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Drugs for Depression

The Medical Letter on Drugs and Therapeutics • December 11, 2023; (Issue 1691)

A selective serotonin reuptake inhibitor (SSRI) is generally used for initial treatment of major depressive disorder (MDD). A serotonin-norepinephrine reuptake inhibitor (SNRI), bupropion (Wellbutrin SR, and others), and mirtazapine (Remeron, and others) are reasonable alternatives. Improvement in symptoms can occur within the first two weeks of treatment with these drugs, but a substantial benefit may not be achieved for 4-8 weeks.

Med Lett Drugs Ther. 2023 Dec 11;65(1691):193-200 | Show Full Introduction Hide Full Introduction

Drugs for Migraine

The Medical Letter on Drugs and Therapeutics • June 12, 2023; (Issue 1678)

An oral nonopioid analgesic is often sufficient for acute treatment of mild to moderate migraine pain without severe nausea or vomiting. A triptan is the drug of choice for treatment of moderate to severe migraine in most patients without vascular disease. Treatment of pain when it is still mild to moderate in intensity improves headache response and reduces the risk of recurrence.

Med Lett Drugs Ther. 2023 Jun 12;65(1678):89-96 | Show Full Introduction Hide Full Introduction

Comparison Table: Some Drugs for Migraine Prevention in Adults (online only)

The Medical Letter on Drugs and Therapeutics • June 12, 2023; (Issue 1678)

...

View the Comparison Table: Some Drugs for Migraine Prevention in Adults

Med Lett Drugs Ther. 2023 Jun 12;65(1678):e100-2 | Show Full Introduction Hide Full Introduction

Nonopioid Drugs for Pain

The Medical Letter on Drugs and Therapeutics • March 7, 2022; (Issue 1645)

Nonopioid drugs can be used in the treatment of many nociceptive and neuropathic pain conditions. For severe pain, especially severe chronic cancer pain, use of opioids may be necessary....

Nonopioid drugs can be used in the treatment of many nociceptive and neuropathic pain conditions. For severe pain, especially severe chronic cancer pain, use of opioids may be necessary. Noninvasive nonpharmacologic treatments, including physical and psychological therapies, have been shown to improve pain and function in patients with some common chronic pain conditions and are unlikely to cause serious harms. A multimodal approach to analgesic therapy can increase pain control while reducing opioid use and adverse effects.

Med Lett Drugs Ther. 2022 Mar 7;64(1645):33-40 | Show Full Introduction Hide Full Introduction

Drugs for Depression

The Medical Letter on Drugs and Therapeutics • February 24, 2020; (Issue 1592)

Complete remission of symptoms is the goal of treatment for major depressive disorder; a partial response is associated with an increased risk of relapse. Improvement in symptoms can occur within the first two weeks of treatment with an antidepressant, but it may take 4-8 weeks to achieve a substantial benefit. Following successful treatment of a first major depressive episode, antidepressant treatment should be continued at the same dose for at least 4-9 months to consolidate recovery. In patients with recurrent depressive episodes, long-term maintenance treatment can reduce the risk of relapse.

Med Lett Drugs Ther. 2020 Feb 24;62(1592):25-32 | Show Full Introduction Hide Full Introduction

Drugs for Chronic Insomnia

The Medical Letter on Drugs and Therapeutics • December 17, 2018; (Issue 1562)

Cognitive behavioral therapy for insomnia (CBT-I) is recommended for initial treatment of chronic insomnia. Pharmacologic treatment should be used in addition to CBT-I when CBT-I alone is not...

Cognitive behavioral therapy for insomnia (CBT-I) is recommended for initial treatment of chronic insomnia. Pharmacologic treatment should be used in addition to CBT-I when CBT-I alone is not effective.

Med Lett Drugs Ther. 2018 Dec 17;60(1562):201-5 | Show Full Introduction Hide Full Introduction

Drugs for Insomnia

The Medical Letter on Drugs and Therapeutics • July 6, 2015; (Issue 1472)

Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications, and "natural" remedies. Behavioral approaches such as cognitive behavioral therapy, which are not...

Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications, and "natural" remedies. Behavioral approaches such as cognitive behavioral therapy, which are not discussed here, are also used. Pharmacologic treatment and behavioral therapy are often combined.

Med Lett Drugs Ther. 2015 Jul 6;57(1472):95-8 | Show Full Introduction Hide Full Introduction

Drugs for Insomnia

The Medical Letter on Drugs and Therapeutics • July 1, 2012; (Issue 119)

Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications and "natural" remedies. Behavioral changes are often needed as...

Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications and "natural" remedies. Behavioral changes are often needed as well.

Treat Guidel Med Lett. 2012 Jul;10(119):57-60 | Show Full Introduction Hide Full Introduction

Drugs for Pain

The Medical Letter on Drugs and Therapeutics • April 1, 2010; (Issue 92)

Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less responsive to opioids; adjuvant medicines such as antidepressants and anticonvulsants are often used to treat neuropathic pain. Combining different types of analgesics may provide an additive analgesic effect without increasing adverse effects.

Treat Guidel Med Lett. 2010 Apr;8(92):25-34 | Show Full Introduction Hide Full Introduction

Milnacipran (Savella) for Fibromyalgia

The Medical Letter on Drugs and Therapeutics • June 15, 2009; (Issue 1314)

Milnacipran (Savella - Forest), an oral selective serotonin and norepinephrine reuptake inhibitor (SNRI), is the third drug approved by the FDA for management of fibromyalgia. The 2 others are pregabalin, a...

Milnacipran (Savella - Forest), an oral selective serotonin and norepinephrine reuptake inhibitor (SNRI), is the third drug approved by the FDA for management of fibromyalgia. The 2 others are pregabalin, a gammaaminobutyric acid (GABA) analog also approved for treatment of diabetic neuropathy, post-herpetic neuralgia and epilepsy, and duloxetine, an SNRI also approved for treatment of depression, diabetic neuropathy and generalized anxiety disorder.

Med Lett Drugs Ther. 2009 Jun 15;51(1314):45-8 | Show Full Introduction Hide Full Introduction

Drugs for Insomnia

The Medical Letter on Drugs and Therapeutics • March 1, 2009; (Issue 79)

The majority of patients with insomnia do not have a predisposing psychiatric disease. Rather, untreated insomnia may be a risk factor for development of psychiatric problems such as depression or...

The majority of patients with insomnia do not have a predisposing psychiatric disease. Rather, untreated insomnia may be a risk factor for development of psychiatric problems such as depression or anxiety.

Treat Guidel Med Lett. 2009 Mar;7(79):23-6 | Show Full Introduction Hide Full Introduction

Duloxetine (Cymbalta) for Fibromyalgia

The Medical Letter on Drugs and Therapeutics • July 28, 2008; (Issue 1291)

Duloxetine (Cymbalta - Lilly) is the second drug to be approved by the FDA for treatment of fibromyalgia. Pregabalin (Lyrica), which is also approved for treatment of neuropathic pain and epilepsy, was the...

Duloxetine (Cymbalta - Lilly) is the second drug to be approved by the FDA for treatment of fibromyalgia. Pregabalin (Lyrica), which is also approved for treatment of neuropathic pain and epilepsy, was the first. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) that is already marketed for treatment of depression and diabetic neuropathy.

Med Lett Drugs Ther. 2008 Jul 28;50(1291):57 | Show Full Introduction Hide Full Introduction

Extended-Release Cyclobenzaprine (Amrix)

The Medical Letter on Drugs and Therapeutics • December 17, 2007; (Issue 1276)

An extended-release formulation of the centrally-acting muscle relaxant cyclobenzaprine (Amrix - Cephalon) has been approved by the FDA for treatment of muscle spasms. Immediate-release (IR) cyclobenzaprine...

An extended-release formulation of the centrally-acting muscle relaxant cyclobenzaprine (Amrix - Cephalon) has been approved by the FDA for treatment of muscle spasms. Immediate-release (IR) cyclobenzaprine (Flexeril, and others) has been available since 1977.

Med Lett Drugs Ther. 2007 Dec 17;49(1276):102-3 | Show Full Introduction Hide Full Introduction

Pregabalin (Lyrica) for Fibromyalgia

The Medical Letter on Drugs and Therapeutics • September 24, 2007; (Issue 1270)

Pregabalin (Lyrica - Pfizer) is the first drug approved by the FDA for management of fibromyalgia. When it was first marketed, pregabalin, which is structurally similar to gabapentin (Neurontin, and others),...

Pregabalin (Lyrica - Pfizer) is the first drug approved by the FDA for management of fibromyalgia. When it was first marketed, pregabalin, which is structurally similar to gabapentin (Neurontin, and others), was approved for treatment of neuropathic pain associated with postherpetic neuralgia and diabetic peripheral neuropathy and for adjunctive treatment of partial onset seizures in adults with epilepsy. It has also been prescribed off-label for other types of neuropathic pain such as sciatica.

Med Lett Drugs Ther. 2007 Sep 24;49(1270):77-9 | Show Full Introduction Hide Full Introduction

Drugs in the Elderly

The Medical Letter on Drugs and Therapeutics • January 16, 2006; (Issue 1226)

The physiologic changes that occur with aging can affect the pharmacokinetics and pharmacodynamics of many prescription and over-the-counter drugs, increasing the likelihood of adverse...

The physiologic changes that occur with aging can affect the pharmacokinetics and pharmacodynamics of many prescription and over-the-counter drugs, increasing the likelihood of adverse effects.

Med Lett Drugs Ther. 2006 Jan 16;48(1226):6-7 | Show Full Introduction Hide Full Introduction

AmpliChip CYP450 Test

The Medical Letter on Drugs and Therapeutics • August 15, 2005; (Issue 1215)

The FDA recently cleared the AmpliChip CYP450 Test (Roche), which analyzes blood-derived DNA to detect genetic variations in the activity of cytochrome P450 (CYP) enzymes CYP2D6 and CYP2C19 and determines the...

The FDA recently cleared the AmpliChip CYP450 Test (Roche), which analyzes blood-derived DNA to detect genetic variations in the activity of cytochrome P450 (CYP) enzymes CYP2D6 and CYP2C19 and determines the metabolizer status of the patient. The test is intended to help guide clinicians in prescribing individualized drug therapy. About 25% of all drugs, including many antidepressants and antipsychotics, are substrates of either CYP2D6 or CYP2C19. The test is being promoted initially to psychiatrists.

Med Lett Drugs Ther. 2005 Aug 15;47(1215):71-2 | Show Full Introduction Hide Full Introduction

Drugs for Pain

The Medical Letter on Drugs and Therapeutics • July 1, 2004; (Issue 23)

Three types of analgesic drugs are available: non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; opioids; and adjuvant drugs that are not usually thought of as analgesics, such as antidepressants, which can act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. Combining two different types of analgesics may provide an additive analgesic effect without necessarily increasing adverse effects.

Treat Guidel Med Lett. 2004 Jul;2(23):47-54 | Show Full Introduction Hide Full Introduction

Gabapentin (Neurontin) for Chronic Pain

The Medical Letter on Drugs and Therapeutics • April 12, 2004; (Issue 1180)

Gabapentin (Neurontin - Pfizer), which has been available in the US since 1994, is approved by the FDA only for treatment of partial epilepsy and postherpetic neuralgia, but is widely used off-label for a...

Gabapentin (Neurontin - Pfizer), which has been available in the US since 1994, is approved by the FDA only for treatment of partial epilepsy and postherpetic neuralgia, but is widely used off-label for a number of other indications, especially neuropathic pain syndromes. According to one report, among Medicaid recipients in Florida receiving gabapentin, 71% of prescriptions were for chronic pain and 8% for seizures and neuralgia ("The Pink Sheet" February 2, 2004; 66:30).

Med Lett Drugs Ther. 2004 Apr 12;46(1180):29-31 | Show Full Introduction Hide Full Introduction

Drug Interactions

The Medical Letter on Drugs and Therapeutics • June 8, 2003; (Issue 1158)

Changes caused by one drug in the absorption, distribution, metabolism or excretion of another may lead to a pharmacokinetic adverse drug interaction (DN Juurlink et al, JAMA 2003; 289:1652). Additive drug interactions, such as vasodilation caused by both sildenafil (Viagra) and nitrates, can also have adverse effects.

Med Lett Drugs Ther. 2003 Jun 8;45(1158):46-8 | Show Full Introduction Hide Full Introduction

Drug Interactions with St. John's Wort

The Medical Letter on Drugs and Therapeutics • June 26, 2000; (Issue 1081)

Even though its effectiveness has not been established, many patients take St. John's Wort (Hypericum perforatum), an over-the-counter herbal extract, to treat symptoms of depression, often without the...

Even though its effectiveness has not been established, many patients take St. John's Wort (Hypericum perforatum), an over-the-counter herbal extract, to treat symptoms of depression, often without the knowledge of their physicians. Recent reports indicate that St. John's wort interacts adversely with a number of drugs.

Med Lett Drugs Ther. 2000 Jun 26;42(1081):56 | Show Full Introduction Hide Full Introduction

SAMe For Depression

The Medical Letter on Drugs and Therapeutics • November 5, 1999; (Issue 1065)

S-adenosyl-methionine (SAM; SAMe; ademetionine; adomet), an endogenous compound synthesized from methionine and adenosine-triphosphate (ATP), has been marketed in stores and on the internet as a dietary...

Med Lett Drugs Ther. 1999 Nov 5;41(1065):107-8 | Show Full Introduction Hide Full Introduction

Drugs for Depression and Anxiety

The Medical Letter on Drugs and Therapeutics • April 9, 1999; (Issue 1050)

The number of drugs marketed for treatment of depression has increased in recent years. Antidepressants are generally also effective for treatment of...

The number of drugs marketed for treatment of depression has increased in recent years. Antidepressants are generally also effective for treatment of anxiety.

Med Lett Drugs Ther. 1999 Apr 9;41(1050):33-8 | Show Full Introduction Hide Full Introduction

New "Triptans" and Other Drugs for Migraine

The Medical Letter on Drugs and Therapeutics • October 9, 1998; (Issue 1037)

Three new 5-HT1 receptors agonissts ('triptans') have been marketed recently for treatment of migraine. Some drugs for prevention of migraine are listed in the table on page 99. Treatment of migraine in the...

Med Lett Drugs Ther. 1998 Oct 9;40(1037):97-100 | Show Full Introduction Hide Full Introduction

Drugs for Pain

The Medical Letter on Drugs and Therapeutics • August 14, 1998; (Issue 1033)

Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, some drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain.

Med Lett Drugs Ther. 1998 Aug 14;40(1033):79-84 | Show Full Introduction Hide Full Introduction

Pentosan for Interstitial Cystitis

The Medical Letter on Drugs and Therapeutics • June 6, 1997; (Issue 1002)

Pentosan polysulfate sodium (Elmiron - Baker Norton), a semi-synthetic mucopolysaccharide structurally similar to heparin, has been approved by the US Food and Drug Administration for oral treatment of...

Pentosan polysulfate sodium (Elmiron - Baker Norton), a semi-synthetic mucopolysaccharide structurally similar to heparin, has been approved by the US Food and Drug Administration for oral treatment of interstitial cystitis.

Med Lett Drugs Ther. 1997 Jun 6;39(1002):56 | Show Full Introduction Hide Full Introduction

Drugs for Psychiatric Disorders

The Medical Letter on Drugs and Therapeutics • April 11, 1997; (Issue 998)

The number of new drugs marketed for psychiatric indications has increased sharply in recent years. The recommendations in this article are based on the results of controlled trials and on the experience and opinions of Medical Letter consultants. Interactions with other drugs can be found in The Medical Letter Handbook of Adverse Drug Interactions, 1997.

Med Lett Drugs Ther. 1997 Apr 11;39(998):33-40 | Show Full Introduction Hide Full Introduction

Mirtazapine - A New Antidepressant

The Medical Letter on Drugs and Therapeutics • December 20, 1996; (Issue 990)

Mirtazapine (mir taz a peen; Remeron - Organon) has been approved by the US Food and Drug Administration for treatment of depression. A tetracyclic piperazinoazepine, it is an analog of mianserin, an...

Mirtazapine (mir taz a peen; Remeron - Organon) has been approved by the US Food and Drug Administration for treatment of depression. A tetracyclic piperazinoazepine, it is an analog of mianserin, an antidepressant available in Europe, but is structurally unrelated to antidepressants previously available in the USA.

Med Lett Drugs Ther. 1996 Dec 20;38(990):113-4 | Show Full Introduction Hide Full Introduction

Hypnotic Drugs

The Medical Letter on Drugs and Therapeutics • July 5, 1996; (Issue 978)

Superseded by Drugs of Choice HandbookInsomnia is a commom complaint, particularly among the elderly. Many drugs are approved by the US Food and Drug Administration (FDA) for treatment of insomnia, including...

Superseded by Drugs of Choice Handbook
Insomnia is a commom complaint, particularly among the elderly. Many drugs are approved by the US Food and Drug Administration (FDA) for treatment of insomnia, including five benzodiazepines and zolpidem (Ambien), a non-benzodiazepine that binds to benzodiazepine receptors in the brain. Some drugs marketed for other indications, such as antihistamines, antidepressants and antipsychotics, are also used as hypnotics. For many patients, nonpharmacological treatment of insomnia may be more effective than drugs, especially in the long term (CM Morin et al, Am J Psychiatry, 151:1172, 1994).

Med Lett Drugs Ther. 1996 Jul 5;38(978):59-61 | Show Full Introduction Hide Full Introduction

Nefazodone for Depression

The Medical Letter on Drugs and Therapeutics • April 14, 1995; (Issue 946)

Nefazodone (Serzone - Bristol-Myers Squibb) was recently approved by the US Food and Drug Administration for treatment of depression. A phenylpiperazine, nefazodone is chemically related to trazodone...

Nefazodone (Serzone - Bristol-Myers Squibb) was recently approved by the US Food and Drug Administration for treatment of depression. A phenylpiperazine, nefazodone is chemically related to trazodone (Desyrel, and others).

Med Lett Drugs Ther. 1995 Apr 14;37(946):33-5 | Show Full Introduction Hide Full Introduction

Drugs for Migraine

The Medical Letter on Drugs and Therapeutics • March 3, 1995; (Issue 943)

Drugs are used both to prevent and treat migraine symptoms. The effectiveness of such use can be difficult to evaluate, even with double-blind controlled trials, because migraine is episodic, response to placebo is frequent, and patients vary in response to a given agent (KMA Welch, N Engl J Med, 329:1476, 1993; SD Silberstein and RB Lipton, Neurology, 44 suppl 7:S6, Oct 1994).

Med Lett Drugs Ther. 1995 Mar 3;37(943):17-20 | Show Full Introduction Hide Full Introduction

Venlafaxine - A New Antidepressant

The Medical Letter on Drugs and Therapeutics • June 10, 1994; (Issue 924)

Venlafaxine hydrochloride (Effexor - Wyeth-Ayerst) was recently approved by the US Food and Drug Administration for treatment of depression. An aminomethyl-benzyl- cyclohexanol, it is chemically related to...

Venlafaxine hydrochloride (Effexor - Wyeth-Ayerst) was recently approved by the US Food and Drug Administration for treatment of depression. An aminomethyl-benzyl- cyclohexanol, it is chemically related to bupropion (Wellbutrin).

Med Lett Drugs Ther. 1994 Jun 10;36(924):49-50 | Show Full Introduction Hide Full Introduction

Choice of an Antidepressant

The Medical Letter on Drugs and Therapeutics • March 19, 1993; (Issue 892)

Since the introduction of fluoxetine (Prozac - Medical Letter, 30:45, 1988), bupropion (Wellbutrin - Medical Letter, 31:97, 1989), sertraline (Zoloft - Medical Letter, 34:47, 1992) and paroxetine (Paxil - this issue), the choice of an antidepressant has become more difficult. Should these widely prescribed new drugs replace tricyclic antidepressants such as amitriptyline (Elavil, and others), imipramine (Tofranil, and others), or nortriptyline (Aventyl, and others) for treatment of most patients with depression?

Med Lett Drugs Ther. 1993 Mar 19;35(892):25-6 | Show Full Introduction Hide Full Introduction

Drugs for Pain

The Medical Letter on Drugs and Therapeutics • January 8, 1993; (Issue 887)

Three types of analgesic drugs are available in the USA: first, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. (American Pain Society, Principles of analgesic Use, 3rd ed, Skokie, illinois: American pain society, 1992).

Med Lett Drugs Ther. 1993 Jan 8;35(887):1-6 | Show Full Introduction Hide Full Introduction

Sertraline For Treatment Of Depression

The Medical Letter on Drugs and Therapeutics • May 15, 1992; (Issue 870)

Sertraline (Zoloft - Roerig), a serotonin reuptake inhibitor, was recently approved for marketing by the US Food and Drug Administration for treatment of depression. Another serotonin reuptake inhibitor,...

Sertraline (Zoloft - Roerig), a serotonin reuptake inhibitor, was recently approved for marketing by the US Food and Drug Administration for treatment of depression. Another serotonin reuptake inhibitor, fluoxetine (Prozac), is prescribed more frequently in the USA than any other antidepressant (Medical Letter, 32:83, 1990).

Med Lett Drugs Ther. 1992 May 15;34(870):47-8 | Show Full Introduction Hide Full Introduction

Bupropion For Depression

The Medical Letter on Drugs and Therapeutics • November 3, 1989; (Issue 804)

Bupropion (Wellbutrin - Burroughs Wellcome) was recently marketed in the USA for treatment of depression. First approved by the Food and Drug Administration in late 1985, the drug was withdrawn from the...

Bupropion (Wellbutrin - Burroughs Wellcome) was recently marketed in the USA for treatment of depression. First approved by the Food and Drug Administration in late 1985, the drug was withdrawn from the market in early 1986 because of a high incidence of seizures in one study.

Med Lett Drugs Ther. 1989 Nov 3;31(804):97-8 | Show Full Introduction Hide Full Introduction

Oral Hypnotic Drugs

The Medical Letter on Drugs and Therapeutics • March 10, 1989; (Issue 787)

Three benzodiazepines and 16 other compounds are marketed in the USA for treatment of insomnia. Many authorities believe that insomnia is overdiagnosed and overtreated (MK Erman, ed, Sleep Disorders,...

Med Lett Drugs Ther. 1989 Mar 10;31(787):23-4 | Show Full Introduction Hide Full Introduction

Fluoxetine For Depression

The Medical Letter on Drugs and Therapeutics • April 22, 1988; (Issue 764)

Fluoxetine (Prozac - Dista), a phenylpropylamide, is the first serotonin-reuptake blocker introduced in the USA for treatment of . It is being promoted as causing fewer adverse effects than other...

Fluoxetine (Prozac - Dista), a phenylpropylamide, is the first serotonin-reuptake blocker introduced in the USA for treatment of . It is being promoted as causing fewer adverse effects than other antidepressants. Claims of greater safety and patient tolerability have often been made for new non-tricyclic antidepressants in recent years, but unpredicted adverse effects have emerged with widespread use, including priapism with trazodone (Desyrel - Medical Letter, 26:35, 1984) and fatal hemolytic anemia with nomifensine (Merital - Medical Letter, 27:73, 1985).

Med Lett Drugs Ther. 1988 Apr 22;30(764):45-7 | Show Full Introduction Hide Full Introduction