How do you treat depression pharmacologically

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Depression Alternative Treatments

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The first-line treatment option is the selective serotonin reuptake inhibitors (SSRIs) (see Table 13.1).

Table 13.1 SSRIs and Their Unique Properties

Generic Name

Brand Name

Side Effects

Other

Citalopram

Celexa

Standard (Sexual side effects, nausea, vomiting, headache, anxiety, insomnia)

Fewest medication interactions

Escitalopram

Lexapro

Standard

Isomer of citalopram, very similar

Fluoxetine

Prozac

Standard

Long half-life, drug-drug interactions

Paroxetine

Paxil

Standard, plus has anticholinergic effects that can cause weight gain, constipation, and sedation

Short half-life, can cause withdrawal symptoms (except CR form), drug-drug interactions

Sertraline

Zoloft

Most GI side effects

Very few drug-drug interactions

Abbreviations: GI, gatrointestinal.

Are there any other antidepressants Yes, there are other antidepressants also considered as first-line treatment with different mechanism of action options? (see Table 13.2).

Table 13.2 Other Antidepressants Indicated for the Treatment of Depression

Generic

Brand

Mechanism

Side

Name

Name

of Action

Effects

Other

Bupropion

Wellbutrin

Unknown, likely

Seizures,

Contraindicated

Zyban (for

via dopamine

insomnia,

in patients with

smoking

and

headache,

seizures,

cessation)

norepinephrine

nausea,

bulimia, and

vomiting,

anorexia

constipation,

Used to treat

and tremor

sexual side

effects caused

by SSRIs

Mirtazapine

Remeron

Presynaptic alpha-2-

Highly

Agranulocytosis

adrenergic

sedating,

in 0.1%

antagonist (T

Tappetite,

Also used to

norepinephrine

Tweight

^ nausea

and serotonin)

also potent

antagonist of

5-HT2 and

5-HT3

Trazodone

Desyrel

Weakly inhibits

Highly

Used as a

serotonin

sedating,

sleeping aid

reuptake

orthostatic

hypotension

Postsynaptically

Uncommon

antagonizes

but can

5-HT2

cause

priapism

(painful

erection)

and

arrhythmias

Nefazodone

Serzone

Similar to

Headache,

FDA black-box

trazodone

dry mouth,

warning due

blurred

to risk of liver

vision,

failure

somnolence,

and

orthostatic

hypotension

Table 13.2 Other Antidepressants Indicated for the Treatment of Depression (Continued)

Generic

Brand

Mechanism

Side

Name

Name

of Action

Effects

Other

Venlafaxine

Effexor

Serotonin and

Nausea,

Can increase

norepinephrine

dizziness,

blood pressure

reuptake

sexual

inhibitor, also

dysfunction,

inhibitor of

headache,

dopamine

and dry

reuptake at

mouth

high doses

Duloxetine

Cymbalta

Similar to

Nausea, dry

Also indicated

venlafaxine

mouth,

for neuropathic

constipation,

pain

diarrhea,

dizziness,

and

insomnia

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