Types of Antidepressants
Antidepressant medications are categorized in several different classes, as follows:
Selective serotonin reuptake inhibitors (commonly referred to as SSRIs)
Monoamine oxidase inhibitors (also known as MAOIs)
Each class of antidepressant medication works differently and has its own set of potential side effects. Let's look at each of the classes and the names of the medications found in each.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective serotonin reuptake inhibitors, or SSRIs, are drugs that inhibit the immediate reuptake of the serotonin transmitter back to its originating neuron. SSRIs are among the most commonly prescribed medications, and, once you see the names of some, you'll probably recognize them from television commercials and magazine advertisements. The following antidepressants are in the SSRI family (shown along with their most recognizable brand names):
Fluoxetine, marketed as Prozac
Sertraline, marketed as Zoloft
Paroxetine, marketed as Paxil
Fluvoxamine, marketed as Luvox
Citalopram, marketed as Celexa
Escitalopram oxalate, marketed as Lexapro
SSRI side effects may include headaches, nausea, dry mouth, insomnia, nervousness, sexual dysfunction (if you have a sexually active teen), diarrhea, tiredness, and agitation.
Of the SSRI antidepressant drugs approved for use in children and teens, only Prozac has been approved by the FDA as an antidepressant appropriate for use in treating kids twelve and over for major depressive disorder. No other antidepressant drugs have been approved for use in treating kids; however, your doctor may prescribe them for “off-label” use. Prozac, Zoloft, and Luvox have also been approved for treating obsessive-compulsive disorder in children and teens.
Atypical antidepressants are thought to be as effective as SSRIs, and may be used when other antidepressants aren't having the desired effect or when side effects from the SSRI medication are problematic. An atypical antidepressant may also be used in conjunction with an SSRI.
The following are the atypical antidepressants (shown with their most recognizable brand names):
Bupropion hydrochloride, marketed as Wellbutrin
Venlafaxine hydrochloride, marketed as Effexor
Nefazodon, marketed as Serzone
Mirtazapine, marketed as Remeron
Trazodone, marketed as Desyrel
Duloxetine hydrochloride, marketed as Cymbalta
The side effects of some atypical antidepressants may resemble those of SSRI medications. However, there are side effects that are unique to this class. Wellbutrin should be avoided if your child has an eating disorder or a history of seizures. Other side effects of Wellbutrin may include weight loss (as much as five pounds), anxiety, confusion, allergic reaction (uncommon), and heart palpitations (rare).
Side effects of Effexor may include constipation, cholesterol increase, and, uncommonly, allergic reaction, blurred vision, seizures, and heart palpitations (rare).
Remeron, in addition to side effects in common with SSRI medications, may create an increased appetite leading to increased weight gain and high cholesterol. Desyrel has its own additional set of side effects as well (though it is most often used as a sleep aid): low blood pressure, skin disorders, irregular heartbeat, abnormal white blood cell count, liver toxicity, and seizures (rare).
One urgent advisory about taking atypical antidepressants is the potentially serious or life-threatening reaction that can occur when they are used at the same time as monoamine oxidase inhibitors, or MAOIs. When transitioning from an MAOI to an atypical antidepressant, it is recommended that there be at least a two-week wait. It is also recommended that after discontinuing Effexor, there be a seven-day wait until an MAOI is started.
This is the oldest class of antidepressants, having been prescribed since the 1950s. Tricyclic antidepressants work similarly to SSRIs in that they affect serotonin and norepinephrine levels by slowing the rate of reuptake by nerve cells in the brain. They are not currently used as often as other antidepressants because of the greater (and unpleasant) number of potential side effects. Tricyclic antidepressants include the following:
Imipramine, marketed as Tofranil
Amitriptyline, marketed as Elavil
Nortriptyline, marketed as Pamelor
Side effects of tricyclic antidepressants may include dry mouth, drowsiness, dizziness, blurred vision, skin rash, weight gain, constipation, urinary retention, confusion or trouble thinking or concentrating, profuse sweating, muscular twitches, tiredness, nausea, increased heart rate, and irregular heart rhythm (uncommon).
In the 1990s, a possible linkage between desipramine and the sudden deaths of some young children from heart abnormalities was questioned in the medical community. As recently as 2004, the American Academy of Pediatrics, in their ADHD: A Complete and Authoritative Guide, addressed the desipramine controversy and concluded that, “there is no proof that this medication actually caused the deaths.”
Another tricyclic antidepressant, desipramine, is effective in treating kids with symptoms of ADD and ADHD, and has been prescribed as such since the 1980s. As always, proceed in partnership with your child under the close advisement of his doctor. Where ADD and ADHD are concerned, desipramine has had its advantages for being a nonaddicting, once-a-day dose that has helped kids to sleep at night (and is up to 90 percent effective in preventing bedwetting). Overall it has been found to be up to 80 percent effective in treating ADD and ADHD symptoms.
Monoamine oxidase is a natural enzyme found throughout portions of the human body. In the brain it works to eradicate the all-important neurotransmitters such as serotonin and norepinephrine. Where mental health is concerned, this is a recipe for disaster! The class of antidepressant medications called monoamine oxidase inhibitors (MAOIs for short) intercept the deterioration of the neurotransmitters, caused by monoamine oxidase, with the intent of restoring balance. MAOIs are known to work quickly (faster than tricyclic antidepressants) and can be used to treat individuals who don't respond well to other types of antidepressant medications. However, MAOIs are often the last line of medication defense in combating depression because of potentially severe side effects and necessary dietary adjustments. They are usually not recommended for use by children. (One MAOI, moclobemide, has shown some sign of helping kids, but it is not available in the United States.) The MAOIs include the following:
Isocarboxazid, marketed as Marplan
Selegiline, marketed as Eldepryl
Tranylcypromine, marketed as Parnate
Phenelzine, marketed as Nardil
In addition to symptoms of dizziness, hypertension, and rapid heartbeat, side effects of MAOIs may also involve serious reactions with some over-the-counter products, such as cold and allergy medicines, and other medications such as insulin, appetite suppressants, and anesthetics. This serious reaction may not be readily apparent until hours after the medication is taken, and may include headaches, nausea and vomiting, rapid heartbeat, confusion, dangerously high rise in blood pressure, seizures, stroke, and coma.
The same potentially urgent reactions can also occur when certain foods are consumed while taking MAOIs. To be avoided while taking MAOIs are foods with significant amounts of tyramine, an amino acid that interacts with MAOIs to quickly raise blood pressure (thus the preceding list of side effects). Known to negatively interact with MAOIs are the following foods and beverages:
Meats, fish, and soy products that have been smoked, pickled, processed, or fermented
Foods containing MSG (monosodium glutamate)
Chianti and other kinds of red wine
If an MAOI medication is considered to treat your child's depression, you'll need to weigh the options if any of the foods listed are part of your family's diet, or if they are absolute favorites of your child or teen.