Non-Antidepressants

In addition to antidepressants, there are three other classes of medications that need to be thought of in the treatment of depression: Anti-anxiety agents Anti-psychotic agents Mood-stabilizing agents Depression can reach psychotic and delusional levels, and in such cases, a low dose of newer, low side effect agent such as risperdone (0.5 mg to 1 mg) or ziprasidone (5 mg) can be helpful during the intensely symptomatic, psychotic phase of treatment. Once the intensity of depression no longer creates delusional thoughts, the antipsychotic can be discontinued usually long before the antidepressant. Poor sleep and irritability may be a sign that a low dose of an anti-anxiety agent such as lorazepam 5 mg, can be helpful in the first 2 weeks of treatment while waiting for the antidepressant to take effect. This provides some modicum of immediate relief, but usually should not be continued beyond the first 2 weeks. If sleep continues to be a problem even after the antidepressant kicks in, then a low-dose of trazodone (sedating antidepressant) can be added at hour of sleep (50 mg-100 mg) on a regular basis. A mood stabilizer, such as lithium, or the anticonvulsants carbamazepine (Tegretol), divalproex sodium (Depakote), or lamotrigine (Lamictal) can be important in the treatment of depression if it occurs in a patient with a history of mood swings or if there is a strong family history of bipolar disorder. Lamotrigine, in particular, is associated with a rash and should be started slowly at 25 mg QHS X 4 days, BID X 4 days, and TID thereafter, with slow increases up to a maintenance dose of 100 mg to a maximum of 300 mg a day. For dosing of the other mood stabilizers, please consult a psychiatrist.