Antidepressant Drug Options

By Kristina Randle, Ph.D., LCSW

I was on Cymbalta (think 60 mg) for depression and anxiety. I was on it for over a year. A number of debilitating side-effects were persistent throughout my course of being on the medicine, including dizziness, intense fatigue, and significant hypotension. In addition, I eventually experienced strong insomnia, leaking urine, and harmful and suicidal thoughts. Cymbalta’s ability to relieve my depression also diminished during that time. I went cold turkey in Nov. 2008, went through terrible withdrawal symptoms and have not been on an AD since because of the fear Cymbalta gave me. My depression though has worsened since that time, and I am going to see a psychiatrist now (I’m already seeing a psychologist). Because of my severe problems with Cymbalta, what other AD options are there? I don’t want a repeat of Cymbalta, as obviously my body did not agree with the medicine. If most of the ADs work in a similar fashion to Cymbalta, I’m worried the side-effects are going to be worse than the benefits. As well, in 1991, I was on reglan after an endoscopy, and it took only 3 pills to cause serious central nervous system problems, including sensory “dementia” and hallucinations. With that problem in mind and what happened on Cymbalta, I’m worried there is a connection and that my neurological system is ultra-sensitive or something. I even get buzzed from pseudoephedrine, so if I use them for sinus problems, I have to take them at half dosage, or I end up wired for hours. I know this is a complex issue, but I need medical help for my depression and I’m not sure what even a psychiatrist can do to evaluate my tolerance for brain-altering drugs. Any advice or reassurance you could give me would be greatly appreciated.

A. There are different types of antidepressant drugs. Cymbalta is a serotonin and norepinephrine uptake inhibitor (SNRI). SNRIs target two brain chemicals thought to be associated with depression, serotonin and norepinephrine. Effexor and Effexor XR are also SNRIs.

The most common type of antidepressant drugs on the market are the selective serotonin reuptake inhibitors (SSRIs). SSRIs include medications such as Celexa, Prozac and Lexapro. SSRIs focus on only one specific brain chemical, serotonin (versus two with the SNRIs). Two other types of depression medications include Monoamine Oxidase Inhibitors (MAOIs) and tricyclics. Here’s a link to a webpage that further explains the differences between antidepressant drugs. Perhaps the type of antidepressant medication you had been taking is not a good match for you.

Usually finding the right medication is a trial and error process. It is the norm. It is the rare occasion that an individual tries an antidepressant medication and it works perfectly. Usually adjustments need to be made that may include adding on an additional drug, adjusting the dosage or switching to an entirely new medication. Medication that works well for other individuals may not be effective for you and vice versa. What might further complicate your situation is that you may be hypersensitive to medication. This is something you should explore with your prescribing physician.

You may also want to explore other types of medication. For instance, some individuals have been prescribed a low-dose mood stabilizer or antipsychotic medication in combination with the antidepressant medication. Perhaps switching to a different type of antidepressant medication or an entirely new class of drugs may produce a better outcome for you. You may have to try multiple medications to find the one that works best. You should be working in tandem with your doctor to assess which medication is a better match.

How should you proceed? I would suggest reading about the various types of antidepressant medications. Also, keep track of which medications don’t work for you and why. Work with a psychiatrist who is patient and willing to help you find the right medication. I would also recommend tempering expectations. Don’t expect to find the “perfect” medication. It may be more realistic to expect to find a tolerable medication. Almost all medications have some side effects. Some of the side effects are more endurable than others. Lastly, I would also suggest continuing therapy. It’s good that you are engaged in counseling but if it is not effective, consider a new therapist. How do you know if therapy is effective? You should feel better over time. If not, then you may not be getting the best help. Please take care. I wish you well.

Dr. Kristina Randle

Photo

 

 

Last reviewed: By John M. Grohol, Psy.D. on 28 Nov 2010

APA Reference
Randle, K. (2010). Antidepressant Drug Options. Psych Central. Retrieved on November 26, 2014, from http://psychcentral.com/ask-the-therapist/2010/11/28/antidepressant-drug-options/