Best antidepressants: prescription and over the counter antidepressants list
What is the best antidepressant for anxiety or depression? What do antidepressants do? How to get antidepressants? We can try to answer these and other common questions in this article.
Antidepressants are a group of drugs, intended to treat depression and anxiety. However, the range of common medications for depression is much broader, than it might seem. In addition to depression, this type of drugs is able to deal with melancholy, fears, relieve emotional stress, normalize sleep and appetite. Some of them are even prescribed to help you give up smoking (Wellbutrin) and to treat nocturnal enuresis. Drugs for depression are quite often used as painkillers for chronic pain. Currently, there are a significant number of drugs, which are referred to antidepressants, and the list is steadily increasing. This article provides information and reviews about the most common and widely used drugs for depression.
How do antidepressants work?
Antidepressants have an impact on brain neurotransmitter systems through various mechanisms. A neurotransmitter is a special substance, which helps transfer various information between nerve cells. Not only on a person's mood and emotional background depends on the content and ratio of neurotransmitters, but almost all the nervous activity.
The main neurotransmitters, imbalance or deficiency of which is associated with depression, are serotonin, norepinephrine, and dopamine. Antidepressants work by returning the number and ratios of neurotransmitters back to normal levels, thereby eliminating the clinical manifestations of depression. Thus, they have a regulatory, not a replacement effect. It means that depression medications do not cause addiction (contrary to prevailing opinion).
Antidepressants slow decay and increase the concentration of serotonin, dopamine, norepinephrine, and other neurotransmitters, responsible for mood. Depending on a type of your depression, a doctor may prescribe you:
- Sedative antidepressants or sedative medications in case of anxiety and agitation;
- Antidepressant stimulants, that stimulate your mind in the case of apathy and lethargy;
- Balanced action antidepressants, which effect depends on your daily dosage.
There is no a single antidepressant on the market today, which is going to provide any visible effect after only one pill. It takes rather long time for most depression meds to start working. This disadvantage is often the cause of why people stop to take anti-depression drugs because everybody wants a magic effect right now. Unfortunately, such magic antidepressant has not been synthesized yet. A constant search for the new drugs is caused not only by the desire to speed up the positive effect of antidepressants, but also the need to get rid of unwanted side effects antidepressants may cause.
What is the best antidepressant?
It is not easy to find antidepressant, which will be the best for you, among all the abundance of medical products on the pharmaceutical market. That is why you should remember an important thing – only a doctor can prescribe you medication for depression, which would best fit your needs. You, your relatives or some person cannot determine the right diagnosis considering your depression symptoms. A pharmacist is also not the right person to advise you buy antidepressants or other anxiety medication.
Antidepressants are not harmless drugs. They have a large number of side effects and contraindications. Moreover, sometimes depression symptoms are the first signs of another, more serious illness (eg, brain tumors). Thus, uncontrolled use of antidepressants can play a fatal role in this case. Therefore, this type of drugs should be prescribed only after your doctor set an accurate diagnosis.
Types of antidepressants
Each depression medication is usually referred to a certain group according to its chemical structure. For health professionals, such antidepressants types division also means a mechanism of their action.
There are following types of antidepressants:
Monoamine oxidase inhibitors (MAOIs)
(the first synthesized group of antidepressants)
- non-selective: isocarboxazid (Marplan), Phenelzine (Nardil), Tranylcypromine (Parnate). These drugs are not used widely today as antidepressants, because of the large number of side effects;
- selective: Moclobemide, Pirlindole, etc. Using of its subgroup is rather limited now. Their use is associated with a number of difficulties and inconveniences. This type of antidepressant is incompatible with many other drugs (such as painkillers and medications for colds), as well as the need to be on a diet during treatment. You should avoid eating cheese, beans, liver, bananas, herring, smoked meats, chocolate, pickled cabbage and a variety of other products, because of possible so-called "cheese" syndrome (high blood pressure with a greater risk of myocardial infarction or stroke). Therefore, the use of these drugs is constantly fading, giving way to more comfortable ones.
Non-selective neurotransmitters reuptake inhibitors
(drugs that block the seizure of all neurotransmitters by neurons without exception)
- Tricyclic antidepressants: amitriptyline (Elavil), imipramine (Tofranil), clomipramine (Anafranil); Nortriptyline
- Atypical antidepressants: maprotiline (Ludiomil ), mianserin (Lerivon).
Selective neurotransmitters reuptake inhibitors
- Serotonin: fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), Paroxetine (Paxil)
- Serotonin and norepinephrine: venlafaxine (Effexor ), duloxetine (Cymbalta)
- Norepinephrine and dopamine: Bupropion (Zyban).
Antidepressants with other mechanisms of action: Tianeptine. Selective serotonin reuptake inhibitors are currently the most frequently used antidepressants worldwide. They are so popular due to their relatively good tolerability, a small number of contraindications and wide possibilities for use not only for depression.
From a clinical point of view, anti-depression pills are often divided into drugs with predominantly sedative, stimulant and balanced action. The latter classification is convenient for the physician and the patient, as it reflects the basic effects of drugs, in addition to the antidepressant.
Antidepressant pills with sedative effects include amitriptyline, mianserin, fluvoxamine; Balanced action - maprotiline, sertraline, paroxetine, milnacipran, duloxetine; stimulant action - fluoxetine, imipramine. It turns out there are significant differences in terms of additional therapeutic effect even within the same sub-group of drugs for depression with the same structure and mechanism of action.
How to use antidepressants
First of all, in most cases taking antidepressants require gradual adjustment of individually effective dosage - in each separate case the dosage can be different. Continue taking antidepressant medication after reaching the desired effect for some time, and then cancel the drug gradually. This mode allows you to avoid possible side effects and recurrence of the disease in case of abrupt cancellation.
Secondly, instant action medication for depression does not exist. It is impossible to get rid of depression for a couple of days. Thus, antidepressants are prescribed for a long time, and the effect appears on the 1-2 the week of use (and even later). The drug is replaced by another only if there are no improvements after a month from the beginning of treatment.
Thirdly, almost all antidepressants unsuitable for use during pregnancy and breastfeeding. You should also avoid taking antidepressants with alcohol.
Another feature of antidepressants is that sedative or stimulant action takes place earlier than antidepressant action. Sometimes this feature becomes a basis for choosing the definite drug.
Virtually all meds for depression has such unpleasant side effect as sexual dysfunction. This may be a decrease in sexual desire, anorgasmia, erectile dysfunction. Of course, this complication of antidepressant treatment does not occur in all patients. Although this issue is very sensitive, you should not remain silent about it. In any case, sexual dysfunction is fully transient.
Each group of drugs has its advantages and disadvantages. For example, tricyclic antidepressants have a good and fairly rapid antidepressant action, are rather cheap (as compared to other groups), but cause tachycardia, delayed urination, and increased intraocular pressure, decreased cognitive (mental) functions.
That is why this type of antidepressants can not be used by people with enlarged prostate, glaucoma, and problems with heart rhythm, which is quite often the case in old age, because of these side effects. Selective serotonin reuptake inhibitors (SSRIs) does not have such side effects. However, they usually start to work only after 2 or even 3 weeks of treatment, and a price of such anti-anxiety medications is not cheap. In addition, there is less information about their clinical efficiency in case of severe depression.
To sum up, your physician should be prescribed an antidepressant individually, which would be as much suitable for you as possible. There are a lot of different factors should be taken into account choosing the right drug. That is why avoid buying antidepressants by yourself and trust a medical specialist in choosing the best antidepressant for you.
Let's take a closer look at a number of most commonly used medications for depression.
It is a tricyclic antidepressant. It has high bioavailability and is well tolerated among the drugs of this group. The drug is available as pills and injectable solution (which is necessary in extreme cases). It is taken by mouth after your meals, starting from 25-50-75 mg of Amitriptyline a day. The dosage is gradually increased until the desired effect. When symptoms of depression recede, the dosage should be reduced to 50-100 mg a day, and taken for a long time (several months).
The most common side effects include dry mouth, urinary retention, dilation of pupils blurred vision, drowsiness and dizziness, hand tremors, heart rhythm disorders, impaired memory, and thinking.
The drug is contraindicated in case of increased intraocular pressure, prostate cancer, serious cardiac conduction disorders.
Besides depression, Amitriptyline may be used to treat neuropathic pain (including migraine), nocturnal enuresis in children, psychogenic disorders of appetite.
This is perhaps is one of the most popular drugs of the last generation. Both doctors and patients prefer to use this drug. Doctors prefer it for high efficiency, patients - for ease of use and tolerability. You can buy Prozac generic as well as Prozac brand on the market. Prozac brand is a rather expensive drug, especially when you consider taking it for a long time. That is why buying Fluoxetine generic will be a wise decision.
The only downside of this drug is, perhaps, connected with its delayed antidepressant effect. Typically, persistent improvement develops in 2-3 weeks of treatment. The drug is taken at a dosage of 20-80 mg a day using various schemes (only in the morning or twice a day). Elder people should not take more than 60 mg of Prozac a day. Use of food has no effect on the drug absorption.
This depression drug can be used safely in people with cardiovascular and urological disorders.
Although side effects are rare during treatment with Fluoxetine, they still exist. Most common side effects include drowsiness, headache, loss of appetite, nausea, vomiting, constipation, dry mouth. The drug is contraindicated only if you are hypersensitive to its components.
Effexor belongs to new drugs and is gaining popularity in treatment of depressive disorders. It is taken from 37.5 mg 2 times a day (does not require gradual dose titration). In rare cases (severe depression) you may need to increase the daily dosage to 150 mg. As with most medications for depression, you should reduce the dosage at the end of treatment. Venlafaxine should be taken with meals.
Venlafaxine has an interesting feature: it has dose-related side effects. This means that in case of side effects, the dosage should be reduced for a while. Frequency and severity of side effects (if any) are reduced, if the drug is used for a long time, and there is no need to switch to another antidepressant. The most common side effects include nausea, vomiting, increased blood cholesterol, high blood pressure, red skin, dizziness.
Contraindications to use of Venlafaxine are age less then18 years old, severe liver and kidney function, hypersensitivity, concomitant use of monoamine oxidase inhibitors.
Cymbalta is also a new drug. It is recommended to take 60 mg of Cymbalta 1 time a day with or without meals. The maximum daily dosage is 120 mg. Duloxetine can also be used to relieve pain in case of diabetic polyneuropathy, chronic pain syndrome of fibromyalgia.
Side effects often cause decreased appetite, insomnia, headache, dizziness, nausea, dry mouth, constipation, fatigue, frequent urination, increased sweating.
Duloxetine is contraindicated in case of renal and hepatic insufficiency, glaucoma, uncontrolled hypertension, age till 18 years old, in case of hypersensitivity to the drug and concomitant use with MAO inhibitors.
This antidepressant is known to be effective helping people getting rid of nicotine addiction. However, it is also pretty good just as an anti-anxiety medication as well as an antidepressant. Its advantage over a number of other drugs is the lack of side effects such as sexual dysfunction. If such side effects occur when using, for example, selective serotonin reuptake inhibitors, the patient should be transferred to the taking bupropion. There are studies that showed an improvement of sexual quality of life even in people without depression. Bupropion does not affect sexual life of a healthy person and only works only if there are any problems in this area (and therefore it is not Viagra).
Bupropion is also used in the treatment of obesity and neuropathic pain.
Bupropion is usually taken as follows: the first week 150 mg is taken once a day 1, with or without meals, and then 150 mg 2 times a day for several weeks.
Bupropion also has possible side effects, which include dizziness and unsteadiness when walking, trembling limbs, dry mouth, abdominal pain, stool disorders, pruritus or rash, seizures.
The drug is contraindicated in case of epilepsy, Parkinson's disease, Alzheimer's disease, diabetes, chronic liver disease and kidney failure, until 18 and after 60 years old.
Taking into account information above, there is no perfect antidepressant. Each drug has its own advantages and disadvantages. And individual sensitivity is also a major factor in terms of effectiveness of a particular depression medication. And although it is not always possible to get rid depression at the first attempt, you should try different antidepressants to find, which would be the best for you.
Can I treat depression without medication?
In case of mild depression doctors rarely prescribe antidepressants, as the risks of their intake may exceed the benefits. The severity and type or your depression are determined by a doctor. If therapeutic methods do not help you to cope with depressed mood and symptoms of depression remain or increase, consider using antidepressants.
Do not think that depression is just a bad mood, which happens to everyone. In case of a severe form, depression can last for months or years, making it difficult for a person to work, interact with people and enjoy life. In some cases, depression may even cause suicide.
Are antidepressants addictive?
Antidepressants are not addictive. Even if you take depression medication for more than two years, withdrawal syndrome (typical of any medication) will not last more than 2-4 weeks, until complete elimination of the drug's ingredients from your body. In any case, addiction to antidepressants is a myth, which is not confirmed either by psychiatrists or by patients.
You nature cannot be changed as a result of taking antidepressants, but you may experience a decrease in activity, deteriorating memory and concentration.
How to get antidepressants or anxiety medications without a prescription?
Only a qualified medical specialist can prescribe you pills for anxiety and depression with right dosages. Otherwise, you are at risk or are not going to feel positive effect of treatment. Healthy people can not improve their mood with antidepressants because their condition is not related to the activity of neurotransmitters. In addition, you should know that each patient has its own antidepressant threshold, and if the drug does not reach it - there is no therapeutic effect.
After consulting with your doctor you can buy over the counter anxiety medications or antidepressants online or in your nearby pharmacy. Typically, you need to have a prescription to get antidepressants. However, you can consider buying over the counter antidepressants or ordering non-prescription medications.
Are antidepressants safe?
Since antidepressants are very strong drugs, you may get an appropriate effect during their intake. They differ depending on the type of antidepressant and its dosage, but common side effects may include: insomnia, confusion, lethargy, cognitive impairment, sensory disturbances, anxiety, tremors, sexual dysfunction, and so on. Overdose with antidepressants can be a very dangerous condition, which requires immediate hospitalization. That is why take your medications strictly according instruction, not to exceeding a daily dosage.
How should I take antidepressants?
Take medications for depression regularly at the same time of a day. The daily dosage, number of intakes and the best time of a day to take antidepressants depends on your health condition and a type of antidepressant. For example, sedatives with hypnotic effect are often taken at night. Drugs that increase activity are recommended to be taken in the morning. The daily dosage is often divided into several intakes during a day, but for some antidepressants, it is enough to take them one time a day. You attending physician should provide you with more specific recommendations about administration of antidepressants.
Will you be able doing your daily activities taking anti-depression drugs?
Definitely yes. Some people note slight weakness or drowsiness at the beginning of treatment or when increasing the dosage. You should be cautious while driving a car or doing work associated with the risk of injury if you experience such unpleasant effects. In most cases, these effects disappear after two or three days, so that you can do almost all kinds of activities. If, however, you are still sleepy in a few days of treatment, you may have to change for another antidepressant drug that causes less lethargy. You doctor will help you to find the best antidepressant for you.
Can I take other medications along with antidepressants?
Yes. Take your doctor about all prescription and over the counter medication as well as about all vitamins and natural supplements you are currently taking. Your doctor should know this information in order to prescribe you the right anxiety or depression medication, because some drugs may interfere with each other. If you experience any side effects from taking the drugs, contact your doctor.
Can I drink alcohol while taking antidepressants?
You should avoid mixing alcohol with antidepressants. It is not recommended drinking alcoholic beverages during treatment.
Do antidepressants cause side effects?
Some people may experience unpleasant symptoms such as dry mouth, drowsiness, constipation while taking antidepressants medicines or medications for anxiety. These side effects are usually temporary. If you experience any unusual reaction to the drug or have concerns about its intake, consult with your doctor.
Side effects are usually observed during the first or second week of treatment, and then they disappear. If you have any discomfort, you should not stop taking medication for depression and contact your attending physician. You are going to observe that the severity of side effects decreases with each passing day of treatment. Most people adapt to these minor difficulties. Many side effects gradually disappear completely.
What should I do in case of side effects?
Consider minor side effects as temporary difficulties and do not terminate your treatment. Most side effects disappear after a few days. As soon as your body adapts to the drug, you are going to feel better. Consult with your doctor if you experience any even minor side effects.
Some frequent difficulties during treatment with depression medications
Some people procrastinate to start treatment of depression with medications.
It is important to start taking depression medication as soon as possible after you doctor has prescribed it. Do not delay the start of treatment on a weekend or when you feel better. If you have concerns about the start of drug treatment - contact your doctor.
Some people for various reasons are reluctant to increase the dosage
Sometimes people are concerned that they are taking too many anti-depression pills. Generally, treatment is started with taking a very small number of pills. Then your dosage is gradually increased during treatment. Each pill contains a small amount of the active ingredient. That is why you should take a certain amount of active substance in order to get an effective dosage. Doctors usually try to prescribe drugs containing a large dosage in each pill, if possible, in order to decrease the number of pills for depression taken a day.
People often forget to take medication regularly
Treat your usual depression drugs intake as an everyday routine such as tooth brushing. This will help take them the same time every day. You can ask someone from relatives to remind you about it or leave a note or sticker. You need to know precisely what dosage and what time a day to take your antidepressants or anxiety meds. You doctor is going to provide you with this information.
Sometimes people stop taking medications before finishing treatment because their state of health does not improve.
It is very important to be patient taking antidepressants. It can take from 3 to 6 weeks before your health condition improves significantly.
Some patients prematurely stop taking medication, because they feel better
It is important to take antidepressants for a long time (several months), even if you feel better, in order to reach maximum effect. It takes some time to make your mood and overall health condition stable.