What is depression?

Depression is a medical illness, like diabetes or high blood pressure. People don’t choose to be depressed. It’s not because they’re weak or “crazy.” Depression affects more than 17 million people in the United States each year. It’s twice as common in women as in men. Symptoms of depression include the following:

• Feeling sad most of the day, nearly every day, for 2 weeks or longer
• Loss of interest in things you used to enjoy
• Lack of energy
• Sleep and appetite disturbances
• Weight changes
• Feelings of hopelessness, helplessness and worthlessness
• Not being able to make decisions
• Thoughts of death and suicide

What causes depression?

The exact cause of depression is not known. Doctors think it may be caused by a chemical imbalance in the brain. The imbalance could be caused by your genes or by events in your life. Sometimes there aren’t enough chemical messengers (called neurotransmitters) in the brain. Two primary messengers, called serotonin (say “seer-o-tone-in”) and norepinephrine (say “nor-ep-in-ef-rin”), are responsible for your moods (how you feel).

How will my doctor treat my depression?

Depression can be treated with medicine, counseling or both. The combination of medicine with counseling helps most people. Counseling can help you change a negative view of yourself, your past and your future. Exercising on a regular basis and avoiding alcohol, illegal drugs and too much caffeine can also help.

Medicines that treat depression are called antidepressants. They help increase the number of chemical messengers (serotonin and norepinephrine) in your brain.

How will my doctor choose an antidepressant for me?

Your doctor will probably think about the following 10 points when choosing an antidepressant medicine for you:

1. If you were depressed before and a certain antidepressant worked well, that antidepressant might be the right choice of medicine for you again.
2. If any of your brothers or sisters, parents, uncles or aunts had depression and a certain antidepressant worked well for them, that medicine might work for you too.
3. The choice of an antidepressant depends on your health. If a certain antidepressant would have a bad effect on a health problem you have, that medicine wouldn’t be the right choice for you.
4. Antidepressants may cause side effects. The right medicine for you may be the one that gives you the fewest side effects.
5. The choice of an antidepressant depends on how often you have to take it. The less often you have to take the medicine, the easier it is for you to take all the doses you need to treat your depression.
6. Some antidepressants cost more than others. Your doctor will choose an antidepressant that works for you and that you can afford.
7. Your doctor will want to choose a medicine he or she has experience prescribing.
8. Your doctor will choose an antidepressant that will help you with symptoms like sleeplessness, anxiety and lack of energy.
9. If you’re taking other medicines, your doctor will consider how an antidepressant will work with these other medicines.
10. Some antidepressants don’t work well with certain foods. If your doctor gives you one of these antidepressants, he or she will let you know which foods you should stop eating.

What are some of the common side effects of antidepressants?

Different antidepressants can cause different side effects. Possible side effects may include the following:

• Anxiety
• Bladder problems
• Blurred vision
• Constipation
• Diarrhea
• Dizziness when standing up
• Dry mouth
• Excessive tiredness
• Feeling of weakness
• Hand tremors
• Increased heart rate
• Increased sleepiness

Antidepressants are put into groups based on which chemicals in the brain they affect. There are many different kinds of antidepressants, including:

• Selective serotonin reuptake inhibitors (SSRIs)
  • citalopram (brand name: Celexa)
  • escitalopram (brand name: Lexapro)
  • fluoxetine (brand name: Prozac)
  • paroxetine (brand names: Paxil, Pexeva)
  • sertraline (brand name: Zoloft)

These medicines tend to have fewer side effects than other antidepressants. Some of the side effects that can be caused by SSRIs include dry mouth, nausea, nervousness, insomnia, sexual problems and headache.

• Tricyclics
  • amitriptyline (brand name: Elavil)
  • desipramine (brand name: Norpramin)
  • imipramine (brand name: Tofranil)
  • nortriptyline (brand name: Aventyl, Pamelor)

Common side effects caused by these medicines include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These antidepressants can also affect a person’s blood pressure and heart rate.

• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • venlafaxine (brand name: Effexor)
  • duloxetine (brand name: Cymbalta)

Some common side effects caused by these medicines include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased heart rate and increased cholesterol levels can also occur.

• Norepinephrine and dopamine reuptake inhibitors (NDRIs)
  • bupropion (brand name: Wellbutrin)

Some of the common side effects in people taking NDRIs include agitation, nausea, headache, loss of appetite and insomnia. It can also cause increase blood pressure in some people.

• Combined reuptake inhibitors and receptor blockers
  • trazodone (brand name: Desyrel)
  • nefazodone (brand name: Serzone)
  • maprotiline
  • mirtazpine (brand name: Remeron)

Common side effects of these medicines are drowsiness, dry mouth, nausea and dizziness. If you have liver problems, you should not take nefazodone. If you have seizures, you should not take maprotiline.

• Monamine oxidase inhibitors (MAOIs)
  • isocarboxazid (brand name: Marplan)
  • phenelzine (brand name: Nardil)
  • tranlcypromine (brand name: Parnate)