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Q. What are the major categories of anti-depressants?
There are many classes of antidepressants. Two kinds of
antidepressants have been around for over 30 years. These are the
tricyclic antidepressants and the monoamine oxidase inhibitors. While
there are newer antidepressants, many with fewer side-effects, none
of the newer antidepressants has been shown to be more effective than
these two classes of drugs. In fact, many people who have not
responded to newer antidepressants have been successfully treated
with one of these classes of drugs.
The tricyclic antidepressants (TCAs) include such drugs as imipramine
(Tofranil, amitriptyline (Elavil), desipramine (Norpramin),
nortriptyline (Aventyl and Pamelor).
The monoamine oxidase inhibitors (MAOIs) include tranylcypromine
(Parnate), phenelzine (Nardil), and isocarboxazid (Marplan) which has
recently been taken off the market in the U.S.A. for marketing rather
than safety or efficacy reasons.
One of the popular new classes of antidepressants are the selective
serotonin reuptake inhibitors (SSRIs). The first of these drugs to be
marketed in the USA was fluoxetine (Prozac). Sertraline (Zoloft), and
paroxetine (Paxil) soon followed, and fluvoxamine (Luvox) is
scheduled to be marketed in late 1994, or early 1995.
Bupropion (Wellbutrin) is the only drug in its class, as is trazodone
(Desyrel). The most recently marketed antidepressant (4/94) is
venlafaxine (Effexor), the first drug in yet another class of drugs.
Q. What are the side-effects of some of the commonly used
antidepressants?
Below is a list of some of the more frequently prescribed
antidepressants, and their most common side effects. The figure
following each side effect is the percentage of people taking the
medication who experience that side effect.
Aventyl (nortriptyline): Dry mouth (15); Constipation (15);
Weakness-fatigue (10); Tremor (10).
Effexor (venlafaxine) Nausea (35); Headache (25); Sleepiness (25);
Dry mouth (20); Insomnia (20); Constipation (15).
Elavil (amitriptyline): Dry mouth (40); Drowsiness (30); Weight gain
(30); Constipation (25); Sweating (20).
Nardil (phenelzine): dry mouth (30); insomnia (25); Increased heart
rate (25); Lowered blood pressure (20); Sedation (15); Over
stimulation (10);
Norpramin (desipramine): dry mouth (15); increased pulse (15);
constipation (10); reduced blood pressure (10).
Pamelor - see Aventyl
Parnate (tranylcypromine) Dry mouth (20); Insomnia (20); Increased
pulse rate (20); Lowered blood pressure (15); Over stimulation (15);
Sedation (15).
Paxil (paroxetine): Decreased sexual interest and/or problems
achieving orgasm (30); Nausea (25); Sedation (25); Dizziness (15)
Insomnia (15)
Prozac (fluoxetine): Decreased sexual interest and/or problems
achieving orgasm (30); Nausea (20); Headache (20); Nervousness (15);
Insomnia (15); Diarrhea (15).
Sinequan (doxepin): Dry mouth (40); Sedation (40); Weight gain (30);
Lowered blood pressure (25); Constipation (25); Sweating (20).
Tofranil (imipramine): Dry mouth (30), Reduced blood pressure (30),
Constipation (20), Difficulty with urination (15).
Wellbutrin (bupropion): Agitation (30); Weight loss (25), Dizziness
(20); Decreased appetite (20);
Zoloft (sertraline): Decreased sexual interest and/or problems
achieving orgasm (30);Nausea (25); Headache (20); Diarrhea (20);
Insomnia 15); Dry mouth (15); Sedation (15).
Q. What are some techniques that can be used by people taking
antidepressants to make side effects more tolerable?
Listed below are some frequent side effects of antidepressants, and
some techniques to reduce their severity:
Dry mouth: Drink lots of water, chew sugarless gum, clean teeth
daily, ask the dentist to suggest a fluoride rinse to prevent
cavities, visit the dentist more often than usual for tooth and gum
hygiene
Constipation: Drink at least six 8-ounce glasses of water every day,
eat bran cereals, eat salads twice a day, exercise daily (walk for at
least 30 minutes a day), ask your doctor about taking a bulk
producing agent such as Metamucil, also ask about taking a stool
softener such as Colace, be sure to avoid laxatives such as Ex-Lax.
Bladder problems: The effects of some antidepressants, especially the
tricyclic medications may make it difficult for you to start the
stream of urine. There may be some hesitation between the time you
try to urinate and the time your urine starts to flow. If it takes
you over 5-minutes to start the stream, call your doctor.
Blurred vision: The tricyclic antidepressants may make it difficult
for you to read. Distant vision is usually unaffected. If reading is
important to you the effects of the antidepressant can be compensated
for by a change in glasses. As you may compensate for the change in
your vision, try to postpone getting new glasses as long as possible.
Dizziness: Dizziness when getting out of bed or when standing up from
a chair, or when climbing stairs may be a problem when taking
tricyclic antidepressants and monoamine oxidase inhibitors. Changing
posture slowly may help prevent this kind of dizziness. Drinking
adequate amounts of liquid and eating enough salt each day is
important. Be sure to speak to your doctor if this side-effect is
severe.
Drowsiness: This side effect often passes as you get used to taking
the antidepressant that has been prescribed for you. Ask your doctor
if it is safe for you to increase your intake of caffeine, and if so,
by how much. If you are drowsy be sure not to drive or operate
dangerous machinery.
Q. Many antidepressants seem to have sexual side effects. Can anything
be done about those side-effects?
Both lowered sexual desire and difficulties having an orgasm, in both
men and women, are particularly a problem with the selective
serotonin re-uptake inhibitors (Prozac, Zoloft, Paxil and Luvox), and
the monoamine oxidase inhibitors (Nardil and Parnate). There is no
treatment for decreased sexual interest except lowering the dose or
switching to a drug that does not have sexual side effects such as
bupropion (Wellbutrin). Difficulty having orgasms may be treated by a
number of medications. Among those medications are: Periactin,
Urecholine, and Symmetrel. None of these are over-the-counter drugs
and they must be prescribed by a physician. Unfortunately, many
psychiatrists are not familiar with using these medications to treat
the sexual side-effects of antidepressants.
Q. What should I do if my antidepressant does not work?
Many people decide that their antidepressant is not working
prematurely. When one starts an antidepressant the hope is for rapid
relief from depression. What must be remembered is that for an
antidepressant to work, you must be on an adequate dose of the drug
for an adequate length of time. A fair trial of any antidepressant is
at least two months. Prior to a two month trial the only reason to
abandon an antidepressant trial is if the medication is causing
severe side effects. With many antidepressants the dose has to be
increased at intervals far above the starting dose. Unfortunately,
the two-month period mentioned above, refers to two months following
the most recent increase in the dose, not the time from starting the
particular antidepressant.
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