This group of drugs, including fluoxetine Prozac , paroxetine Paxil , fluvoxamine Luvox , citalopram Celexa , escitalopram Cipralex and sertraline Zoloft , is usually the first choice for treatment of depression and anxiety disorders. These medications are known to have milder side-effects than some other antidepressants.

Buspirone Buspar is similar to SSRIs and has been found to help with anxiety but not depression. Common side-effects include nausea, vomiting, diarrhea, weight gain, dry mouth, headaches, anxiety, sedation and a decrease in sexual desire and response.

This group of drugs may also cause a jittery or restless feeling and sleep difficulties, such as problems falling asleep, waking in the night, vivid dreams or nightmares.

This class of medications includes venlafaxine Effexor , duloxetine Cymbalta , levomilnacipran Fetzima and desvenlafaxine Pristiq. These drugs are used to treat depression, anxiety problems and chronic pain.

Common side-effects include nausea, drowsiness, dizziness, nervousness or anxiety, fatigue, loss of appetite and sexual problems. In higher dosage, these medications may increase blood pressure.

The medication available in this class is bupropion Wellbutrin, Zyban. When used to treat depression, it is often given for its energizing effects, in combination with other antidepressants.

Mirtazapine Remeron , the medication available in this class, is the one of the most sedating antidepressants, making it a good choice for people who have insomnia or who are very anxious.

This medication also helps to stimulate appetite. This older group includes amitriptyline Elavil , , imipramine Tofranil , desipramine Norpramin , nortriptyline Aventyl , trimipramine Surmontil and clomipramine Anafranil.

Because these drugs tend to have more side-effects than the newer drugs, they are not often a first choice for treatment. However, when other drugs do not provide relief from severe depression, these drugs may help. Common side-effects include dry mouth, tremors, constipation, sedation, blurred vision, difficulty urinating, weight gain and dizziness.

Because cyclics may cause heart rhythm abnormalities, your doctor should order an electrocardiogram ECG before you take this medication. Monoamine oxidase inhibitors, or MAOIs, such as phenelzine Nardil and tranylcypromine Parnate were the first class of antidepressants.

MAOIs are effective, but they are not often used because people who take them must follow a special diet. A newer MAOI, moclobemide Manerix , can be used without dietary restrictions; however, it may not be as effective as other MAOIs. Common side-effects include a change of blood pressure when moving from a sitting to a standing position orthostatic hypotension , insomnia, swelling and weight gain.

When you start a new antidepressant, the first step is to decide whether you can tolerate the side-effects; this should become clear within a few weeks. The next step is to decide whether the drug helps with your depression or anxiety.

Improvements should be seen in two to four weeks. Full remission is seen at six to twelve weeks. If the medication does work for you, your doctor will advise you to continue taking it for at least six to nine months after you start to feel its beneficial effects.

People who stop taking antidepressants too soon risk having the symptoms of their depression or anxiety problem return. Most people who take antidepressants need to take them for at least a year.

People who experience depression that keeps coming back may need to take them for a longer term. Drugs that are addictive produce a feeling of euphoria, a strong desire to continue using the drug, and a need to increase the amount used to achieve the same effect.

Antidepressants do not have these effects. Antidepressants do, however, have one thing in common with some addictive drugs—they can cause withdrawal effects when you stop taking them. When you take antidepressants for months or years, your body adjusts to the presence of the drug.

If you then stop using it, especially if you stop suddenly, you may experience withdrawal effects such as muscle aches, electric-shock-like sensations, dizziness, headache, nausea, chills and diarrhea.

These effects are most commonly reported with paroxetine Paxil and venlafaxine Effexor ; however, they can occur with any antidepressant.

Some people find these effects distressing and have difficulty withdrawing from these drugs. Whether you want to cut down your dose or stop taking a medication, the same rule applies: go slowly. Sudden changes in your dose can greatly increase your risk of having another mood episode or having withdrawal effects.

The first step is to ask yourself if this is the right time. Are you feeling well? Is the level of stress in your life manageable?

Do you feel supported by your family and friends? If you are not satisfied with his or her reasons, you may want to see another doctor for a second opinion. If your doctor does agree, he or she will advise you not to skip doses but to reduce your dose gradually—usually by about 10 per cent at a time—with at least two to three weeks between each reduction.

This process of cutting back will take several months. Using a pill cutter can help you to cut your dose down in small amounts.

If you want to stop taking more than one medication, your doctor will usually suggest that you lower the dose of one drug at a time. As you cut down, if you start to feel unwell, let your doctor know. He or she can help you determine whether you are experiencing withdrawal effects or signs that symptoms are returning.

Find the dose that works best for you. Antidepressants may interact with some other types of medication, even over-the-counter medications, such as cold or allergy tablets or cough syrups, and some herbal remedies, such as St.

Always ask your doctor, dentist or pharmacist about potential drug interactions with the medication you are taking before you take other medications. Drinking alcohol can worsen symptoms of depression or anxiety. Alcohol can also worsen some side-effects of antidepressants, making you more sleepy, dizzy and lightheaded.

However, if you have been taking antidepressants for more than a few weeks, and you are feeling well, having a drink or two on occasion should be okay—but remember that one drink could have the effect of two or even three drinks.

The caffeine in coffee and other beverages can cause problems if you struggle with depression or anxiety. Depression disrupts sleep, and caffeine, a stimulant, can make the problem worse.

It is better to drink decaffeinated coffee and beverages or to decrease the amount you drink. You want to feel well. While street drugs such as marijuana or cocaine may have some effects that seem to make you feel better for a while, mixing the effects of these drugs may make your situation worse.

Street drugs may also interact with your medication, for example, by interfering with its effectiveness or by worsening side-effects. Depression itself can lead to fatigue and concentration problems, affecting your ability to drive. Antidepressant medications may also cause drowsiness, especially in the early stages of treatment, before your body has adjusted to the medication.

If you feel drowsy, do not drive a car or operate machinery. Alcohol, sedatives and antihistamines cold and hay fever medication will worsen the problem. Antidepressants, especially those that increase serotonin activity, can also negatively affect sexual function.

Sexual side-effects of antidepressants can include delayed ejaculation and the inability to experience an orgasm. Many factors affect your sexuality. When antidepressants bring relief from the distress of depression or anxiety, this may help you to focus more on your partner and to feel more desire.

If you think your medication affects your sexual function, your doctor may be able to help by changing your dose, switching medication or adding other medications. For any pregnant woman with a history of depression, the question of whether to take antidepressants during pregnancy usually comes down to a risk-benefit analysis.

When treatment with an antidepressant helps to avoid a relapse or to reduce distress, the benefits of continuing the medication may outweigh the risks.

Antidepressants are relatively safe to use during pregnancy. When they are used close to delivery, newborns may be restless and irritable, and may have sleeping, feeding and breathing difficulties.

These problems resolve within three days to two weeks. Antidepressants do not increase risk for birth defects. The amount of antidepressant passed through breast milk is very small and is not considered to be a risk to the baby, especially when weighed against the benefits of breastfeeding. If you decide to stop taking medications during pregnancy or while breastfeeding, it is a good idea to see your doctor more often, to help you monitor for a return of symptoms.

Most antidepressants are not officially approved for use by children and teens. However, when distress is so severe that non-drug approaches are not possible, or when they do not work, antidepressants may be considered.

Studies of children and and young people who take antidepressants suggest an increased risk of suicidal thoughts and behaviour, but not death by suicide. Antidepressants are an effective treatment for depression in adults over 65 and are known to decrease the risk of suicide in this population.

However, due to the increased sensitivity of the older body, older adults are more vulnerable to side-effects. As older adults often take multiple medications, they are also more vulnerable to drug interactions. Older adults usually start with lower doses, and the dose is increased at a slower rate.

Adapted from Understanding psychiatric medications: Antidepressants c CAMH, Understanding psychiatric medications: Antidepressants PDF For more information on medications, contact your doctor, nurse or pharmacist.

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Overview Antidepressant medications are most commonly used to help relieve the distress of depression or anxiety. Do I need this treatment? What do Antidepressant Medications do? Most of the studies compared medication treatment to placebo, so the authors conducted a network meta-analysis to compare outcomes among the various medication classes and medications identified in the systematic review:.

Our network meta-analysis identified 11 current drug classes for the treatment of panic disorder, highlighting benzodiazepines, tricyclic antidepressants, and SSRIs as the highest ranked treatments for remission based on SUCRA values.

Although benzodiazepines were associated with the lowest probability of dropout, they were also associated with the highest risk of adverse events.

Overall, SSRIs provided high benefit remission with low risk of adverse events. Across individual SSRIs, sertraline and escitalopram were identified as the most efficacious agents with low risk of adverse events.

The researchers also evaluated included studies for risk of bias, and they noted that " [t]he findings were based on studies of moderate to very low certainty levels of evidence, mostly as a result of within study bias, inconsistency, and imprecision of the findings reported.

Accessing support resources can be beneficial; I included a list of mental health resources developed during the pandemic in this blog post from , and I especially like this one from the World Health Organization that emphasizes the importance of simple self-care habits.

It's also important to precisely diagnose patients to guide treatment recommendations. This AFP article on " Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults " includes diagnostic criteria for both Generalized Anxiety Disorder and panic disorder along with an overview of treatment options - both pharmaceutical and non-pharmaceutical - to discuss with patients.

There's also an AFP By Topic on Anxiety Disorders if you'd like to read more. Sign up to receive twice monthly emails from AFP. You'll get the AFP Clinical Answers newsletter around the first of the month and the table of contents mid-month, shortly before each new issue of the print journal is published.

Disclaimer The opinions expressed here are those of the authors and do not necessarily reflect the opinions of the American Academy of Family Physicians or its journals.

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