Antidepressants are medicines prescribed by doctors to help people who have low mood or depression. About half of patients with depression get better with treatment that includes these antidepressant medicines. Natural antidepressant alternative supplements include 5-HTP, St. John's wort, SAM-e, and others. Taking prescription antidepressants appears to raise the risk of suicidal thoughts and behavior in adults younger than 25. No increase in suicidal behavior was seen in adults older than age 25 who take prescription antidepressants.
   The swings in mood from depression to mania that afflict people with bipolar disorder can be tempered with drugs such as lithium, but adding an antidepressant drug to ease the depression component is not helpful.
   The number of Americans using antidepressants doubled in only a decade. About 10% of Americans — or 27 million people — were taking antidepressants in 2005, about twice the number in 1996.

How do antidepressants work?
Most antidepressants work by influencing brain levels of chemicals called neurotransmitters. Neurotransmitters are needed for normal brain function. Antidepressants help some people with depression by making these natural chemicals more available to the brain. People with depression who also have high blood pressure, diabetes, high cholesterol, or other risk factors for heart disease may not respond well to antidepressant drug therapy

How long will I have to take an antidepressant?
Antidepressants are typically taken for at least 4 to 6 months. In some cases, patients and their doctors may decide that antidepressants are needed for a longer time.

Do antidepressants really work?
Anti-depressants may not work as well as doctors believe. Almost 50 clinical trials were reviewed by psychologists from the University of Hull. They found that new-generation anti-depressants worked no better than a placebo – a dummy pill – for mildly depressed patients. Even the trials that suggested some clinical benefit for the most severely depressed patients did not produce convincing evidence. Most depressed patients improve without medications. Perhaps anti-depressant medications should be used only in severely depressed patients. The antidepressant medications reviewed included fluoxetine (Prozac), venlafaxine (Efexor), and Paroxetine (Seroxat).

An article in an April 2009 issue of Time magazine discussed this issue. A review published in the Journal of Affective Disorders in February 2009 attributed 68% of the benefit from antidepressants to the placebo effect. Likewise, a paper published in PLoS Medicine in 2008 suggested that widely used SSRIs, including Prozac, Effexor and Paxil, offer no clinically significant benefit over placebos for patients with moderate or severe depression. Meanwhile, pharmaceutical companies maintain that their research shows that SSRIs are powerful weapons against depression. An April, 2009 study published in the American Journal of Psychiatry suggests that both critics and proponents might be right about SSRIs: the drugs can work, but they appear to work best for only a subset of depressed patients - those with a limited range of psychological problems. People whose depression is compounded with, say, substance abuse or a personality disorder may not get much help from SSRIs - which is unfortunate for the 45% to 60% of patients in the U.S. who have been diagnosed with a common mental disorder like depression and also meet the criteria for at least one other disorder, like substance abuse. (Multiple diagnoses are known in medical parlance as comorbidities.)

FDA warns new antidepressant users - risk of suicide with antidepressant use
May 2007 - Young adults beginning treatment with antidepressants should be warned about an increased risk of suicidal thoughts and behavior. The Food and Drug Administration proposed labeling changes that would expand a warning now on all antidepressants. The current language applies only to children and adolescents. The expanded warning would apply to adults 18-24 during the first month or two of treatment with the drugs. The proposed FDA labeling changes also would note that studies have not shown this increased risk in adults older than 24, and that adults 65 and older taking antidepressants have a decreased risk of suicidal thoughts and behavior. The proposed expanded warnings emphasize that depression and certain other serious psychiatric disorders are themselves the most important causes of suicide.
   Comments: For mild to moderate cases of depression, certain supplements such as 5-HTP, St. John's wort, or SAM-e may be helpful.

Different types of antidepressants
Antidepressants are put into groups based on which chemicals in the brain they affect. There are many different kinds of antidepressants, including:

Selective serotonin reuptake inhibitors (SSRIs) antidepressants
citalopram (brand name: Celexa)
escitalopram (brand name: Lexapro) also known as Cipralex. Side effects include diarrhea (9%), insomnia (36%) and yawning (16%) and decreased appetite.
fluoxetine (brand name: Prozac)
fluvoxamine (brand name Luvox) is a selective serotonin reuptake inhibitor (SSRI) antidperssant used to treat obsessive-compulsive disorder (OCD). It may also be used to treat depression and other conditions as determined by your doctor. The effectiveness of fluvoxamine maleate for long-term use, i.e., for more than 10 weeks, has not been systematically evaluated in placebo-controlled trials. Therefore, the physician who elects to use fluvoxamine maleate for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.
paroxetine (brand names: Paxil, Pexeva) - Newer antidepressants, already suspected of raising the risk of suicide in some patients, may also cause a few people to become violent. People who take the antidepressant Paxil are more likely to have what is called a "hostility event" as those given a placebo.
sertraline (brand name: Zoloft) - the first generic version of the antidepressant Zoloft was approved in 2006 in tablet form and the liquid concentrate form (which has the additional use of treating some anxiety-related disorders). In 2005, Zoloft was the sixth highest-selling brand-name drug in the United States.
 

These medicines tend to have fewer side effects than older antidepressants. Some of the side effects that can be caused by SSRIs include dry mouth, nausea, nervousness, insomnia, sexual problems and headache. See SSRI for more information. SSRI antidepressants raise the risk for bone thinning or osteoporosis.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) antidepressants
Venlafaxine (brand name: Effexor)
duloxetine (brand name: Cymbalta) - The antidepressant Cymbalta (duloxetine HCl; a dual-reuptake inhibitor of serotonin and norepinephrine, 60 mg once or twice daily, has been found in one study to reduce pain in more than half of women treated for fibromyalgia, with and without major depression.

Q. I have a question about the antidepressant Cymbalta. Can Passion Rx, Passion Rx with Yohimbe and Mind Rx be taken with Cymbalta antidepressant medication?
   A. We don't suggest taking these supplements the same day as Cymbalta or other antidepressants since we don't know what kind of side effects would arise. Passion Rx and Mind Power Rx are potent supplements, and Cymbalta is a potent antidepressant. We recommend taking a new supplement on a different day than an antidepressant medication.
Pristiq - In February 2008, Wyeth received approval by the FDA for a new antidepressant called Pristiq. Wyeth needs an antidepressant that will replace the revenue expected to be reduced  to generic competitors of Effexor XR, whose patent protection expires in 2010. Pristiq is chemically similar to Effexor.

Some common side effects caused by these antidepressants include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased heart rate and increased cholesterol levels can also occur.
 

Norepinephrine and dopamine reuptake inhibitors (NDRIs)
bupropion (brand name: Wellbutrin) also known as Zyban (bupropion) for smoking cessation.

Some of the common side effects in people taking NDRI antidepressants include agitation, nausea, headache, loss of appetite and insomnia. It can also cause increase blood pressure in some people.

Combined reuptake inhibitors and receptor blockers as antidepressants
trazodone (brand name: Desyrel)
nefazodone (brand name: Serzone)
maprotiline
mirtazpine (brand name: Remeron) - Preliminary indications are that women taking the antidepressant mirtazapine (brand name, Remeron) during pregnancy do not increase the risk of having a baby with birth defects. However, use of the antidepressant Remeron can lead to higher rates of preterm birth and miscarriages.

Common side effects of these antidepressants are drowsiness, dry mouth, nausea and dizziness. If you have liver problems, you should not take nefazodone. If you have seizures, you should not take maprotiline.

Tricyclic Antidepressants
amitriptyline (brand name: Elavil)
desipramine (brand name: Norpramin)
imipramine (brand name: Tofranil)
nortriptyline (brand name: Aventyl, Pamelor). Side effects include dry mouth (74%), constipation (33%) and weight gain (15%), problems with urination and drowsiness.

Common side effects caused by these tricyclic antidepressants include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These antidepressants can also affect a person's blood pressure and heart rate.

Monamine oxidase inhibitors (MAOIs)
isocarboxazid (brand name: Marplan)
phenelzine (brand name: Nardil)
tranlcypromine (brand name: Parnate)

Best antidepressants
A review of studies in the journal The Lancet in January 2009, found Pfizer Inc's Zoloft and Forest Laboratories Inc's Lexapro to be the most effective and well-tolerated antidepressants among a group of 12 new drugs. A team reviewed 117 studies from 1991 to 2007 that compared the response and drop-out rates of the drugs among more than 25,000 men and women with major depression. Overall, Zoloft, or sertraline, and Lexapro, or escitalopram, were best when it came to both reducing symptoms after eight weeks and drop-out rates during the studies. Far more people remained on the two drugs compared to Eli Lilly and Co's Cymbalta, or duloxetine; Solvay's Luvox, or fluvoxamine; GlaxoSmithKline Plc's Paxil, or paroxetine; Pfizer's Edronax or reboxetine; and Wyeth's Effexor, or venlafaxine, the study showed. The team, which also found Remeron and Effexor were more effective than the other drugs, did not look at things like side-effects, toxicity, how well people functioned socially while on the treatments, or cost-effectiveness. Remeron, or mirtazapine, comes from Dutch chemical group Akzo Nobel's Organon unit.The researchers also analysed Wellbutrin XL, manufactured by Biovail, sold by Glaxo and known generically as bupropion and Cypress Bioscience Inc's Savella, or milnacipran.

Third Antidepressant attempt not helpful

Two prior unsuccessful antidepressant trials usually spell treatment failure with a third. In this scenario, remission rates are less than 20 percent. The findings of the study, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, continue to be disappointing. The focus of the analysis was to determine which agent, Remeron (mirtazapine) or Pamelor (nortriptyline), was most effective antidepressant after two consecutive failed medication treatments for depressed outpatients. The study involved 235 adults who had failed treatment with Celexa (citalopram) and then with other antidepressants. The subjects were randomized to receive the antidepressants Remeron (up to 60 mg/day) or Pamelor (up to 200 mg/day) for 14 weeks. Pamelor therapy was associated with a remission rate of roughly 20 percent -- higher but not significantly different from the 12 percent rate seen with Remeron. American Journal of Psychiatry July 2003.
 

Antidepressants prescribed for the treatment of depression include the following drugs: Wellbutrin (bupropion), Celexa (citalopram), Cipralex (escitalopram), Prozac (fluoxetine), Luvox (fluvoxamine), Remeron (mirtazapine), Paxil (paroxetine), Zoloft (sertraline) and Effexor (venlafaxine), and Zyban (bupropion) for smoking cessation.

Weaning off Antidepressant drugs

It has been more than two decades since Prozac — the first of the antidepressants known as SRIs, or selective serotonin reuptake inhibitors — hit the market. Since then, many patients have reported extreme reactions to discontinuing the SSRI drugs. Two of the best-selling antidepressants — Effexor and Paxil — have prompted so many complaints that many doctors avoid prescribing them altogether. Patients report experiencing all sorts of symptoms, sometimes within hours, but most often within days, of stopping their antidepressant medication. They can suffer from flu-like nausea, muscle aches, uncontrollable crying, dizziness and diarrhea. There are case reports of people who have just quit antidepressants showing up in hospital emergency rooms, thinking they are suffering from seizures.
     The brain chemical affected by most of the SSRI antidepressants on the market today, serotonin, does a lot more than regulate mood. It is also involved in sleep, balance, impulse control, relaxation, digestion and other physiological processes. So when you throw the brain’s serotonin system out of whack, which is essentially what you’re doing by either starting or discontinuing an antidepressant, virtually the whole body can be affected.
     Generally the antidepressants that are metabolized most quickly cause more severe symptoms. Effexor, with a half-life of just a few hours, is one of the worst antidepressants in that regard; Prozac, which has a half-life of about a week, is considered the best. Some doctors have been able to minimize antidepressant withdrawal symptoms in patients who are quitting Effexor or Paxil by gradually switching them over to Prozac, then tapering them off the more easily discontinued drug.
     Would taking 5-HTP or St. John's wort reduce the symptoms of SSRI withdrawal? Perhaps these natural antidepresants may help, but research is lacking.

SSRI Antidepressants and Pregnancy
Babies born to women who take the newer type of antidepressants called selective serotonin reuptake inhibitors or SSRIs during pregnancy appear to be at increased risk of having a low birth weight and to develop respiratory distress.

Babies whose mothers used antidepressants during pregnancy visit the doctor more often and have higher risks of certain health problems than other children their age. BJOG, November 2009.

Antidepressant use by elderly

Among depressed older adults, use of an SSRI antidepressant like Prozac may lead to apathy, even though it relieves symptoms of depression. Apathy is a psychological term used to describe a state of indifference, where an individual is unresponsive or indifferent to aspects of emotional, social, or physical life.

Use with Passion Rx or sexual enhancing herbal products
Q. I take an antidepressant and on hormone pill. Why cant you take Passion Rx with an anti-depressant? I take it everyday because the hormone pill makes me depressed. I have lost all passion and desire for sex. I am only 36 and am married to a wonderful man.
   A. Herbal formulas used for sexual and libido enhancement are potent and can influence brain chemistry. It is difficult to predict the interactions between aphrodisiac herbs and prescription anti-depressants. If your doctor approves, you can take half a capsule of Passion Rx libido formula 2 days on, one day off and take less or more depending on your early response.
 

Alternatives to prescription antidepressant questions

Q. Is the problem with antidepressants simply that they interfere with libido and the intent of Passion RX, or do antidepressants have additional negative health interactions?

     A. Yes, antidepressants, especially of the SSRI class, increase serotonin levels and hence interfere with libido, they may also cause side effects potentially if taken the same day as Passion Rx.

Q. I am writing a research paper on the effects of 5-HTP vs. prescription anti-depressants. Where may I find current statistics regarding studies and trials? I am running into dead ends. Is there current testing / studies/ findings? I have gone of my meds and am taking 150mgs a day with St. Johns Wort and have never felt better.
   A. We are not aware of any studies comparing 5-HTP to prescription antidepressants.

Q. I have been taking about 200mg of L tyrosine to lift my mood and it has greatly helped me. However my concern is that if I take this supplement over a long period of time I may develop tolerance and have to take ever larger doses. Does this happen with tyrosine and other amino acid supplements such as 5HTP? Also if I were to stop taking this supplement after a period of time could I develop withdrawal systems? Having taking anti-depressant medications in the past, I have experienced the powerful dependency antidepressant drugs can create. I have experienced terrible withdrawal symptoms coming off anti-depressant medications and often had rebound depressions as these drugs so altered my brain chemistry. Therefore I am wary of taking anything new lest I become dependent on them. Do amino acids create a similar dependency as drugs that act directly at the receptor sites? If so, how can I prevent this?
   A. There have not been enough long term studies with natural antidepressant supplements such as tyrosine, 5-HTP, SAM-e, St. John's wort, etc. but my understanding and experience says that dependency could potentially occur with natural supplements but to a lesser degree than antidepressant medications. Taking breaks and switching antidepressant herbs and supplements could reduce this potential problem.

Q. Why is Passion Rx not recommended to take with antidepressant drugs, SSRI's, SNRI's ,specifically Paxil or Wellbutrin SR. What are the ramifications, adverse reactions, and side effect? I need to take a sexual enhancement product of some kind.
   A. Antidepressant drugs influence various levels of neurotransmitters and hormones and we don't know how Passion Rx would interact with them. Furthermore, many antidepressants can influence alertness or have a stimulating nature, and so does Passion Rx. There could be unexpected side effects of overstimulation, insomnia, heart beating faster, increased body temperature, etc. It would be best not to take sexual enhancement herbs the same day as an antidepressant drug since many of these herbs stimulate the body and mind.

Q. I came across your website while researching the loss of sex drive due to antidepressants. My husband suffers from clinical depression and takes 3 medications for his disorder. Needless to say we have NO SEX LIFE and we really need help. Your formulation Passion Rx seems like it would help, is it safe? I am a believer in herbal therapies.
   A. We feel uncomfortable recommending Passion Rx to those who are on medications since unexpected side effects are possible when antidepressant drugs and herbs are combined. The long term solution is to follow the suggestions on the depression page of this web site, see link at top of page. The long term approach is to gradually come off the drugs, perhaps try SAM-e or St. John's wort, fish oils, eating more fish and changing to a healthier diet, doing meditation, career enhancement, improving relationships, stress reductions, yoga, exercise, etc. A comprehensive approach needs to be taken. Herbal sexual products could help but we can't easily predict any side effects that could occur when they are combined with SSRI antidepressants or other types of antidepressants.

Q. Q. Your Passion Rx page says not to take it on the same day as antidepressants (in my case, Celexa). But Celexa takes a while to be effective after you start taking it, and stays in the system for a while after you stop. How long do you suggest I wait after stopping Celexa before taking Passion Rx, and vice versa? Might Passion Rx be effective
with a reduced dosage of antidepressant?
   A. It is difficult to make any suggestions that would apply to everyone taking antidepressants since each person is different on how they metabolize drugs and herbs, and the dosage of the medicines makes a significant difference. However, if the Celexa dosage is low, and a person skips a day, they can take a small amount of Passion Rx, such as half a capsule the day when the antidepressant is not being used, and perhaps alternate one day using Celexa and another day using half a capsule of Passion Rx. However, one must realize that Celexa, and most antidepressants, increase serotonin levels and serotonin is known to inhibit sexual drive. Whether Passion Rx can overcome this effect is difficult to say, but it may in many people. Ideally, for Passion Rx to work best, it is preferable that it be taken during a week where an antidepressant is not being used at all. These are general guidelines that your doctor can use to manage your own case.

Q. I am very interested in Passion Rx product, but the direction clearly states you cannot take on the day you take your antidepressant medication which I have to take every day, so does this mean I can not take this product?
   A. Unexpected reactions can occur when antidepressant medications are mixed with certain potent herbs and thus we prefer to be on the safe side and not recommend their use the same day. It is up to your doctor to determine if you need your antidepressant medication to be taken every day.

Q. I am currently taking 30mg a day of the antidepressant Cymbalta. I take this at night right before I got to bed. If I take 1/2 capsule every other day of Passion Rx, would it cause trouble? My depression is mild, but I do lack the hormones I would like to have.
   A. It is difficult to make any suggestions that would apply to everyone taking antidepressants since each person is different on how they metabolize drugs and herbs, and the dosage of the medicines makes a significant difference. However, if the Cymbalta dosage is low, and a person skips a day, they can take Passion Rx the day when the antidepressant is not being used, and perhaps alternate one day using Cymbalta and another day using half a capsule of Passion Rx. However, one must realize that Cymbalta increases serotonin levels and serotonin is known to inhibit sexual drive. Whether Passion Rx can overcome this effect is difficult to say, but it may in many people. Ideally, for Passion Rx to work best, it is preferable that it be taken during a week where an antidepressant is not being used at all. These are general guidelines that your doctor can use to manage your own case.

Q. I am taking Serzone, an anti-depressant. Am I correct in understanding that I cannot take Passion Rx?
   A. We have not had any people report to us problems with taking antidepressants and Passion Rx, with or without yohimbe, but we don't want to take the risk of an untoward reaction. We prefer those who take these antidepressant drugs to take Passion Rx on a day when they are not taking the medications, or, if they doctor approves, to take half a capsule of the Passion Rx 2 days on, one day off. Passion Rx can cause alertness and gives more energy, and we don't know how this will interact with the antidepressant medications. Plus, each person's reaction may be different, along with how potent the drugs are, and their dosage.

Q. I read that Passion Rx should not to be taken the same day with Prozac or other antidepressants. Why not? I take the antidepressant Wellbutrin 150 mg daily, and I've used other 'pro-sexual' herbal formulas with no adverse effects.

   A. We try to be extra cautious in our recommendations. There may be 99 out of a 100 people who may not have a problem combining Passion Rx with an antidepressant such as Wellbutrin or Paxil or Zoloft, but we want to avoid even a small percentage of potential unpleasant interactions which can occur unexpectedly when pharmaceutical antidepressants or other drugs are combined with potent herbal formulas.

I am currently taking Pristiq 50mg/day. I started this med in May 2009. I was on Cymbalta since last year, but it was not helping. My internist wanted me to take both the Cymbalta and Pristiq, but due to cost and not wanting to be on 2 different anti-depressants, advised I only wanted to take one. I see no difference and have now decided to wean myself off the Pristiq. What is the safest way to do so?
    This is a decision you and your doctor would need to make.