder, Social Phobia, and PTSD. 

 

Paxil®

What is Paxil®?

Paxil® is a medication that is approved by the FDA to treat depression and anxiety. Paxil® was created in 1992 and is prescribed to those 18 years and older.

Paxil® Drug Class

SSRI

Generic Name

Paroxetine Hcl

Similar Brands to Paxil®

Brisdelle®, Paxil CR®, and Pexeva® 

Side Effects of Paxil®

Nausea, asthenia, diarrhea, dizziness, headache, drowsiness, ejaculatory disorder, erectile dysfunction, constipation, insomnia, male genital disease, decreased libido, delayed ejaculation, diaphoresis, and xerostomia. 

Adverse Effects of Paxil®

Anxiety, infection, lack of concentration, decreased appetite, tremors, visual disturbance, blurred vision, female genital tract disease, impotence, orgasm disturbance, vasodilation, paresthesia, abnormal dreams, and yawning.

Precautions

Tell your doctor if you think you may be allergic, if you have any other allergies, liver problems, diabetes, low sodium in the blood, severe loss of body water (dehydration), seizures, stomach/intestinal ulcers, or if you have a personal or family history of Bipolar Disorder, suicide attempts, and glaucoma (angle-closure type).

Related Drugs to Paxil® 

Lexapro®, Celexa®, Prozac®, and Zoloft®.

 Paxil® Dosage 

Tablets 10/20/30/40mgs, for a capsule 7.5mg, for tablet/extended release 12.5/25/37.5mg, and for oral suspension 10mg/5mL. 

Paxil® Treatment Period

The typical treatment length is about 6-8 weeks for symptoms to fully improve. 

Paxil®’s Molecular Formula

C19H20FNO3

Ingredients in Paxil®

The active ingredient in Paxil® is paroxetine hydrochloride. Inactive ingredients in the tablet are dibasic calcium phosphate dihydrate, hypromellose, magnesium stearate, polyethylene glycols, polysorbate 80, sodium starch glycolate, titanium dioxide, and 1or more of the following: D&C Red No. 30 aluminum lake, D&C Yellow No. 10 aluminum lake, FD&C Blue No. 2 aluminum lake, FD&C Yellow No. 6 aluminum lake. Inactive ingredients in the capsule are polacrilin potassium, microcrystalline cellulose, propylene glycol, glycerin, sorbitol, methylparaben, propylparaben, sodium citrate dihydrate, citric acid anhydrous, sodium saccharin, flavorings, FD&C Yellow No. 6 aluminum lake, and simethicone emulsion, USP.

Paxil® Drug Interactions

Paxil® interacts with thioridazine, other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, “blood thinners” such as warfarin).

Pregnancy and Breastfeeding

Paxil® taken during pregnancy has been associated with increased risk of heart defects in newborns.

Paxil® Overdose

It’s possible to overdose on Paxil®. Symptoms of overdose include facial flushing, nausea, sedation, vomiting, dizziness and sweating; at very high doses it can cause hyperreflexia, myoclonus, and seizures.

Paxil® and Insurance

Paxil® is covered by most insurance providers and Medicare

Other Clinical Uses

Paxil® is also used to treat panic attacks, anxiety disorders, and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).

 

Paxil CR®

What is Paxil CR®?

Paxil CR® is an antidepressant medication approved by the FDA that was created in 1999.

Paxil CR® Drug Class

SSRI

Generic Name

Paroxetine

Similar Brands to Paxil CR®

Brisdelle®, Paxil®, and Pexeva®.

Side Effects of Paxil CR®

Weakness, dizziness, tiredness, drowsiness; vision changes; shaking, sweating, anxiety; insomnia; nausea, loss of appetite, diarrhea, constipation, vomiting; yawning, dry mouth; infection; headache; or impotence, decreased sex drive, abnormal ejaculation, or difficulty having an orgasm.

Adverse Effects of Paxil CR®

Some young people have suicidal thoughts when taking an antidepressant for the first time. Monitor changes in your mood or symptoms. Immediately report new or worsening symptoms to your doctor.

Precautions

You should not use Paxil CR® if you are also taking pimozide or thioridazine. Do not use Paxil CR® within 14 days before or 14 days after you have used an MAO inhibitor, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. Paxil CR® is not for use in people younger than 18 years old.

Related Drugs to Paxil CR® 

Related drugs are Abilify®, Albuterol®, Sulfate Tablets, Aplenzin®, Celexa®, Effexor®, Effexor XR®, Fetzima®, Irenka®, Lexapro®, Luvox®, Parnate®, Paxil®, Pexeva®, Pristiq®, Prozac®, Thorazine®, Trintellix®, Viibryd®, Vivactil®, and Zoloft®.

Paxil CR® Dosage 

Typically, a single daily dose of 20mg/day, with or without food, normally in the morning.

 

Paxil CR®’s Molecular Formula

C19H20FNO3

Ingredients in Paxil CR®

The active ingredient in Paxil CR® is paroxetine hydrochloride. Inactive ingredients in tablets are hypromellose, polyvinylpyrrolidone, lactose monohydrate, magnesium stearate, silicon dioxide, glyceryl behenate, methacrylic acid copolymer type C, sodium lauryl sulfate, polysorbate 80, talc, triethyl citrate, titanium dioxide, polyethylene glycols, and 1 or more of the following colorants: Yellow ferric oxide, red ferric oxide, D&C Red No. 30 aluminum lake, FD&C Yellow No. 6 aluminum lake, D&C Yellow No. 10 aluminum lake, FD&C Blue No. 2 aluminum lake.

Paxil CR® Drug Interactions

Pimozide and thioridazine.

Pregnancy and Breastfeeding

Use during pregnancy is not recommended. Use while breastfeeding, however, is relatively safe.

Paxil CR® Treatment Period

The usual treatment duration is 6 months to a year after depression symptoms have gone away.

Paxil CR® Overdose

Seek emergency medical attention or call the Poison Help Line at 1-800-222-1222, as an overdose of Paxil CR® can be fatal.

Paxil CR® and Insurance

Paxil CR® is covered by some private insurance companies and Medicare.

Other Clinical Uses

Anxiety disorders, panic disorder, PTSD, OCD, and premenstrual dysphoric disorder (PMDD).

Zoloft®

What is Zoloft®?

Zoloft®, developed in 1992, is approved by the FDA to treat depression, panic attacks, obsessive compulsive disorder.

Zoloft® Drug Class

SSRI

Zoloft® Generic Name

Sertraline

Similar Brands to Zoloft®

Paxil®, Prozac®, Symbyax®, Lexapro® and Celexa®

Side Effects of Zoloft®

Side effects include nausea, dizziness, drowsiness, dry mouth, loss of appetite, increased sweating, diarrhea, upset stomach, or trouble sleeping. Serious side effects include easy bruising/bleeding, decreased interest in sex, decrease in sexual ability (ejaculation delay), muscle cramps/weakness, shaking (tremor), unusual weight loss. 

Adverse Effects of Zoloft®

Adverse effects include fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting, diarrhea, twitching muscles, unexplained fever, and unusual agitation/restlessness.

Precautions

Before taking sertraline, tell your doctor or pharmacist a list of allergies. This product may contain inactive ingredients (such as latex found in the medicine dropper), which can cause allergic reactions or other problems. Tell your doctor or pharmacist your medical history, especially of personal or family history of Bipolar Disorder, bleeding problems, liver disease, seizure disorder, thyroid disease, personal or family history of glaucoma (angle-closure type). 

Sertraline may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

Zoloft® Dosage 

Typical dosages for oral capsules are 25 mg, 50 mg, 100 mg. Dosage for an oral solution is 20 mg/mL.

Zoloft® Treatment Period

Clinical trials show it is safe to use sertraline long-term, with many cases of people using it for years at a time. When used as a treatment for depression, doctors typically recommend using sertraline for up to one year after your depression symptoms end.

Zoloft®’s Molecular Formula

C17H18Cl3N

Ingredients in Zoloft®

The active ingredient is sertraline hydrochloride. Inactive ingredients are: (tablets) dibasic calcium phosphate dihydrate, D&C Yellow #10 aluminum lake (in 25 mg tablet), FD&C Blue #1 aluminum lake (in 25 mg tablet), FD&C Red #40 aluminum lake (in 25 mg tablet), FD&C Blue #2 aluminum lake (in 50 mg tablet), hydroxypropyl cellulose, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, sodium starch glycolate, synthetic yellow iron oxide (in 100 mg tablet), and titanium dioxide. (Oral solution) glycerin, alcohol (12%), menthol, butylated hydroxytoluene (BHT).

Zoloft® Drug Interactions

Zoloft® interacts with pimozide, other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen, and “blood thinners” such as warfarin/dabigatran).

Pregnancy and Breastfeeding

During pregnancy, this medication should be used only when clearly needed as it may harm an unborn baby. Also, babies born to mothers who have used this drug during the last 3 months of pregnancy may develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. This is rare, but if you do notice any of these symptoms in your newborn, tell the doctor immediately.

Zoloft® Overdose

Symptoms of overdose may include: passing out, trouble breathing, severe dizziness, and fainting.

Zoloft® and Insurance

Zoloft® is covered by most Medicare and insurance plans. 

Other Clinical Uses

Zoloft® is also used to treat post-traumatic stress disorder (PTSD), a severe form of premenstrual syndrome (premenstrual dysphoric disorder), and social anxiety disorder (social phobia). People ages 6-18 are prescribed Zoloft® only for treatment of OCD. Ages 18+ recommended for other treatments.

Related Drugs to Zoloft® 

Drugs related to Zoloft® include Paxil®, Prozac®, Symbyax®, Lexapro® and Celexa®.

Lexapro®

What is Lexapro®?

Lexapro®, developed in 2002, is approved by the FDA to treat depression and anxiety.

Lexapro® Drug Class

SSRI

Lexapro® Generic Name

Escitalopram

Similar Brands to Lexapro®

Cipralex®

Side Effects of Lexapro®

Side effects include nausea, dry mouth, trouble sleeping, constipation, tiredness, drowsiness, dizziness, and increased sweating. 

Adverse Effects of Lexapro®

Bloody/black/tarry stools, fainting, fast/irregular heartbeat, vomit that looks like coffee grounds, seizures, eye pain/swelling/redness, widened pupils, and vision changes (such as seeing rainbows around lights at night, or blurred vision). Older adults may be more sensitive to the side effects of this drug. They may also be more likely to lose too much salt (hyponatremia), especially if they are also taking diuretics with this medication. Loss of coordination can increase the risk of falling.

Precautions

Tell your doctor if you are allergic to Lexapro®, citalopram, or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Tell your doctor if you have personal or family history of Bipolar Disorder, personal or family history of suicide attempts, liver disease, seizures, intestinal ulcers/bleeding (peptic ulcer disease) or bleeding problems, low sodium in the blood (hyponatremia), or history of glaucoma (angle-closure type).

Related Drugs to Lexapro® 

Related drugs include citalopram (Celexa®), fluoxetine (Prozac®), paroxetine (Paxil®) and sertraline (Zoloft®). 

Lexapro® Dosage 

The recommended dose of Lexapro® is 10 mg, once daily. A flexible-dose trial of Lexapro® (10 to 20 mg/day) demonstrated the effectiveness of Lexapro®. If the dose is increased to 20 mg, this should occur after a minimum of three weeks.

Lexapro®’s Molecular Formula

C20H21FN2O

Ingredients in Lexapro®

Lexapro® oral solution contains escitalopram oxalate equivalent to 1 mg/mL escitalopram base. Inactive ingredients are sorbitol, purified water, citric acid, sodium citrate, malic acid, glycerin, propylene glycol, methylparaben, propylparaben, and natural peppermint flavor.

Lexapro® Drug Interactions

Some products that may interact with this drug include: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, and “blood thinners” such as warfarin).

Pregnancy and Breastfeeding

During pregnancy, this medication should be used only when clearly needed, as it may harm an unborn baby. Babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. If you notice any of these symptoms in your newborn, tell the doctor as soon as possible.

Lexapro® Treatment Period

If you are experiencing the first episode of depression or anxiety, you may take Lexapro® for a defined period such as between six months and one year. However, for individuals experiencing a chronic mental health condition, it may be necessary to take Lexapro® for an extended period over many years. 

Lexapro® Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222.

Lexapro® and Insurance

Lexapro® is covered by most Medicare and insurance plans. 

Other Clinical Uses

It is also used to treat obsessive compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder. It is prescribed for ages 12 and up, but in some cases, a doctor may decide escitalopram is the best medication to treat a child’s condition.

Effexor®

What is Effexor®?

Effexor® was developed in 1993, and approved by the FDA to treat depression. It is prescribed for ages 18 and older.

Effexor® Drug Class

SNRI

Generic Name

Venlafaxine

Similar Brands to Effexor®

Effexor XR®

Side Effects of Effexor®

Side effects include confusion, mood swings, headaches, tiredness and sleep disorders. Side effects include confusion, mood swings, headaches, tiredness and sleep disorders. 

Adverse Effects of Effexor®

Adverse effects include nausea, drowsiness, dizziness, dry mouth, constipation, loss of appetite, blurred vision, nervousness, trouble sleeping, unusual sweating, or yawning.

Precautions

Avoid driving, using machines, drinking alcohol or doing anything else that could be dangerous if you are not fully alert.

Related Drugs to Effexor® 

Drugs related to Effexor® include Savella®, Cymbalta®, and Pristiq®.

Effexor® Dosage 

The recommended starting dose is 75 mg/day, taken in two or three doses with food. The dose may be increased to 150 mg/day depending on a case by case scenario. If needed, the dose could be increased further up to 225 mg/day.

Effexor® Treatment Period

The average treatment length can last between 6 months and a year after depressive symptoms have gone away.

Effexor®’s Molecular Formula

Effexor®’s molecular formula is C17H27NO2.

Ingredients in Effexor®

Active ingredients are venlafaxine hydrochloride equivalent to 37.5 mg, 75 mg, or 150 mg venlafaxine. Inactive ingredients include cellulose, ethylcellulose, gelatin, hypromellose, iron oxide, and titanium dioxide.

Effexor® Drug Interactions

Effexor® interacts with other drugs that can cause bleeding/bruising (including antiplatelet drugs, NSAIDs including ibuprofen/naproxen, and “blood thinners” including warfarin). Aspirin can increase the risk of bleeding when used with Effexor®. Avoid taking MAO inhibitors with this medication, as it can cause a serious, potentially fatal, drug interaction. 

Pregnancy and Breastfeeding

During pregnancy, only use when absolutely necessary as it can harm an unborn baby. Babies born to mothers who have used this drug during the last 3 months of pregnancy may (rarely) develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. Effexor® passes into breast milk and may have negative effects on a nursing infant. Consult your doctor before breast-feeding.

Effexor® Overdose

Overdose symptoms include: severe drowsiness, seizures, and fast/irregular heartbeat.

Effexor® and Insurance

Generic venlafaxine is covered by most Medicare and insurance plans.

Other Clinical Uses

It is also used to treat anxiety, panic attacks, social phobia, and unwanted thoughts.

Pristiq®

What is Pristiq®?

Pristiq® was developed in 2008, and is approved by the FDA to treat depression. It is recommended for use in ages 18 and older.

Pristiq® Drug Class

SNRI

Generic Name

Desvenlafaxine.

Similar Brands to Pristiq®

Other brand names are Khedezla® and Effexor XR®.

Side Effects of Pristiq®

Side effects such as drowsiness, dizziness, nausea, dry mouth, constipation, loss of appetite, weight loss, blurred vision, nervousness, trouble sleeping, or excessive sweating may occur. 

Adverse Effects of Pristiq®

Adverse effects include hypersensitivity, suicidal thoughts, serotonin syndrome, elevated blood pressure, increased risk of bleeding, angle closure glaucoma, and activation of mania/hypomania.

Precautions

Before taking desvenlafaxine, tell your doctor or pharmacist if you are allergic to it, to venlafaxine, or if you have any other allergies. Before using this medication, tell your doctor or pharmacist your medical history, especially if it includes: personal or family history of psychiatric disorders (such as Bipolar Diosrder), personal or family history of suicide attempts, bleeding problems, personal or family history of glaucoma (angle-closure type), high blood pressure, heart problems (such as chest pain, heart failure, heart attack), history of stroke, high cholesterol, kidney disease, liver disease, seizure disorder or low sodium in the blood (hyponatremia).

Related Drugs to Pristiq® 

Cymbalta®, Effexor XR® and Fetzima® are related drugs.

Pristiq® Treatment Period

It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacologic therapy.

Pristiq®’s Molecular Formula

Pristiq®’s molecular formula is C20H33NO7.

Ingredients in Pristiq®

Inactive ingredients consist of hypromellose, microcrystalline cellulose, talc, magnesium stearate, a film coating which consists of polyvinyl alcohol, polyethylene glycol, talc, titanium dioxide, and iron oxides. Sometimes FD&C yellow #6.

Pristiq® Drug Interactions

Some products that may interact with this drug include: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen and “blood thinners” such as dabigatran/warfarin).

Pregnancy and Breastfeeding

During pregnancy, this medication should be used only when clearly needed as it may harm an unborn baby. Additionally, babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness or constant crying.

Pristiq® Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Symptoms of overdose may include: severe drowsiness, seizures and fast or irregular heartbeat.

Pristiq® and Insurance

Pristiq® is covered by most Medicare and insurance plans. 

Other Clinical Uses

Pristiq® could also be used to treat generalized anxiety disorder, social anxiety disorder and panic disorder.

Pristiq® Dosage 

For Major Depressive Disorder, a typical dosage is 50 mg/day. Higher dosages, up to 400 mg/day, have been used but have not been proved more efficacious. Other forms: 25mg, 100mg.

Cymbalta®

What is Cymbalta®?

Cymbalta® was developed in 2004, and is approved by the FDA to treat depression and anxiety. Children younger than 18 years of age should not normally take duloxetine, but in some cases, a doctor may decide that duloxetine is the best medication to treat a child’s condition. 

Cymbalta® Drug Class

SNRI

Generic Name

Duloxetine

Similar Brands to Cymbalta®

Savella®, Effexor®, and Pristiq®. 

Side Effects of Cymbalta®

Side effects include nausea, dry mouth, constipation, loss of appetite, tiredness, drowsiness, dizziness, lightheadedness, or increased sweating may occur. 

Adverse Effects of Cymbalta®

Adverse effects include Diabetic Peripheral Neuropathic Pain: nausea, somnolence, decreased appetite, constipation, hyperhidrosis, and dry mouth. Fibromyalgia: nausea, dry mouth, constipation, somnolence, decreased appetite, hyperhidrosis, and agitation. Chronic Pain due to Osteoarthritis: nausea, fatigue, constipation, dry mouth, insomnia, somnolence, and dizziness. Chronic Low Back Pain: nausea, dry mouth, insomnia, somnolence, constipation, dizziness, and fatigue.

Precautions

Before using this medication, tell your doctor or pharmacist about any allergies and your medical history, especially of personal or family history of psychiatric disorders (such as Bipolar Disorder), personal or family history of suicide attempts, bleeding problems, personal or family history of glaucoma (angle-closure type), high blood pressure, kidney disease, liver disease, seizure disorder, stomach problems (such as slow emptying of the stomach), or use/abuse of alcohol.

Related Drugs to Cymbalta® 

Related drugs are Savella®, Effexor®, and Pristiq®. 

Cymbalta® Treatment Period

Once feeling better, it’s likely that you’ll continue to take duloxetine for several more months. Most doctors recommend that you take antidepressants for 6 months to a year after you no longer feel depressed or anxious.

Cymbalta®’s Molecular Formula

Cymbalta®’s molecular formula is C18H19NOS•HCl.

Ingredients in Cymbalta®

Ingredients in Delayed Release Capsules are FD&C Blue No. 2, gelatin, hypromellose, hydroxypropyl methylcellulose acetate succinate, sodium lauryl sulfate, sucrose, sugar spheres, talc, titanium dioxide, and triethyl citrate. The 20 and 60 mg capsules also contain iron oxide yellow. 

Cymbalta® Drug Interactions

Some products that may interact with this drug include: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, and “blood thinners” such as warfarin).

Pregnancy and Breastfeeding

During pregnancy, this medication should be used only when clearly needed. When this medication is taken during the last 30 days of pregnancy, the mother may be at an increased risk of bleeding at birth. This medication may also harm an unborn baby. Babies born to mothers who have used this drug during the last 3 months of pregnancy may develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying.

Cymbalta® Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. 

Cymbalta® and Insurance

Cymbalta® is covered by some insurance plans, speak to your provider for more information.

Other Clinical Uses

It is also used to help relieve nerve pain (peripheral neuropathy) in people with diabetes or ongoing pain due to medical conditions such as arthritis, chronic back pain, or fibromyalgia (a condition that causes widespread pain).

Cymbalta® Dosage 

The recommended starting dosage in adults with MDD is 40 mg/day (given as 20 mg twice daily) to 60 mg/day (given either once daily or as 30 mg twice daily). For some patients, it may be desirable to start at 30 mg once daily for 1 week, to allow patients to adjust to Cymbalta® before increasing to 60 mg once daily. While a 120 mg/day dose was shown to be effective, there is no evidence that doses greater than 60 mg/day confer any additional benefits.

Non-Medication Alternatives

Medications may not be the best or most effective line of treatment for everyone. Often, another form of treatment can help the efficacy of the medication. Luckily, there are other forms of treatment for depression that can either replace medications, or be administered in tandem. Psychotherapy, or talk therapy, is an effective form of treatment for depression. There are various therapy frameworks and techniques that can help. Cognitive Behavioral Therapy (CBT), is a highly effective treatment that focuses on identifying, understanding, and changing thoughts and behaviors. Benefits from CBT are usually seen in 12 to 16 weeks. Other forms of therapy are also beneficial, depending upon your background, personality, and circumstances. These include Dialectical Behavior Therapy approaches, Interpersonal Therapy, or Acceptance and Commitment Therapy frameworks and techniques. 

Another non-medication treatment option is a brain stimulation therapy called Transcranial Magnetic Stimulation (TMS). TMS is a non-invasive procedure that stimulates nerve cells in the brain to improve depressive symptoms. During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The treatment uses painless magnetic pulses to stimulate nerve cells in the area of the brain that controls depression, which is the left prefrontal cortex. These magnetic pulses have a positive stimulating effect on the neurotransmitters of the brain, leading to a reduction in symptoms of depression. NeuroSpa TMS beats national averages, with 81% of our patients responding positively to the treatment, and 53% of our patients achieving complete remission of depressive symptoms with no systemic side effects. This treatment can be an option if other forms of treatment are not beneficial, or can be a first line choice in your treatment journey. 

Conclusion

We know that depression is a debilitating mental illness. With symptoms that cause us to feel physical and mentally unlovable and unworthy, it is important to remember the various treatment options that are available. There are numerous medications to consider and trial, as well as psychotherapy and brain stimulation therapies. A specific therapy or medication that works for one person, may not work for the next. The best place to start on this journey of improving your mental health is to reach out to your primary care doctor, or get in touch with a mental health professional that can evaluate your situation and help you decide on what the best treatment is for you.

References

Anxiety and Depression Association of America. (n.d.-c). Therapy | Anxiety and Depression Association of America, ADAA. Retrieved December 11, 2020, from https://adaa.org/finding-help/treatment/therapy.

Mayo Clinic. (2019, October 5). Serotonin and norepinephrine reuptake inhibitors (SNRIs). Retrieved December 8, 2020, from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20044970.

Mayo Clinic. (2019, September 17). Selective serotonin reuptake inhibitors (SSRIs). Retrieved December 8, 2020, from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825.

Mayo Clinic. (2019, October 8). Tricyclic antidepressants and tetracyclic antidepressants. Retrieved December 8, 2020, from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983.

Mayo Clinic. (2018, November 27). Transcranial magnetic stimulation – Mayo Clinic. Retrieved December 8, 2020, from https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625.

National Institute of Mental Health. (n.d.-e). NIMH » Depression. Retrieved December 8, 2020, from https://www.nimh.nih.gov/health/topics/depression/index.shtml.

NeuroSpa TMS. (2020, December 1). How Does TMS Work? | NeuroSpa TMS. Retrieved December 11, 2020, from https://neurospatms.com/how-tms-works/.

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