Depression and Antidepressants

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As of 2007, the most prescribed medications in America are antidepressants. Once hailed as miraculous, now they are under scrutiny by the medical health profession and those suffering from mental illness. But many depressives have found antidepressants or a combination of antidepressants as a helpful weapon in their arsenal to help manage depression symptoms.

The three main types of antidepressants are tricyclic antidepressants (TCAs,) monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs.) Patients may be prescribed one or more antidepressant, but usually they are all antidepressants within the same type.

Monoamine Oxidase Inhibitors

The oldest type of antidepressant belongs to the monoamine oxidase inhibitors (MAOIs.) They first came to the market in the 1950s. Depression and antidepressants had a tentative beginning. A recent sub-category is called reversible inhibitors of monoamine oxidase antidepressants (RIMAs) but they also have many of the same side effects as MAOIs.

They first hit the market about 2000. Specific MAOIs include iscarboxazid (brand name Marplan), phenelzine (brand name Nardil) and tranylcypromine (brand name Parnate.)

MAOIs are thought to work by removing a chemical called monoamine which prevents the brain from properly absorbing neurotransmitters serotonin, dopamine and norepinephrine. These neurotransmitters help regulate emotions and possibly the perception of pain. Serotonin malabsorption, for example, is also thought to be the main culprit behind migraines.

Unfortunately, there are many serious side effects with MAOIs. The most serious side effect is a spike in blood pressure so high that it causes a hemorrhage and death. Patients on MAOIs have to avoid many medications to avoid bad side effects, have to avoid all alcoholic beverages and need to exclude numerous foods from their diets including avocados, aged cheese and smoked fish. Because of these side effects, MAOIs are only prescribed if TCAs and SSRIs fail.

Tricyclic Antidepressants

Tricyclic antidepressants are the second oldest known antidepressants. These are thought to work by helping the brain absorb neurotransmitters instead of specific neurotransmitters. Their chemical composition contains three prominent rings, hence the “tri” in their name.

The most popular TCAs are imipramine (brand name Tofranil); amitriptyline (brand name Elavil) and clomipramine (brand name Anafranil.) They are mostly prescribed for depressives that cannot tolerate SSRIs, depressives that also suffer from an anxiety disorder or those with severe depression such as suicidal depression.

TCAs contain severe side effects including heart problems, sudden drop in blood pressure, sexual dysfunction, blurred vision and sudden weight gain. Minor side effects include chronic constipation and dry mouth. Some side effects become less after two to four weeks but some are persistent.

The big advantage of TCAs is that most of them are available in less expensive generic forms. However, many people cannot tolerate the side effects. TCAs are also easy to overdose on so the patient may only be allowed to have a week’s worth of pills at a time.

Selective Serotonin Reputake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs,) particularly Prozac (fluoxetine) forever linked depression and antidepressants. Even dogs and cats are prescribed Prozac. SSRIs are the most prescribed drugs in America. They have the least known side effects to the general population making them the first choice of antidepressants by doctors and psychiatrists. They are also prescribed off label for such conditions as migraines.

SSRIs also work on brain chemistry, this time focusing on the neurotransmitter serotonin. It can take as little as ten days for a patient to feel the benefits but can take as long as a month. SSRIs can be prescribed for six months or they can be prescribed for life. SSRIS should never be combined with the popular herb St. John’s Wort.

But not all patients react the same to SSRIs. Some people find their depression worsens considerably to the point where they attempt suicide. This worsening happens especially to people under 21 years old. Anyone beginning an SSRI needs to be contacted daily by a trusted loved one or a doctor’s office to be sure symptoms are not worsening.

NB: This article is not to be used as a substitute for a medical professional’s diagnosis and treatment.


Smith, Laura L., PhD. & Charles H. Elliot, PhD. Depression For Dummies. Wiley Publishing; 2003.

Morey, Bodie & Kim T. Mueser, PhD. The Family Intervention Guide to Mental Illness. New Harbinger; 2007.

Cohen, Elizabeth. “CDC: Antidepressants most prescribed drug in US.” CNN Health. July 9, 2007.

Help “Antidepressants: What You Need to Know About Depression Medications.”

Crazy Meds.