Atypical Antidepressants

“Atypical” antidepressants include: bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron), trazadone (Desyrel) and nefazadone (Serzone). The last two work by a similar mechanism but the others are each different from the three major classes of antidepressants and from each other.

Bupropion is used to treat depression and to help individuals quit smoking. In addition some find it helpful in Attention Deficit Disorder. Bupropion can cause insomnia and seizures. The risk of seizures is believed to be greater if one has a history of seizures or an eating disorder, so it is important to warn your doctor if either of these are the case. It should not be used with MAOIs.

Venlafaxine is used to treat depression and anxiety disorders. It can cause an increase in blood pressure. This medication can cause uncomfortable symptoms if it is stopped abruptly especially from higher doses. Therefore, always a have a discussion with your doctor before stopping this medication.

Mirtazapine, nefazadone and trazadone are all used to treat depression. Side effects include sedation and weight gain. In addition, on very rare occasions, trazadone causes priapism, an erection of the penis that will not go down. This is actually a dangerous condition that can cause permanent damage to the penis, therefore one should go immediately to an emergency room if this occurs.

ANTIANXIETY MEDICATONS (Also known as Anxiolytics)

These medications are mainly used to treat anxiety disorders. They relieve or reduce symptoms such as rapid heartbeat and breathing, hand tremors, stomachaches and difficulty in sleeping. Depending on the medication, it may take only an hour or so, or up to six to eight weeks for it to take effect.

Special Precautions: These medications can cause severe interactions with alcohol and other drugs. Death can result. Because of the serious risks of these medications, a doctor must closely monitor their use. Know the signs of overdose. These include slow heartbeat, difficulty breathing, slurred speech, severe drowsiness, confusion and seizures. If you detect any unexpected effects, immediately contact your doctor or go to the Emergency Room.

The main group of antianxiety medications are the benzodiazepines, such as alprazolam (Xanax), clonazepam (Klonopin), oxezepam (Serax), diazepam (Valium), lorazepam (Ativan), clorazepate (Tranxene), triazolarn (Halcion), and chlordiazepoxide (Librium). Other types of antianxiety drugs include buspirone (BuSpar); beta blockers, such as propranolol (lnderal), and antidepressents.

Possible side effects of benzodiazepines are drowsiness, loss of coordination, Impaired concentration, muscle weakness, dizziness, headache, nausea, amnesia (particularly with Halcion) and confusion. Benzodiazepines should be used cautiously in patients prone to violence, as they may produce a worsening of that behavior. Also, they should not be used during the first trimester of pregnancy. Side effects may decrease with time or as the dosage is adjusted.

Possible long-term effects of benzodiazepines: Used properly for a short time, these medications are considered safe and effective. However, long-term use can result in: tolerance of the drugs, dependence on them (both physical and psychological), and withdrawal symptoms (severe headaches, insomnia, nausea, etc., when treatment is stopped). In other words, they are addictive.

BuSpar and some antidepressants are good anti-anxiety medications. However, they work slower than the benzodiazepines. Their advantage is that they are not addictive. Beta-blockers may work quickly and are not addictive but they can cause a drop in blood pressure.

Drug interactions include the following: Antibuse (prevents alcoholics from drinking) increases the effects of Librium and Valium. Serax and Ativan can be used safely with Antabuse. Tagamet (for peptic ulcers) increases the effects of benrodiazepines. Antacids delay the absorption of anti-anxiety drugs. Isoniazid and Rifampin (anti-tuberculosis drugs) increase the effect of Valium. The effects of Valium must be closely monitored when these two drugs are used. Antianxiety drugs decrease the effect of Levodopa (which is contained in some anti-Parkinson disease medication) and increase the effect of Digoxin (heart medication). Oral contraceptives increase the effects of the antianxiety drugs.

Antianxiety medications have been used in combination with the major tranquilizers (or antipsychotics) in the treatment of agitation.

CAUTION: NAMI-NYS does not give medical advice. This page is for informational purposes only. Discuss all medication and medical decisions with your physician.