Non sedating antidepressants
Although some patients require a smaller or larger dosage, the usual maintenance dosage is between 150 mg and 250 mg per day. Insomnia and the tendency for weight gain are mild. Source: Best Health Magazine, September 2008 Most of these (among the most-prescribed antidepressants in Canada) work the same way, says Wende Wood, a psychiatric pharmacist with the Centre for Addiction and Mental Health in Toronto.Pros: Some find this SSRI has the fewest side effects.Whom it may be suitable for: Those with milder or chronic cases of depression, because it has fewer side effects. Men with an enlarged prostate should avoid certain antidepressants. Weight gain can be as much as one pound per month with about 25% of patients gaining 20 pounds or more. Should not be used by patients with narrow-angle glaucoma or certain heart abnormalities.Pros: This norepinephrine dopamine reuptake inhibitor (NDRI) is often added on to other antidepressant treatments that lose effectiveness over time or cause sexual dysfunction.Side effects: Jitteriness, insomnia, headaches, dry mouth, nausea (and, rarely, risk of seizure).
Other common side effects: headache, dry mouth, constipation, sweating, dizziness, sexual dysfunction.
Physicians use tricyclic antidepressants in the treatment of panic disorder, PTSD, generalized anxiety and depression that occurs with anxiety. If uncomfortable side effects appear, one approach is to wait two to three weeks for them to diminish before increasing to the next higher dose. The sedating side effects can limit productivity and concentration during the day.
Of this family, imipramine has been the focus of most of the panic treatment research. Often effective in reducing panic attacks and elevating depressed mood. If the patient adjusts to the side effects, the physician increases the dosage every two or more days until the patient is taking the preferred dosage. One quarter to one half of imipramine patients relapse after tapering from the drug. Initial use of imipramine occasionally causes an increase in anxiety that usually diminishes in several weeks. Patients with certain abnormal electrocardiograms, with narrow-angle glaucoma, or with an enlarged prostate should not take this medication. Like imipramine, you may experience more general anxiety the first few days up to three weeks. Increase by 25 mg every three to four days to 100 mg per day, usually taken in one dose. Avoid during first three months of pregnancy and consult physician before using last six months and before breast-feeding.
Whom it may be suitable for: Depression sufferers with fatigue-like symptoms (norepinephrine works on the adrenal system); also a good option when SSRIs don’t work; not ideal for patients with hypertension.
Pros: This SSRI has fewer overall side effects than some antidepressants, but the serotonin-related side effects can be powerful.