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Other Antidepressants for Depression

Other Antidepressants for Depression

Examples

Generic Name Brand Name
bupropion Wellbutrin
desvenlafaxine Pristiq
duloxetine Cymbalta
mirtazapine Remeron
trazodone Oleptro
venlafaxine Effexor

All of these antidepressants are tablets taken by mouth (orally).

These antidepressants are newer (second-generation) antidepressants and tend to have fewer side effects than older (first-generation) antidepressants such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs). Serotonin reuptake inhibitors (SSRIs) also are second-generation antidepressants.

How It Works

Bupropion, duloxetine, mirtazapine, trazodone, and venlafaxine balance certain brain chemicals ( neurotransmitters ) that are important to your mood. When these brain chemicals are balanced, it helps the symptoms of depression.

Why It Is Used

Your doctor may suggest these medicines when other antidepressants don't work or have bothersome side effects. For example:

  • Bupropion may be used if other antidepressants cause problems with sexual function. It is less likely to do this.
  • Mirtazapine may be useful if you are experiencing insomnia or agitation.
  • Trazodone in small dosages is often used along with an SSRI to help with sleep disturbances.

You take these medicines alone or with another medicine.

Make sure your doctor knows all your medical history, all health problems you have, and all medicines you are taking before you use these medicines.

These medicines have not been approved for use in people younger than age 18.

How Well It Works

These antidepressants work to treat depression.

Bupropion, duloxetine, mirtazapine, trazodone, and venlafaxine help adults and have been approved by the U.S. Food and Drug Administration (FDA) for treating depression.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Bupropion

Call your doctor right away if you have:

  • Hives.
  • Agitation and restlessness.
  • Anxiety.

Common side effects of this medicine include:

  • Dry mouth.
  • Dizziness.
  • Abdominal pain.
  • Nausea and vomiting.
  • Constipation.
  • Trouble sleeping.
  • Trembling or shaking.

Bupropion may trigger seizures in some people. Talk to your doctor before taking this medicine if you have a history of seizures or eating disorders .

Desvenlafaxine and venlafaxine

Call your doctor right away if you have:

  • Hives.
  • Thoughts of suicide.
  • Agitation and restlessness.
  • Seizures.
  • Blurry vision.
  • Headache.

When you stop using venlafaxine, side effects can include dizziness, nausea, headache, abnormal touch sensation or tingling ( paresthesia ), vomiting, irritability, and nightmares.

Venlafaxine makes bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking venlafaxine with NSAIDs (such as Advil or Aleve) makes bleeding even more likely. Taking medicines that control acid in the stomach may help. 1

Duloxetine

Call your doctor right away if you have:

  • Hives.
  • Thoughts of suicide.
  • Agitation and restlessness.
  • Dark urine or light-colored stool.
  • Nausea and vomiting.
  • Yellow eyes and skin (jaundice).
  • Upper right abdominal (belly) pain .

Common side effects of these medicines include:

  • Constipation.
  • Cough.
  • Decrease in sexual desire or ability.
  • Dizziness.
  • Dry mouth.
  • Increased sweating.
  • Headache.
  • Nausea and loss of appetite.
  • Sleep problems.
  • Weight loss.

More serious side effects are rare but can include liver problems (particularly in people who drink a lot of alcohol), increased blood pressure, mania or hypomania, seizures, and mydriasis (pupil dilation), which can cause problems for people who have narrow-angle glaucoma.

When you stop using duloxetine, side effects can include dizziness, nausea, headache, paresthesia (abnormal touch sensation or tingling), vomiting, irritability, and nightmares.

Mirtazapine

Call your doctor right away if you have:

  • Hives.

Common side effects of this medicine include:

  • Dry mouth.
  • Dizziness.
  • Drowsiness
  • Constipation.
  • Increased appetite.
  • Weight gain.

Trazodone

Call your doctor right away if you have:

  • Hives.
  • Thoughts of suicide.
  • Agitation and restlessness.
  • Seizures.
  • Fast heartbeat.
  • Nausea and vomiting.

Common side effects of this medicine include:

  • Dry mouth.
  • Dizziness.
  • Drowsiness.
  • Headache.
  • Weight gain.
  • Constipation.

FDA advisories

  • The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. Talk to your doctor about these possible side effects and the warning signs of suicide.
  • The FDA recommends people at risk for glaucoma be watched for signs of pupil dilation (mydriasis) when taking venlafaxine.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Antidepressant medicines work in different ways. No antidepressant works better than another, but different ones work better or worse for different people. The side effects of antidepressant medicines are different and may lead you to chose one instead of another. Tell your doctor about side effects.

You may have to try different medicines or take more than one to help your symptoms. Most people find a medicine that works within a few tries. Other people take longer to find the right one and may need to take the antidepressant and another type of medicine.

Take your antidepressant as your doctor says. Don't quit taking your medicines without talking to your doctor. If you quit suddenly, it can cause dizziness, anxiety, fatigue, and headache. If you and your doctor decide you can quit using medicine, gradually reduce the dose over several weeks.

You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

As with other antidepressants, these medicines should not be used along with monoamine oxidase inhibitors (MAOIs) because serious, sometimes fatal, reactions can occur. To avoid serious reactions, wait at least 14 days after ending an MAOI treatment before beginning treatment with any one of these antidepressant medicines.

These medicines must be used very carefully in those who have bipolar disorder, because they may trigger a manic episode. If you have bipolar disorder, your doctor may prescribe them along with a mood stabilizer.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Women who use this medicine during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

  1. Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.

Credits

By Healthwise Staff
Kathleen Romito, MD - Family Medicine
Lisa S. Weinstock, MD - Psychiatry
Last Revised January 11, 2013

Last Revised: January 11, 2013

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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