Antidepressant Medication

What are the types of antidepressant medications?

SSRIs (Selective Seritonin Reuptake Inhibitors):

  • Citalopram

  • Escitalopram (Lexapro)

  • Fluoxetine (Prozac)

  • Paroxetine (Paxil, Pexeva)

  • Sertraline (Zoloft)

SNRIs (Serotonin and norepinephrine reuptake inhibitors):

  • Venlafaxine (Effexor).

  • Duloxetine (Cymbalta).

  • Desvenlafaxine (Pristiq)

NaSSA (Noradrenergic and specific serotonergic antidepressants):

  • Mirtazapine

Tricyclic Antidepressants:

  • Amitriptyline (Elavil),

  • Clomipramine (Anafranil),

  • Doxepin (Sinequan),

  • Imipramine (Tofranil),

  • Desipramine (Norpramin),

  • Nortriptyline (Pamelor)

Newer Antidepressants:

  • Vortioxetine

  • Agomelatine

What are the side effects of SSRIs and SNRIs?

Common (>1%):

  • nausea, diarrhoea, agitation, insomnia, drowsiness, tremor, dry mouth, dizziness, headache, sweating, weakness, anxiety, sexual dysfunction

  • SNRIs are more likely to cause withdrawal symptoms if tablets or missed or dose is reduced rapidly. They are also more likely to cause increased anxiety, heart rate or blood pressure.

Infrequent (0.1–1%):

  • extrapyramidal reactions (including tardive dyskinesia and dystonia), sedation, confusion, palpitations, tachycardia, hypotension, hyponatraemia (usually occurs early in treatment, may be asymptomatic, and is part of SIADH), abnormal platelet aggregation/haemorrhagic complications (eg bruising, nose bleeds, GI, vaginal or intracerebral bleeding), mydriasis

Rare (<0.1%):

  • Elevated liver enzymes, hepatitis, hepatic failure, hyperprolactinaemia, eg galactorrhoea, blood dyscrasias, akathisia, paraesthesia, taste disturbance, acute angle-closure crisis (especially with paroxetine)

Serious side effects:

  • Serotonin syndrome

  • Very rarely patients may experience excessive increases of serotonin. This will generally only be found in patients taking other medication that increases serotonin level. Your doctor will ask about your other medication and take steps to avoid this condition from occurring.

  • Serotonin syndrome symptoms include high body temperature, sweating, shivering, clumsiness, tremors, and confusion

  • Suicidal ideations:

  • Rarely patients may experience increased suicidal ideations in the first few weeks of commencing an antidepressant or increasing the dose.

  • If you experience this symptom, please contact call 000 or present to your nearest emergency department.

  • Mania:

  • This includes risk-taking behaviour, grandiose thoughts, increased energy, pressured speech and decreased need for sleep

  • If you experience this symptom, please contact call 000 or present to your nearest emergency department.

How long will I need to take antidepressants for?

  • The recommendation is that antidepressants are taken for at least 9-12 months after your first depressive episodes. If you have had 2 depressive episodes, we recommend that you take antidepressants for at least 2 years.

What happens if you miss a dose of antidepressant?

  • If you miss a dose of your antidepressant or stop your medication suddenly you may experience discontinuation symptoms (anxiety, insomnia, nausea, fatigues, irritability, flu-like symptoms). This is caused by your body adjusting to a lowered dose or serotonin and/or noradrenaline. As such, it is essential to take your antidepressant every day. If you forget, please set up a system to help your remember (Eg. reminders on your phones, alarms, sticky notes on your mirror, placing your medication next to your toothbrush)