Tricyclic AntidepressantsTricyclic antidepressants were the first line of treatment for major depression from the 1960s through the 1980s. We now know that these medications affect two chemical neurotransmitters called norepinephrine and serotonin. Tricyclics are as effective in treating depression as the newer antidepressants, but their side effects are somewhat more unpleasant. They are no longer the first medication tried for most depressed patients.
Tricyclic antidepressants such as imipramine, amitriptyline, nortriptyline, and desipramine are used when newer medications are not effective. They may also be used at night to improve sleep. Some of these medications are also used to treat neuropathic (nerve-related) pain.
Monoamine Oxidase Inhibitors
Monoamine oxidase inhibitors (MAOIs) are older antidepressants that are effective for some people with major depression who do not respond to other antidepressants. They are also effective for the treatment of panic disorder and bipolar depression. MAOIs approved for the treatment of depression are Nardil (phenelzine), Parnate (tranylcypromine), and Marplan (isocarboxazid).
These medications can have severe side effects in some situations, so patients must follow directions very carefully. Because substances in certain foods, beverages, and medications can cause dangerous interactions when combined with MAOIs, people on these agents must adhere to dietary restrictions.
Other antidepressants have been introduced since the early 1990s. The first of these medications were the selective serotonin reuptake inhibitors (SSRIs). It has been thought that these medications work by increasing the amount of serotonin (a neurotransmitter) between nerve cells. Neurotransmitters are chemicals that pass a nerve impulse from one cell to another. Research has shown that these medications may also help people grow new brain cells.
SSRIs include Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), Paxil (paroxetine), Celexa (citalopram), and Lexapro (escitalopram). Many people may notice sexual side effects when taking SSRIs.
Other newer medications include Effexor (venlafaxine), Cymbalta (duloxetine) and Serzone (nefazadone). Serzone was taken off the market in the U.S. because of cases of liver failure, although generic nefazadone is still available.
Other medications include Remeron (mirtazepine), which can have a sedating effect, and Wellbutrin (bupropion), which tends to be more activating. Wellbutrin has not been associated with weight gain or sexual dysfunction, but it needs to be used with caution in anyone at risk for a seizure.