Depression medications: The Optum Perks Guide

Table of contents

1. What causes depression?
2. How do I know if I have depression?
3. How is depression treated?
4. What are the most common depression medications?
5. What are the most common side effects of depression medication?
6. Will I be on depression medication forever?

Everyone feels blue from time to time. But if you’re often sad or feel empty or uninterested, you may have depression. This disorder affects your mood. It can also affect the way you think and act. And it may cause noticeable problems in your day-to-day life.

Depression is common. An estimated 8.4% of U.S. adults have it each year. And more than 17% will have it in their lifetime. It can seem to strike out of nowhere. Or it may happen alongside other life events or illnesses.

Thankfully, depression can be managed — and even cured. If you’ve been diagnosed with depression, your doctor may prescribe medication or also suggest counseling and lifestyle changes that could help you feel better.

Here’s more about this condition.

What causes depression?

Depression can happen for many reasons, says LaToya Gaines, PsyD. She’s a licensed clinical psychologist who provides a variety of counseling services through her company, Culture of Wellness, in New York City.

Common causes of depression include:

• Family history. You’re more likely to have depression if a relative has it.
• Life events. Abuse, neglect, poverty, stress, the loss of a loved one and isolation can all lead to depression.
• Medical conditions. People with diabetes, cancer or heart disease may have depression, too.
• Medications. Depression can be a side effect of some prescription medications. These include beta-blockers, calcium channel blockers and angiotensin antagonists.
• Personality. People who feel overwhelmed easily are more likely to become depressed.

Just as there are many reasons for depression, there are also different types of it. They are:

• Major depression. This is also called major depressive disorder or clinical depression. It is one of the most common mental disorders in the U.S. People with major depression have symptoms most of the time that last for at least 2 weeks. These symptoms often affect work, school and home duties.
• Persistent depressive disorder (dysthymia). Less severe symptoms of depression that are felt for at least 2 years.
• Perinatal depression. This condition occurs during or after pregnancy. When it happens after delivery, it’s usually called postpartum depression. Depression is a common problem among new and expecting mothers. About 1 in 9 will have postpartum depression.
• Seasonal affective disorder (SAD). With SAD, symptoms of depression come and go with the seasons. It often starts in late fall and early winter. And it may go away during the spring and summer.
• Depression with psychosis. This is a severe form of depression. It involves symptoms such as delusions or hallucinations.

How do I know if I have depression?

Symptoms of depression can vary from mild to severe, Dr. Gaines says. But they often include:

• Constant sadness or anxiety
• Feelings of hopelessness or pessimism
• Decreased energy
• Difficulty concentrating, remembering things and/or making decisions
• Changes in appetite or body weight
• Feelings of guilt, worthlessness or helplessness
• Loss of interest or pleasure in activities and hobbies
• Difficulty sleeping, or changes in sleep patterns
• Unexplained aches, pains, headaches, cramps or digestive problems
• Suicide attempts, or thoughts of death or suicide

Please get help right away if you’ve attempted suicide or thought about it. Call the 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline).

If you have 5 of these symptoms every day for at least 2 weeks, you may have depression. That’s according to the National Institute of Mental Health.

Talk to your doctor if you think you have depression. He or she may ask about your symptoms and medical history. Sometimes symptoms can be caused by medications or a health condition.

Your doctor can help you find a mental health professional and may discuss medications with you. (Download Optum’s prescription coupon mobile app today to find discounts and compare costs at local pharmacies.

How is depression treated?

Depression is often treated with medication, psychotherapy or both. The medications balance the neurotransmitters in your brain, according to Asha Shajahan, MD. She’s a family doctor and medical director of community health at Beaumont Hospital, Grosse Pointe, in Michigan.

Neurotransmitters are chemicals that let brain cells “talk” to each other. These chemicals include serotonin, dopamine and norepinephrine. They all play a role in regulating mood.

Cognitive behavioral therapy (CBT) — known as talk therapy — can also help. With CBT, a therapist teaches you how to change unhelpful behaviors and thoughts. And that may lessen your symptoms, Dr. Gaines says.

Many CBT sessions are done one-on-one in person. But a 2019 study in JAMA Psychiatry found that group and guided self-help CBT may also be good options. Talking to a therapist on the phone may help, too.

What are the most common depression medications?

There are many different kinds of antidepressants available. That’s good news. More options means you have other choices if a specific medication doesn’t work for you.

Right now, there are 6 classes of antidepressants. They include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)
• Norepinephrine-dopamine reuptake inhibitors (NDRIs)
• N-methyl-D-aspartate (NMDA) receptor antagonists

It’s a good idea to understand how each type of medication treats depression. It can help you and your doctor decide which option may work best.

Here’s how each major class of medication works in your body:

SSRIs

What they do: SSRIs are the most frequently prescribed antidepressants. They work by increasing the level of serotonin in the brain. Serotonin is a neurotransmitter that regulates your mood. When it runs low, depression symptoms can appear.

SSRIs boost serotonin by blocking its reabsorption (or reuptake) into nerve cells. This frees up more serotonin for sending messages between nerve cells. SSRIs are called “selective” because they only target serotonin.

Who they’re for: SSRIs are safe for most people with depression. They’re also sometimes used to treat anxiety disorders.

SSRIs can interact with other medicines and supplements. For example, SSRIs may increase your risk of bleeding if you take nonsteroidal anti-inflammatory drugs (NSAIDs like ibuprofen or naproxen) or aspirin. Your bleeding risk could also go up if you take warfarin (Coumadin®, Jantoven®) or other blood thinners. Talk with your doctor if these medications are already part of your routine.

Examples of SSRIs:

• Sertraline (Zoloft®)
• Paroxetine (Paxil®)
• Fluoxetine (Prozac®)
• Citalopram (Celexa®)

Recommended reading: Lexapro vs. Zoloft: Which one is better for me?

SNRIs

What they do: These work similarly to SSRIs. But they target 2 neurotransmitters — serotonin and norepinephrine. Norepinephrine, also called noradrenaline, is both a neurotransmitter and a hormone. As a neurotransmitter, it helps carry messages between nerve cells. As a hormone, it is released by the adrenal glands when you’re stressed.

Who they’re for: SNRIs can treat depression. They may also be given for anxiety disorders and chronic pain. Like SSRIs, SNRIs may increase your risk of bleeding if you’re using NSAIDs, aspirin, warfarin or other blood thinners. Plus, some SNRIs may raise blood pressure or worsen liver problems.

Examples of SNRIs:

• Venlafaxine (Effexor®)
• Desvenlafaxine (Pristiq®)
• Duloxetine (Cymbalta®)

TCAs

What they do: TCAs are also called cyclic antidepressants. They work like SNRIs to increase levels of serotonin and norepinephrine in the brain. They can also affect other neurotransmitters.

TCAs can have more side effects than other antidepressants. Those include drowsiness, blurred vision, urine retention, weight gain, constipation and dry mouth. TCAs can also cause blood pressure to drop when going from sitting to standing.

Who they’re for: TCAs were among the earliest antidepressants on the market. Today, they’re often replaced by antidepressants that cause fewer side effects. But TCAs can be a good choice for people who haven’t had success with other depression treatments.

Examples of TCAs:

• Nortriptyline (Pamelor®)
• Amitriptyline (Elavil®)
• Imipramine (Tofranil®)

Recommended reading: Everything you need to know about amitriptyline.

MAOIs

What they do: MAOIs were the very first antidepressants. Like other antidepressants, they work by changing your brain chemistry. They prevent an enzyme called monoamine oxidase from breaking down serotonin, norepinephrine and dopamine in the brain. That way, more of those neurotransmitters are allowed to do their job. And that can lower depression symptoms.

Who they’re for: MAOIs aren’t the first choice in treating depression. They can cause dangerous interactions if taken with some pain, cold and allergy medications, as well as with some herbal supplements.

They may also lead to high blood pressure if combined with foods with lots of tyramine. Tyramine is an amino acid that regulates blood pressure. Those foods include aged cheeses, sauerkraut and kimchi, cured meats, wine and beer, and fermented soy products (soy sauce, miso, tofu).

Because of these risks, MAOIs are mainly used only when other prescription medications have failed.

Examples of MAOIs:

• Phenelzine (Nardil®)
• Tranylcypromine (Parnate®)
• Isocarboxazid (Marplan®)

NDRIs

What they do: Like SSRIs and SNRIs, this class of medication keeps neurotransmitters from getting reabsorbed by brain cells. That keeps those brain chemicals more available for use. NDRIs block norepinephrine and dopamine.

Who they’re for: People with depression who don’t respond well to SSRIs. Maybe the medications don’t work for you, or you have side effects. NDRIs can also treat nicotine addiction, attention-deficit hyperactivity disorder and sexual problems from SSRIs. But NDRIs may raise the odds of seizures and cause insomnia. They may also interact with other medications, so be sure to talk to your doctor about that.

Example of an NRDI:

• Bupropion (Wellbutrin®)

Have you gotten your free Optum Perks prescription discount card? It could save you as much as 80% at the pharmacy. Here’s how it works.

NMDAs

What they do: Esketamine was approved for use in 2019. It increases levels of glutamate, which is the most abundant neurotransmitter in the brain. The result: a greater impact on more brain cells in one dose. Esketamine may offer relief within 2 hours. (Other antidepressants can take several weeks to work.)

Who they’re for: Esketamine is available only as a nasal spray. It’s taken with an oral antidepressant. And it’s given only to adults who have tried at least 2 medications without success.

Esketamine is made with a drug called ketamine. And it has the potential for abuse. Esketamine needs to be given to you by a doctor. You can’t get it from a pharmacy.

Example of an NDMA:

• Esketamine (Spravato®)

Recommended reading: Your 10 top questions about treatment for depression.

What are the most common side effects of depression medication?

Side effects are a risk with any medication — antidepressants included. Your doctor will take them into consideration before recommending one, Dr. Shajahan says. But side effects, if they do happen, are usually mild.

Talk to your doctor if you notice any side effects. They may change your dose or try a different medicine. The most common side effects are:

• Insomnia. Insomnia is a potential side effect of most antidepressants. Talk to your doctor about whether it’s best to take your medicine in the morning. If you still need help, reach out about other strategies to help you sleep.
• Feeling tired. Fatigue and drowsiness are common, especially when you first start taking an antidepressant.
• Nausea. This can happen soon after starting an antidepressant. It may go away once your body adjusts to the medication.
• Dizziness. This side effect is more common with TCAs and MAOIs. That’s because these medications can cause low blood pressure.
• Constipation. TCAs can disrupt your digestion, leading to constipation. But other antidepressants may have this side effect as well.
• Weight gain. This is more common with SSRIs, TCAs and MAOIs. But each person responds differently.
• Heart rate and blood pressure changes. Low blood pressure is a common side effect of MAOIs and TCAs. (TCAs can also raise heart rate.) Increased blood pressure can happen with NDMAs, too. Talk to your doctor if you have a heart problem. It may affect which antidepressant you’re given.
• Dissociation and feeling drunk. These side effects are usually linked only to NDMAs.

Keep in mind that it can sometimes take multiple tries to find a medication that works for you. And always check with your doctor before you stop taking an antidepressant on your own. Stopping suddenly may cause withdrawal symptoms, and your depression could return.

Recommended reading: What to eat (and avoid) if you’re taking antidepressants

Will I be on depression medication forever?

Not necessarily. “Most of the time, an antidepressant is needed for a short time — 6 months to 1 year,” Dr. Shajahan says.

If you’ve struggled with depression in the past or have a history of suicide attempts, however, you may need to use an antidepressant long-term.

An antidepressant usually needs up to 6 weeks to take effect. “It takes that long to regulate your neurotransmitters,” says Dr. Shajahan. But many people notice a difference after just a week or so, she adds.

At the 6-month mark, check in with your doctor. Based on how you’re feeling, the doctor may suggest adjusting the amount of medication, switching to another antidepressant or tapering off the medication altogether.

Touch base with your doctor every 3 months or so once you stop taking antidepressants to check for signs of a depression recurrence.

You can feel better. Work with your doctor on finding the right combination of medication, therapy and lifestyle changes that will make a difference.