What are the main medicines for depression?
If you are prescribed a medicine, then there may be many reasons why that one has been chosen. These might include:
- side effects (which ones are important to you)
- local policies or agreements (such as what your GP surgery uses or agreements in your area)
- national policies (e.g. NICE, SIGN - see last question)
- familiarity (it may be better for prescribers to use medicines they are familiar with)
- relative costs for similar medicines (if two medicines are very similar, why waste money on the more expensive one?)
- personal preference (either yours or your prescriber)
- how bad your symptoms are
- any medicine you might have done well with in the past (as it's more likely to work again)
The main medicine treatment options in UK are listed below. They are divided into "Main medicines" and "Others".
For convenience, the "Main medicines” are those medicines that are officially "approved" to treat the condition or symptoms (www.bnf.org/bnf/) and which are listed in the British National Formulary (BNF). To be listed in the BNF there needs to be good evidence that the medicine works and that the manufacturers have applied for a license (a long and costly exercise). "Others" are those medicines where there is some evidence that they help, but either not enough for a license or that no license has been applied for. These should usually only be used where other standard treatments have failed.
There is a myth or misconception that antidepressants are "uppers". Amphetamines ("Speed") might be "uppers" but antidepressants aren't. Antidepressants don't increase the effects of positive emotions. What antidepressants seem to do is reduce the way someone reacts to negative emotions and fears. So, they're stopping lows rather than making you high.
SSRIs (Selective Serotonin Reuptake Inhibitors)
- Citalopram (Cipramil ®) - standard first-line UK antidepressant
- Escitalopram (Cipralex ®) - the active part of citalopram
- Fluoxetine (Prozac ®) - standard first-line UK antidepressant
- Fluvoxamine (Faverin ®) - one of the first SSRIs but little used these days
- Paroxetine (Seroxat ®) - standard UK antidepressant
- Sertraline (Lustral ®) - standard UK antidepressant
- Agomelatine - new in 2009, and very different
- Lithium - usually used as a mood stabiliser
- Mianserin - not used much these days
- Duloxetine (Cymbalta ®) - an SNRI, a little like venlafaxine (click here for the Cochrane review from 2012)
- Mirtazapine (Zispin ®) - standard UK antidepressant
- Moclobemide (Manerix ®)
- Reboxetine (Edronax®) - a noradrenaline booster
- Trazodone (Molipaxin ®) - quite sedative
- Tryptophan (Optimax ®) - discontinued in UK in October 2012 but some supplies are still available
- Venlafaxine (Efexor ® and Efexor XL ®) - has quite a few side effects but may be good for more resistant depression
Tricyclic antidepressants (TCAs)
- Clomipramine (Anafranil ®)
- Dosulepin (dothiepin) - not recommended by NICE
- Lofepramine - the NICE recommended tricyclic
- Maprotiline (discontinued in UK)
You would need to go on a special diet if taking these.
- Isocarboxazid - usually only for more resistant depression
- Phenelzine - usually only for more resistant depression
- Tranylcypromine - usually only for more resistant depression
- Quetiapine XL, which was licensed in 2010 as an "add-on" treatment for depression. It can be used with antidepressants where they have not worked fully. It is also used for bipolar depression.
- Bupropion (Zyban ®) - is available in many countries for smoking cessation but not licensed for depression, although it is used for depression in some countries e.g. USA
- St. John's wort - is not licensed but widely used, seems effective for mild to moderate depression
- Antipsychotics – can help with psychotic symptoms
- Lamotrigine - for bipolar depression only
Depression that doesn't seem to get better with antidepressants can sometimes actually be bipolar depression, as part of a bipolar mood disorder. It might be worth thinking if this could be the cause if the usual antidepressants don't help much.
Sometimes the symptoms of depression can become very severe e.g. when someone tries to kill themselves. This can result in the person becoming very distressed and/or too difficult to cope with and might need to be admitted to hospital. This might then become what is called an "acute psychiatric emergency" or crisis. The treatments for this may need to include some other medicines just to calm the person down and prevent harm to that person, or others. If this happens, follow the link to some information that might help explain what might be going on.