Get this: According to a recent study in the Journal of Clinical Psychiatry, 25% of Americans taking an antidepressant have not received any clinical diagnosis. More and more, people are getting treated for a mental health problem that may not exactly exist, or more likely, are receiving medication for the wrong condition.
Over the last few decades, the booming pharma industry has given us a myriad of pills to choose from in order to chase the blues. For those trying to decide on which one, it’s important to see a psychiatrist — the doctor who traditionally prescribes psychotropic medications — because other doctors may not be quite up to speed on the nuances of the various meds currently on the market.
“There’s a movement among primary care physicians to do more screening for depression,” says Dr. Gerald Hurowitz, assistant professor of clinical psychiatry at Columbia University College of Medicine, who runs a psychopharmacology and neuropsychiatry private practice in New York City. “But sometimes the diagnosis is not accurate.” Dr. Hurowitz says that oftentimes, clinical depression may actually be bipolar depression, which may require a different kind of medication all together. And because depression often goes hand-in-hand with anxiety disorders, sleep problems, OCD and ADHD, the patient also must be treated for the secondary illness.
A few things to note about antidepressants: Each pill reacts differently within every person, and unfortunately, sometimes trial-and-error is the only way to find the right one. Most doctors agree that all antidepressants are safe to take with birth control pills. (Though you should keep all your doctors informed about which medications, vitamins, and supplements you take on a daily basis.)
In general, the best doctors are ones who involve patients in their own treatment. But as a patient and consumer it’s also important to take a little time to do some research on your own, which is why we’ve compiled the information below on the drugs currently available to treat depression and related conditions. After all, happiness doesn’t come just from a little pill, but rather from self-empowerment.
SSRIs (Selective Serotonin Reuptake Inhibitors)
Brand names: Prozac, Paxil, Zoloft, Lexapro, Celexa
Author Elizabeth Wurtzel made this group of drugs famous in the 90s with her seminal classic Prozac Nation. Despite the bad rap for their potential to cause suicidal behavior, SSRIs remain the most popular antidepressants on the market; they’re used to treat a wide range of conditions, including depression, anxiety, OCD, panic disorders, and even migraines and sleep difficulties.
Dr. Srini Pillay, assistant clinical professor of psychiatry at Harvard Medical School and author of Life Unlocked: 7 Revolutionary Lessons to Overcome Fear, says that Lexapro and Zoloft are known to be least sedating; Prozac can pep you up; while Paxil may make you sadder. Paxil, Zoloft, and Celexa all may cause weight gain. Paxil is also the drug in this class that’s most associated with difficult withdrawal symptoms, which patients often describe as an “electric shock” feeling.
Unfortunately, SSRIs are well known for supressing one’s sex drive. For women this may be experienced as a loss of libido and/or difficulty or inability to reach orgasm.
SNRIs (Serotonin–Norepinephrine Reuptake Inhibitors)
Brand names: Effexor, Cymbalta, Pristiq
“These meds have a similar profile to SSRIs in terms of clinical uses and side effects,” says Dr. David J. Muzina, national practice leader for the Medco Neuroscience Therapeutic Resource Center. “Though there may be more nausea and sweating during treatment.” SNRIs are especially effective for patients who suffer a comorbid of social anxiety and panic disorder with clinical depression.
MAOIs (Monoamine Oxidase Inhibitors)
Brand names: Nardil, Parnate, Emsam (patch)
When Don and Betty discussed the possibility of employing a little pill at the Draper household on Mad Men, it’s likely her shrink would have prescribed an MAOI, the oldest class of antidepressants, which first hit the market in the 1950s. These medications have mostly fallen out of favor, due specifically to the way they interact with certain foods including cheese, soy sauce, and beer. (When those are combined with the medication, the patient has the potential to develop dangerously high blood pressure.)
For some, this drug is an oldie but goodie, because the class tends to work well for individuals with refractory or atypical depression, or those who have not seen improvements on one of the newer drugs. “I usually start with this drug if a patient has someone in the family who took one,” said Dr. Pillay. “Parnate is effective and anecdotally slightly better tolerated in my practice.”
Plus, this older class has recently seen a resurgence as a daily transdermal skin patch, known as selegiline (Emsam) — the delivery system means that there are no dietary restrictions because the drug never makes its way to the GI system.
Brand names: Norpramin, Tofranil, Pamelor, Vivactil, Anafranil
When someone said happiness comes at a price, they may have been talking about this class of antidepressants, known to cause a litany of woes like dry mouth, sedation, blurry vision, constipation, and irregular heartbeat. Trycyclics can even be lethal in overdose.
However, Dr. Muzina says Trycyclics work as well as the newer drugs on the market in terms of managing mood; and they’re particularly good for managing anxiety disorders. He added that Anafranil is considered the gold standard for treating OCD.
The drugs may also be a good choice for patients who have a history of chronic pain along with depression. But Tricyclics are especially sedating, so many doctors prescribe them in low doses as a sleeping aid. They may also be used as an add-on therapy with a newer medication, such as an SSRI.
Brand name: Wellbutrin
This popular med hit the market in mid-90s as the answer to SSRIs with fewer side effects. Wellbutrin is beloved by women everywhere because it’s the least likely to cause weight gain and doesn’t negatively affect the libido. “You can be thin and have great sex,” says Dr. Hurowitz. (Now there’s a way to cure depression!)
Wellbutrin has been known to exacerbate panic or anxiety disorders, so it’s mostly given to patients suffering from good, old-fashioned textbook depression; it’s also prescribed as an aid for quitting smoking.
Brand name: Remeron
Another drug in a class all its own, Remeron will make you hungry and very sleepy (which actually sounds worse than depression itself.) It’s often used along with another antidepressant or an anti-anxiety drug like Ritalin. Individuals who have experience depression-related weight loss may do well on this medication since it does stimulate the appetite; though Dr. Muzina warns that this may lead to elevated cholesterol levels.