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All of these antidepressants are tablets taken by mouth
These antidepressants are newer (second-generation)
antidepressants and tend to have fewer side effects than older
(first-generation) antidepressants such
tricyclic antidepressants and
monoamine oxidase inhibitors (MAOIs).
Serotonin reuptake inhibitors (SSRIs) also are
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.
Your doctor may suggest these
medicines when other antidepressants don't work or have bothersome side
effects. For example:
You take these medicines alone or with another
Make sure your doctor knows all your medical history, all
health problems you have, and all medicines you are taking before you use these
These medicines have not been approved for use in
people younger than age 18.
These antidepressants work to treat
Bupropion, duloxetine, mirtazapine, trazodone, and
venlafaxine help adults and have been approved by the U.S. Food and Drug
Administration (FDA) for treating depression.
Bupropion, duloxetine, mirtazapine,
trazodone, and venlafaxine have different side effects than selective serotonin
reuptake inhibitors (SSRIs), cyclic antidepressants, or monoamine oxidase
Trazodone has numerous side effects, and in
rare cases, some can be severe.
The most common side effects of
each of these medicines are listed below.
In rare cases, bupropion can cause other adverse effects
such as allergic reactions, dry mouth, headaches, heart palpitations, and
Bupropion may trigger
seizures in some people. Talk to your doctor before
taking this medicine if you have a history of seizures or
More serious side effects are rare but can include liver
problems (particularly in people who drink a lot of alcohol), increased blood
mania or hypomania, seizures, and mydriasis (pupil
dilation), which can cause problems for people with narrow-angle
When you stop using duloxetine, side effects can include
dizziness, nausea, headache,
paresthesia (abnormal touch sensation or tingling),
vomiting, irritability, and nightmares.
Other more serious side effects are rare but can include
agranulocytosis (insufficient white blood cell count), allergic reactions, and
liver or pancreas problems.
Side effects may also include
priapism, a painful condition in which the penis stays
erect. If this happens, call your doctor at once.
When you stop using venlafaxine, side effects can
include dizziness, nausea, headache, abnormal touch sensation or tingling
(paresthesia), vomiting, irritability, and
makes bleeding more likely in the upper gastrointestinal tract (stomach and
esophagus). Taking venlafaxine with NSAIDs (such as Aleve or Advil) makes
bleeding even more likely. Taking medicines that control acid in the stomach
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
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
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
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.
Like 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
Taking medicines for depression during pregnancy may
make birth defects more likely. If you are pregnant or thinking of becoming
pregnant, talk to your doctor. Medicines may need to be continued if your
depression is severe. You and your doctor must weight the risks of taking these medicines against the risks of not treating depression.
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.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
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.
January 12, 2011
Kathleen Romito, MD - Family Medicine & Lisa S. Weinstock, MD - Psychiatry
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