These "other" antidepressants all have an effect on chemical messengers in the brain, but each has a somewhat different effect. They act differently from selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), making them good options if SSRIs have not worked. Depending on your needs and your doctor's preference, these antidepressants sometimes are prescribed as first, before the better known SSRIs.

Like all antidepressants, these drugs usually take a few weeks to start working fully. All are equally effective, as long as the dosing is correct. Their side effects are different from SSRIs, but they tend to be as well tolerated.

Suicide Risk. All antidepressants carry warnings about suicide. In October 2004, the Food and Drug Administration began requiring that manufacturers include a warning on package inserts for all antidepressants. The warning mentions the risk of suicidal thoughts, hostility and agitation in both children and adults.

After you start taking any antidepressant, there is a risk that you may feel worse rather than better. The danger is greatest in the first few weeks of treatment, so make sure you follow-up with your doctor. There is also a small risk for an increase in suicidal thinking and behavior. Fortunately, some research shows that the overall suicide rate decreases in people taking antidepressants. However, a small number of people using antidepressants do encounter a lower mood, and feel more anxious, irritable, self-destructive or impulsive.

Bupropion (Wellbutrin) works on the neurotransmitters norepinephrine and dopamine. Because bupropion does not cause sexual side effects, it is a popular alternative for people who give up on selective serotonin reuptake inhibitors (SSRIs), which can cause sexual side effects. Because bupropion has a different mechanism from SSRIs, though, so it may not be as effective for people who have already had a good response to an SSRI. Of course, this also means that bupropion may very well work when SSRIs do not.

Bupropion is marketed under two names. Under the name Wellbutrin, it is marketed as an antidepressant, while as Zyban it is marketed as an aid to quit smoking — but these drugs are chemically identical. Be careful therefore NOT to get prescriptions for both drugs at the same time.

Bupropion is usually taken two or three times per day, at least four hours apart. The reason for dividing the doses is that bupropion leaves the body quickly, and if the blood level climbs too high, there is a risk of seizure. Many physicians now prescribe slow-release forms of the drug, which may reduce that risk. Slow-release bupropion pills must be swallowed whole — don't crush or chew them.

Although some people get a good response with doses of 150 to 200 milligrams per day, many people require doses of 300 to 450 milligrams. (Older adults generally take lower doses.) The maximum dose is 450 milligrams per day (three 150-milligram doses). No single dose should be more than 150 milligrams (unless it is a sustained or extended release form). Above that dose, the incidence of seizures goes up significantly.

Bupropion may be taken with food to reduce stomach distress.

Common side effects are not dangerous, but can be uncomfortable:

If you notice these or any other changes, talk to your doctor.

Some severe effects may occur with bupropion. They are rare, except in people who already have a vulnerability to them:

If you miss a dose, do not double up on your dose.

Bupropion carries the same warnings about suicide risk as other antidepressants. (See above.)

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