Major Depression


Major Depression

About Major Depression

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Being sad, blue, or unhappy at times is a normal part of life. But being seriously “down” or depressed for a prolonged period—more than two weeks or so—may not be normal and can usually be helped with appropriate treatment. Depression is not simply unhappiness. Indeed, prolonged depression should be viewed as an illness like any other, no different than an infection, cancer, diabetes, or heart disease. The symptoms are distinct and can be triggered by adverse life events, illness, or arise for no apparent reason. Whatever the cause, the symptoms feel equally painful and the biological changes in the body and brain are the same.

Some studies have found—and many experts believe— that antidepressants often work best in combination with psychotherapy lasting at least several months. But antidepressants on their own play an important role in our culture. That’s because not everyone has access to, can afford, or accepts that psychotherapy can help. On the other hand, many people prefer to try psychotherapy alone, or they are afraid of the side effects and skeptical of the benefits of antidepressant drugs. We would encourage you to seek out whichever type of treatment or combination of treatments you are most comfortable with.

Common Symptoms

People experience depression symptoms differently. But generally, if you have five or more of the following symptoms persistently for several weeks or longer, you may have serious or so-called “major” depression that could warrant treatment with medication. That is especially likely if you have a history of depression and there has been no “triggering” event or trauma in your life, such as a death in the family, a job loss, a divorce, or marital problems.

  • Decreased energy, fatigue, feeling “slowed down”
  • Depressed mood
  • Difficulty concentrating or making decisions
  • Feeling restless or fidgety
  • Feelings of worthlessness or inappropriate guilt
  • Insomnia, early-morning awakening, or oversleeping
  • Loss of interest or pleasure in hobbies, work, and activities you usually enjoy, including sex
  • Recurrent thoughts of death or suicide; suicide attempts
  • Substantial weight loss or gain or appetite changes (eating significantly less or more)

What Causes it?

Depression can be recurrent and chronic, and it can sometimes run in families as a result of genetic inheritance. And no matter what the cause, if left untreated, it can be deadly. People with untreated depression are at much greater risk of premature death, not only from suicide, but also from a host of other illnesses.

Consumer Reports Best Buy Picks

Buproprion (generic of Wellbutrin)

Cost: $64-$80/mo

Citalopram (generic of Celexa)

Cost: $25-$33/mo

Escitalopram (generic of Lexapro)

Cost: $86-$88/mo

Fluoxetine (generic of Prozac)

Cost: $28-$94/mo

Sertraline (generic of Zoloft)

Cost: $29-$33/mo

These medicines are substantially less expensive than brand-name antidepressants and are equally as effective. Both bupropion and escitalopram are more expensive than the others, so if cost is a concern, that may be something to consider when choosing an antidepressant for the first time. If you have drug coverage, talk with your doctor about finding the antidepressant that has the lowest out-of-pocket cost under your insurance plan.

Other Prescription Drugs Evaluated

  • Budeprion XL/SR, Wellbutrin XL/SR, bupropion XL/SR, Aplenzin
  • Celexa
  • Pristiq
  • Cymbalta
  • Lexapro, escitalopram oral solution
  • Prozac, Prozac Weekly, fluoxetine delayed-release
  • Luvox CR, fluvoxamine, fluvoxamine continuous-delivery
  • Rameron, Rameron dissolvable, mirtazapine, mirtazapine dissolvable
  • Paxil, Paxil CR, Pexeva, paroxetine, paroxetine SR
  • Zoloft, sertraline oral suspension
  • Effexor XR, venlafaxine, venlafaxine SR/continuous-delivery

Are they Effective?

On average, 55 to 70 percent of the people who take antidepressants can expect at least a 50 percent improvement or decrease in their symptoms. This is measured using a rigorous rating scale but is still highly subjective. Response is quite different among individuals, as is the length of treatment required. Some people respond within a few weeks and experience an almost complete elimination of their symptoms within a few months. Others may get only about a 50 percent improvement even after months of taking an antidepressant. Roughly 30 to 45 percent of people fail to respond to treatment with an antidepressant.

1 Response defined as at least 50 percent reduction in depression symptoms on behavioral and emotion rating scales.
2 Numbers are the lower and upper quarter percentile of discontinuation rates from studies.
3 Based on multiple studies and combined analysis of studies, or from the drug’s product label information. Statements made in reference to all other drugs listed except where noted. List is not intended to be comprehensive.
4 The other SSRIs were fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
5 Higher than fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox CR) in controlled trials. Highest rate of sexual side effects (53 percent) in a 2004 Consumer Reports survey of 1,664 people when compared with bupropion (Wellbutrin) (21 percent); fluoxetine (Prozac) (41 percent); citalopram (Celexa) (45 percent); sertraline (Zoloft) (46 percent); and venlafaxine (Effexor) (51 percent).

Are they Safe?

The vast majority of people who take an antidepressant (up to 63 percent) will experience at least one side effect. Most of them are minor. Diarrhea, dizziness, dry mouth, fatigue, headache, nausea, sexual side effects, sweating, tremors, and weight changes are the most common. Sometimes they are very severe, making it necessary to discontinue the medication and try another.

Bupropion (Wellbutrin) has a lower rate of sexual side effects and paroxetine (Paxil) has the highest; venlafaxine (Effexor) leads more often to nausea and vomiting, and elevations in blood pressure and heart rate; duloxetine (Cymbalta) has been associated with liver failure, including some cases that were fatal, so it should not be taken by people with liver disease or who consume substantial amounts of alcohol; sertraline (Zoloft) has higher rates of diarrhea; and mirtazapine (Remeron) leads more often to weight gain. High doses—and especially overdoses—of bupropion (Wellbutrin) have been linked to seizures, so most doctors don’t prescribe it to people who have a history of seizures.

Relatively minor side effects include:

  • Diarrhea
  • Dizziness
  • Dry Mouth
  • Headaches
  • Nausea
  • Sweating
  • Tremors

More serious side effects include:

  • Drowsiness or confusion
  • Feelings of panic or dread
  • Increased thoughts of suicide
  • Insomnia
  • Loss of libido, difficulty achieving erections, inability to reach orgasm
  • Nervousness and agitation
  • Weight gain


Consumer ReportsBest Antidepressant Treatments. See which drugs and other options that could help you the most. Published September 2013.