Major depression is a common and treatable disease with many patients benefitting from pharmacologic treatment. Medication choices are made based on patient characteristics, safety and anticipated side effects. Many patients will see a significant decrease in symptoms, though some may not see complete symptom relief. All antidepressants can produce harmful side effects, thus needing to be closely monitored by a qualified healthcare provider; the risk of suicide is always a concern with depression and is not necessarily reduced by the use of antidepressants.

Tricyclic antidepressants (TCAs) block norepinephrine reuptake pumps and, to some degree, serotonin reuptake pumps. TCAs can act on different receptors to help alleviate symptoms of depression, but may also cause some unwanted side effects, such as:

• Weight gain
• Sedation
• Constipation
• Dry mouth
• Drop in blood pressure when standing up
• Reflex tachycardia

Patients will start off at a lower dosage of around 75-100 mg a day when using TCAs before gradually increasing as needed. Compared to SSRIs, TCAs have a higher risk of cardiovascular issues in patients with certain types of heart trouble, so it’s important for patients to disclose medical history before starting any kind of medication.

Other medications used to treat depression are selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). SSRIs have been the most popular treatment for depression since Prozac (fluoxetine) was introduced to the market in 1986. This class of medication works by inhibiting the reuptake of serotonin in certain receptors within the brain, allowing more seratonin to influence mood. Side effects of SSRIs can include:

• insomnia or sleepiness
• Sexual dysfunction
• Weight gain

SNRIs work in a similar fashion, but inhibit both serotonin and norepinephrine reuptake at higher doses. Side effects of SNRIs are:

• Upset stomach
• Insomnia
• Headache
• Sexual dysfunction
• Minor increase in blood pressure