Other antidepressants for depression

Examples

Generic Name Brand Name
bupropion Wellbutrin, Wellbutrin SR
desvenlafaxine Pristiq
duloxetine Cymbalta
mirtazapine Remeron
trazodone  
venlafaxine Effexor, Effexor XR

All of these antidepressants are tablets taken by mouth (orally).

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 second-generation antidepressants.

How It Works

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.

Why It Is Used

Your doctor may suggest these medicines when other antidepressants don't work or have bothersome side effects. For example:

  • Bupropion may be used if other antidepressants cause problems with sexual function. It is less likely to do this.
  • Mirtazapine may be useful if you are experiencing insomnia or agitation.
  • Trazodone in small dosages is often used along with an SSRI to help with sleep disturbances.

You take these medicines alone or with another medicine.

Make sure your doctor knows all your medical history, all health problems you have, and all medicines you are taking before you use these medicines.

These medicines have not been approved for use in people under the age of 18.

How Well It Works

These antidepressants work to treat depression.

Bupropion, duloxetine, mirtazapine, trazodone, and venlafaxine help adults and have been approved by the U.S. Food and Drug Administration (FDA) for treating depression.

Side Effects

Bupropion, duloxetine, mirtazapine, trazodone, and venlafaxine have different side effects than selective serotonin reuptake inhibitors (SSRIs), cyclic antidepressants, or monoamine oxidase inhibitors (MAOIs).

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.

Bupropion possible side effects

  • Weight loss of more than 5 lb (2.3 kg)
  • Agitation, confusion, nervousness, and anxiety

In rare cases, bupropion can cause other adverse effects such as allergic reactions, dry mouth, headaches, heart palpitations, and seizures.

Bupropion may trigger seizures in some people. Talk to your doctor before taking this medicine if you have a history of seizures or eating disorders.

Desvenlafaxine possible side effects

  • Constipation
  • Not feeling hungry
  • Dry mouth
  • Blurred vision
  • Fatigue
  • Odd dreams

Duloxetine possible side effects

  • Nausea
  • Dry mouth
  • Constipation
  • Decreased appetite
  • Fatigue
  • Sleepiness
  • Increased sweating
  • Sexual dysfunction

More serious side effects are rare but can include liver problems (particularly in people who drink a lot of alcohol), increased blood pressure, mania or hypomania, seizures, and mydriasis (pupil dilation), which can cause problems for people with narrow-angle glaucoma.

When you stop using duloxetine, side effects can include dizziness, nausea, headache, paresthesia (abnormal touch sensation or tingling), vomiting, irritability, and nightmares.

Mirtazapine possible side effects

  • Drowsiness
  • Increased appetite or weight gain
  • Increased cholesterol levels
  • Dizziness
  • Dry mouth
  • Constipation

Other more serious side effects are rare but can include agranulocytosis (insufficient white blood cell count), allergic reactions, and liver or pancreas problems.

Trazodone possible side effects

  • Drowsiness
  • Dizziness or lightheadedness
  • Blurred vision
  • Weight gain
  • Dry mouth
  • Constipation
  • Headache
  • Nausea

Side effects may also include priapism, a painful condition in which the penis stays erect. If this happens, call your doctor at once.

Venlafaxine possible side effects

  • Constipation
  • Headaches
  • Weight loss
  • Dry mouth
  • Slight increase in cholesterol
  • Hypertension
  • Sexual dysfunction
  • Enlarged (dilated) pupils

When you stop using venlafaxine, side effects can include dizziness, nausea, headache, abnormal touch sensation or tingling (paresthesia), vomiting, irritability, and nightmares.

Venlafaxine 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 may help.1

FDA Advisories

  • The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.
  • The FDA recommends people at risk for glaucoma be watched for signs of pupil dilation (mydriasis) when taking venlafaxine.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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 medicine.

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 weeks.

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 medicines.

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. Your doctor can help weigh the risks of treatment against the risk of harm to your pregnancy.

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.

References

Citations

  1. 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.

Last Updated: March 13, 2009

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