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 medicines, which is not too far off from the percentage of people placed on placebo pills. Natural antidepressant alternative supplements include 5-HTP, St. John's wort, SAM-e, and others. Taking prescription meds appears to raise the risk of suicidal thoughts and behavior in adults younger than 25. No increase in suicidal behavior is 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. Adding an antidepressant drug to ease the depression component is not helpful.
   Middle-age men who use antidepressants are more likely to have a narrowing of blood vessels increasing the risk of heart attacks and strokes, than those who do not use the medications.

How long will I have to take these natural antidepressant pills?
Prescription antidepressants are typically taken for at least 4 to 6 months and some doctors place their patients on them for several years. In some cases, patients and their doctors may decide that antidepressants are needed for a longer time, decades. There are no accepted guidelines yet on how long natural antidepressants should be taken and how they should be alternated between the different ones such as SAM-e, 5-HTP, tryptophan, or St. John's wort.

Alternatives to prescription antidepressant questions

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? 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. 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. Your formulation Passion Rx seems like it would help? 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.

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?
   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 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.

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.

Q. My sister has been on antidepressants for decades. When she is off of the prescription antidepressants, her severe depression returns. She is now having memory problems. I doubt if her doctor will ever recommend that she stop her medications. Would taking a supplement such as Mind Power RX be of benefit to her?
   A. It is difficult to predict, but if she were to take it it would be a good idea to begin for the first week with half a capsule a day or one capsule every other day with approval by her doctor.

Eur Rev Med Pharmacol Sci. 2014 Nov. Antidepressant activities of Sambucus ebulus and Sambucus nigra.

Do antidepressants really work?
These medications influence brain levels of chemicals called neurotransmitters which 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. However, 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).

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.)

A meta-analysis of placebo-controlled trials of antidepressants found little or no effect on mild to moderate depression. The authors conclude: "Prescribers, policy makers, and consumers may not be aware that the efficacy of antidepressant medications largely has been established on the basis of studies that have included only those individuals with more severe forms of depression. This important feature of the evidence base is not reflected in the implicit messages present in
the marketing of these medications to clinicians and the public. There is little mention of the fact that efficacy data often come from studies that exclude [mildly depressed] patients who derive little specific pharmacological benefit from taking medications.. Whereas antidepressant medications can have a substantial effect
with more severe depressions, there is little evidence to suggest that they produce specific pharmacological benefit for the majority of patients with less severe acute depressions." Antidepressant drug effects and depression severity: A patient-level meta-analysis. JAMA, 2010. 

Not effective for mild depression
Only people with very severe depression appear to derive clear and substantial benefits from taking antidepressant medications. For people who are mildly to moderately depressed, taking an antidepressant like Paxil (paroxetine) may do little to improve mood. JAMA / Journal of the American Medical Association, 2010.

FDA warns new antidepressant users - risk of suicide with antidepressant use
 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.

Antidepressants are known to increase suicidal behavior. That increase, however, is not dependent on the specific drug. Examining a wide range of antidepressants -- including fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil) -- researchers found similar rates of suicide and suicide attempts in more than 20,000 Canadian youth. Pediatrics, 2010.
 

When prescribing antidepressants for teens and young adults, doctors should not start with high doses of the drugs because it might raise the risk of suicidal behavior.

Liver toxicity and harm
Curr Drug Saf. 2013. Liver injury associated with antidepressants. Antidepressants are commonly prescribed and used in the management of depression, anxiety disorders, and other psychiatric illnesses. Antidepressants used in therapeutic dosing ranges are associated with causing several adverse drug reactions including hepatotoxicity. Paroxetine, fluoxetine, fluvoxamine, citalopram, mirtazapine and venlafaxine are associated with reversible liver injury upon discontinuation of the agent. Patient cases of hepatotoxicity involving the use of nefazodone, trazodone, duloxetine, bupropion, and sertraline Zoloft are linked to causing death in its users. Due to the idiosyncratic nature of hepatotoxicity, monitoring of liver function tests and immediate discontinuation upon abnormal lab findings or signs and symptoms of liver dysfunction are crucial since most cases of hepatic damage are reversible when detected early. Onset of antidepressant-associated hepatotoxicity varies from 5 days to 3 years. Antidepressant-induced liver injury can occur in the absence of identifiable, underlying risk factors such as cirrhosis and hepatitis infection; only a few cases of hepatic injury involve patients with chronic hepatitis infection.

Pregnancy, pregnant women
Exposure to these medications in the womb raises a child's risk of autism; July 19, 2017, BMJ, online.

Different types
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)
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.
   Q. For a friend, female age 30, divorced mother of 2, who has begun an anti-depression treatment with Cypralex (for now, 10 mg daily), I would like to ask, is it a good idea for her to supplement also with SAM-e, (200), which I find very effective, and/or 5-htp?
      A. This medication, and the supplements, are potent, and caution is advised when mixing them. If mixed, dosages need to be reduced of each and under medical guidance.

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.
   An antidepressant often prescribed to teenagers may be ineffective and unsafe for the populations it is supposed to help, according to a reanalysis of a 14-year-old study. The research, published in 2015 in the journal The BMJ, contradicts earlier findings that paroxetine -- sold under the labels Paxil, Aropax and Seroxat -- is safe for people under 25. Rather, the new research found the drug can be associated with suicide-related incidents, including suicidal thoughts and attempts, and provides no advantage over placebos.

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.

Women prescribed a common class of antidepressants to ease menopausal symptoms may face a long-term rise in their risk for bone fracture. The antidepressants in question are selective serotonin reuptake inhibitors (SSRI) medications such as Celexa, Paxil, Prozac and Zoloft.
 

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. SSRI antidepressants raise the risk for bone thinning or osteoporosis and the risk for heart rhythm disturbances.

Gen Hosp Psychiatry. 2015. Antidepressant-induced sexual dysfunction during treatment with fluoxetine, sertraline and trazodone; a randomized controlled trial. Compared with fluoxetine, and sertraline, trazodone was associated with the fewest sexual dysfunction. Fluoxetine was also associated with more sexual dysfunction than sertraline. Further research to better identify the differences among antidepressant drugs is recommended.

A 2015 study shows that women who take antidepressants in the later stages of pregnancy are more likely to have a child with autism. The study specifies one particular group of antidepressants in particular — the SSRIs, or selective serotonin reuptake inhibitors, such as Prozac, Zoloft or Paxil.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)
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.

Pristiq - In 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.

Women who use the antidepressant bupropion during early pregnancy may have an increased risk of having a baby with a particular type of heart defect. left outflow tract. Some studies have already linked other antidepressants -- including some of the commonly used selective serotonin reuptake inhibitors (SSRIs) -- to higher-than-average, though small, risks of certain birth defects. American Journal of Obstetrics & Gynecology, online April 26, 2010.

Combined reuptake inhibitors and receptor blockers
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
These have been linked to an increased risk of heart disease.

amitriptyline (brand name: Elavil)
desipramine (brand name: Norpramin). French drugmaker Sanofi-Aventis SA warned in 2009 that its antidepressant Norpramin should be given with extreme caution to patients with a history of certain heart problems. The label for Norpramin (desipramine hydrochloride tablets USP) will also warn that seizures precede abnormal heart rhythms and death in some patients.
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.

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 drugs 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, 2009.

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
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 medication to be taken every day. 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 Serzone, 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 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.
   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.

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?

   Yes, 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.

I am about to start taking an anti-depressant and im concerned about the sexual side effects, is there anything I can take either with the medication or if I skipped the medication for a couple days that would help my sex drive and sexual abilities to be normal?
    Using less of the medication would help reduce the side effects but we are not in a position to offer specific advice on what herb or formula to take. There are many factors involved including the dosage of the medication, the actual type of drug, and the overall health of the person taking the medication.

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.
   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.