SNRIs (Effexor, Serzone)

This class of drugs is also well-tolerated and easy to use.

Common side effects: Overall, the side effects are similar to the SSRIs, although the SNRIs generally cause fewer sexual side effects than the SSRIs. The SNRIs can also produce dry mouth, mild constipation, and urinary retention (excessive build-up of urine in the bladder). At higher doses, venlafaxine (a type of SNRI) may cause high blood pressure; therefore, patients should have their blood pressure checked while taking this medication. The SNRIs are safe in overdose.

Usage: These drugs are usually taken twice a day.

Bupropion (Wellbutrin)

Common side effects: Anxiety, restlessness, and insomnia. At high doses it may cause seizures, so it is not a good choice for individuals with epilepsy or brain injuries.

Usage: One must take Bupropion two or three times a day to limit its side effects, although an extended release form is available that can be used once or twice a day. This drug may cause seizures when taken in large amounts.

Mirtazapine (Remeron)

This is a relatively new antidepressant.

Common side effects: Sedation and weight gain.

Usage: Because mirtazapine is sedating, it is taken once a day at night. This drug is safe in overdose.

TCAs (e.g. Elavil, Pamelor, Norpramin)

This is one of the oldest classes of antidepressants. These drugs tend to have more side effects and require closer monitoring to ensure their safety. They may also be fatal in overdose. Nevertheless, they remain effective antidepressants. Many patients find them to be helpful when the newer medications have failed.

Common side effects: Sedating, dry mouth, blurred vision, constipation, urinary hesitancy, orthostatic hypotension (lightheadedness upon standing that may lead to falls), tremor, excitement, heart palpitations, and weight gain.

Usage: Patients with closed-angle glaucoma may not use this class of drug. Sometimes it is necessary to monitor TCA blood levels to ensure that patients receive the optimum dose. Recent data have raised questions about the safety of these medications in patients with heart disease; therefore, patients with heart disease should avoid them. Patients over 40 years old should have a cardiogram prior to starting a TCA.

    Last reviewed: By John M. Grohol, Psy.D. on 30 Aug 2006
    Published on PsychCentral.com. All rights reserved.