General Information

Antidepressants typically take 10 to 30 days to start working ( therapeutic dose ). It can take up to 6 weeks before receiving their full effect and improvement may continue for months afterwards. Depending on the the type of antidepressant some secondary side effects of the depression may improve sooner.

SSRIs

• More energy in 4 to 7 days.
• Concentration, mood, and interest may begin to improve in 7 to 10 days.
• Feelings of hopelessness, helplessness, and anhedonia should fade in about 10 to 14 days.
• Diurnal mood variation that is worse in the morning should recede in about 8 days.
• Libido revives in about 9 or 10 days.
• Excessive guilt, Dysthymia, and thoughts of suicidal should fade in about 12 to 16 days.

TCAs

• Appetite returns in about 3 to 4 days.
• Insomnia abates in about 5 to 7 days.
• Feelings of hopelessness, helplessness, and anhedonia should fade in about 10 to 14 days.
• Diurnal mood variation that is worse in the morning should recede in about 8 days.
• Libido revives in about 9 or 10 days.
• Excessive guilt, Dysthymia, and thoughts of suicide should fade in about 12 to 16 days.

• SSRIs
  • Inadequate time.
    
• TCAs
  • Inadequate time.
  • Inadequate dose.

• Good predictors:
  • Acute onset.
  • Anhendonia.
  • Anorexia.
  • Emotional withdrawal.
  • Guilt.
  • Middle or late insomnia.
  • Past success with antidepressants.
  • Psychomotor retardation.
• Poor predictors:
  • Atypical symptoms ( Lowers response to TCAs to under 50% ).
  • Atypical antidepressant, MAOIs, and SSRIs are effective on atypical symptoms and/or Hypochondriasis.
  • Childhood depression ( Only Fluoxetine and sertraline superior to placebo, other SSRIs may also be effective ).
  • Hypochondriasis ( Lowers response to under 50% ).
  • Atypical antidepressant, MAOIs, and SSRIs are effective on atypical symptoms and/or Hypochondriasis.
  • Panic attacks with depression, agitation, and anxiety.

Childhood Depression.

• TCAs and placebo same outcome ( increased risk of cavities with TCAs ).
• SSRIs most effective ( safest ).
  • Start with low dose and slowly increase to 50% of a adult dose.
• Use bupropion for depression with ADD.
• Desipramine has a high rate of sudden death ( 8 per million ).

Delusional Depression.

• If suicidal your 1st choice should be ECT.
• If not suicidal your 1st choice should be TCAs with neuroleptics.
  • 2nd choice neuroleptics alone.
  • 3rd choice antidepressants alone.
• Combining antidepressants and antipsychotics.
  • Amoxapine may diminish the need for an antipsychotic.
    • Amitriptyline and perphenazine superior to amoxapine.
  • Avoid low-potency neuroleptics.

Geriatric Depression, Melancholic depression, or severe depression ( inpatient ).

• Mirazapine, nefazodone,TCAs, and venlafaxine
• SSRIs and TCAs same out come.

Late-Life Depression.

• Bupropion, mirtazapine, nefazodone, SSRIs, or velafaxine.
• Secondary amine TCAs ( desipramine, nortriptyline, or ... )

Mild to Moderate Depression.

• Antidepressants and placebo same outcome.
• Antidepressants and Psychotherapy same outcome.

Postpartum Depression.

• Estrogen.
• Venlafaxine.

Antidepressants