The pros and cons of drugs used to combat depression

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We look at a few drugs used to combat depression. Learn about these common antidepressants and their side effects

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Most of these (among the most-prescribed antidepressants in Canada) work the same way, says Wende Wood, a psychiatric pharmacist with the Centre for Addiction and Mental Health in Toronto. They increase the availability of chemicals that enhance nerve impulse transmission and mood.

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Effexor (venlafaxine)

Pros: An SNRI that’s generally well tolerated if started in low doses.
Side effects: Can cause jitteriness, anxiety, insomnia; or can have the opposite effect (somnolence). Other common side effects: headache, dry mouth, constipation, sweating, dizziness, sexual dysfunction.
Whom it may be suitable for: Depression sufferers with fatigue-like symptoms (norepinephrine works on the adrenal system); also a good option when SSRIs don’t work; not ideal for patients with hypertension.

Celexa (citalopram)

Pros: This SSRI has fewer overall side effects than some antidepressants, but the serotonin-related side effects can be powerful.
Side effects: Nausea, insomnia, headaches, sexual dysfunction, jitteriness, dry mouth, drowsiness.
Whom it may be suitable for: Can be ideal for the elderly because of fewer side effects when prescribed at lower doses.

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Paxil (paroxetine)

Pros: A very effective SSRI that can be easier to start and stay on than others.
Side effects: Nausea, insomnia, headaches, sexual dysfunction, jitteriness; possibly drowsiness, dry mouth, constipation. It’s the worst one for weight gain, and among the worst for withdrawal symptoms (unless properly managed).
Whom it may be suitable for: Those whose depression causes fatigue; also ideal for anxiety symptoms and anxiety disorders; not ideal where weight gain is a health concern.

Zoloft (sertraline)

Pros: Some find this SSRI has the fewest side effects.
Side effects: Can cause jitteriness, anxiety, insomnia; or can have the opposite effect (somnolence). Other common side effects: headache, dry mouth, constipation, sweating, dizziness, sexual dysfunction.
Whom it may be suitable for: Those with milder or chronic cases of depression, because it has fewer side effects.

Wellbutrin (bupropion); a.k.a. Zyban (when prescribed for smoking cessation)

Pros: This norepinephrine dopamine reuptake inhibitor (NDRI) is often added on to other antidepressant treatments that lose effectiveness over time or cause sexual dysfunction.
Side effects: Jitteriness, insomnia, headaches, dry mouth, nausea (and, rarely, risk of seizure).
Whom it may be suitable for: Not an ideal first-line treatment: Start-up can be difficult to tolerate, and serotonin is often needed to effect mood change. Ideal for depression sufferers with adult attention deficit disorder.

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Remeron (mirtazapine)

Pros: This noradrenergic/specific serotonergic (NaSSA, the newest class of antidepressants) also blocks receptors that cause sexual dysfunction in other antidepressants; less jitteriness and nausea.
Side effects: Sedation, fatigue, dry mouth, constipation, increased appetite, weight gain.
Whom it may be suitable for: Depression sufferers with anxiety and insomnia: It’s the most sedating antidepressant. Because it causes weight gain, it’s ideal for patients such as the elderly, or cancer patients.

Prozac (fluoxetine)

Pros: The SSRI least likely to have discontinuation symptoms, because it stays in the system for longer periods of time.
Side effects: Nausea, insomnia, headache, decreased libido, agitation, dry mouth, drowsiness.
Whom it may be suitable for: Depression sufferers whose symptoms include fatigue.

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