Depression medication: notes on drugs and herbal treatments

These are just some notes for medical students to revise what they know about depression treatments and medications as well as it may be helpful to others. Only take depression medications that are prescribed by a health professional for you in the recommended doses. This article is for educational use only and not a substitute to medical advice.

• The first line drug treatment for depression and Selective Serotonin Reuptake Inhibitors (SSRIs) such as Citalopram and Fluxetine. They are associated with less side effects and better results in mild to moderate depression.
  
  
• Antidepression drugs should be continued for at least 6 months after improvement/remission of symptoms. In some cases, treatment might need to be taken for 2 years or even more according to the condition of the patient and the doctor's clinical judgement (e.g. if a patient have history of severe depression or still have residual symptoms).
  
  
• It is important to tell the patient that SSRIs and most anti-depression medications doesn't cause addiction.
  
  
• Antidepression medication should be stopped and tapered gradually over a period of about 4 weeks. Sudden stoppage may result in "withdrawal syndrome". Withdrawal symptoms are more with drugs with a short half life such as Paroxetine. Fluxetine, on the other hand is one of the least SSRI associated with withdrawal symptom.
  
  
• Mirtazapine is a presynaptic alpha 2 blocker that can be used if SSRIs are contraindicated or not tolerated.
  
  
• If there is no response to SSRIs, Venlafaxine can be tried. Venlafaxine is an SNRI but it shouldn't be given to hypertensive or cardiac patients.
  
  
• For patients with a recent myocardial infarction or unstable angina, Sertraline is the safest drug. Venlafaxine and Tricyclic Antidepressants (TCAs) are contraindicated (except Lofepramine).
  
  
• MAO inhibitors (e.g. Phenelezine) are rarely used nowadays. They can cause severe hypertension if the patient eats Tyraine rich food or takes a sympathomimetic (as in cold medicines).
  
  
• St. John's wort is one of the herbal remedies for depression that was proven to benefit patients but dosage and concentrations differ with each preparation. I can interact with some drugs and it also induces the liver enzymes leading to diminished effects of some drugs such as Estrogen containing contraceptive pills, anticonvulsants, HIV drugs and anticoagulants.
  
  
• Depression medication and drugs should be associated with psychological interventions such as computer guided CBT, self help and other measures as well as advising the patient about the importance of socializing, exercise, meditation and good sleep.
  
  

More on that topic here: NICE guidance on depression in adults.
Related:
Signs of depression in children.