For many people with depression, medication is an important part of treatment, but not all antidepressants are alike. They work in different ways, and they’re often categorized by the different brain chemicals that they affect. The good news is that if you need an antidepressant for depression, there are several options your healthcare provider can choose from to talk through with you.
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin is an important mood-regulating chemical, and low levels of the chemical have been linked to depression. This is why, often, the first type of antidepressant prescribed to treat depression is a selective serotonin reuptake inhibitor (SSRI), which increases serotonin levels in the brain.
Normally, serotonin is released by nerve cells in the brain, used, and reabsorbed back into the same cells. SSRIs work by blocking this reabsorption (reuptake) of serotonin into nerve cells. When less serotonin is reabsorbed, more is leftover in the brain. The more common SSRIs include:
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Citalopram (Celexa)
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Escitalopram (Lexapro)
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Fluoxetine (Prozac)
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Paroxetine (Paxil, Pexeva)
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Sertraline (Zoloft)
Possible side effects of SSRIs include dry mouth, sexual dysfunction, problems with the stomach or bowels, and trouble sleeping or insomnia. Many side effects resolve within a few weeks.
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Some people experience difficult side-effects to SSRIs, don’t experience a significant improvement with them, or they have other circumstances that require them to try different types of medication. In these cases, they might be prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI).
SNRIs work like SSRIs in that they prevent the reuptake of certain chemicals, except that they affect serotonin and the neurotransmitter norepinephrine. Norepinephrine is a stress hormone that helps the body become more alert and responsive, and low norepinephrine levels have been linked to depression. Common SNRIs include the following:
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Venlafazine (Effexor)
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Desvenlafazine (Pristiq)
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Duloxetine (Cymbalta)
Possible side effects of SNRIs include nausea, anxiety, headache, insomnia, constipation, and sexual problems.
Norepinephrine-dopamine reuptake inhibitors (NDRIs):
NDRIs are less commonly prescribed than SSRIs and SNRIs, but they’re still a good choice for many people. NDRIs work by increasing the amount of norepinephrine and dopamine in the brain. Dopamine is a neurotransmitter that helps with things like memory, attention, cognitive function, mood, desire, pleasure, and sleep. Low dopamine levels have been linked to depression. The most common NDRI is Bupropion (Wellbutrin, Aplenzin, Forfivo XL).
Side effects sometimes caused by NDRIs include anxiety, nausea, loss of appetite, and headache. But NDRIs typically have fewer side effects than SSRIs and SNRIs, and so they are a good alternative for people who experience sexual problems or other certain side effects on other types of antidepressants.
Atypical antidepressants
Atypical antidepressants all work in different ways, but generally they affect the amounts of various neurotransmitters in the brain. Some also improve neural receptors, which helps the brain use neurotransmitters more effectively. Most of these types of antidepressants carry a risk of side effects including nausea, dry mouth, and dizziness. Some of the more common types of atypical antidepressants include:
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Mirtazapine (Remeron)
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Nefazodone
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Trazodone (Oleptro)
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Vortioxetine (Trintellix)
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Vilazodone (Vibryd)
Tricyclic antidepressants
These medications increase the levels of two hormones (serotonin and norepinephrine), while blocking a third neurotransmitter (acetylcholine). They’re a slightly older form of antidepressants, and they aren’t prescribed as often because they can be dangerous in an overdose. Side effects include dry mouth, constipation, and sedation. Though these medications are prescribed less often than SSRIs, they can be very effective in cases where SSRIs are not. More common tricyclic antidepressants include:
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Imipramine (Tofranil)
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Nortriptyline (Pamelor)
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Amitriptyline, doxepin, trimipramine (Surmontil, Elavil)
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Desipramine (Norpramin)
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Protriptyline (Vivactil)
- Clomipramine (Anafranil)
Monoamine oxidase inhibitors (MAOIs)
This type of antidepressant works by preventing the body from breaking down certain chemicals, including dopamine, norepinephrine, and serotonin in the brain. This leads to higher levels of all three in the brain. However, this can cause side effects like weakness, dizziness, and trembling, and people can have a dangerous reaction if they eat certain foods or medications while taking MAOIs. People taking these medications have to follow a strict diet, as well as avoid any other medications that raise serotonin levels, because the combination could lead to a life-threatening condition called serotonin syndrome. They are not very often prescribed. Some MAOIs include:
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Tranylcypromine (Parnate)
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Phenelzine (Nardil)
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Isocarboxazid (Marplan)
Which one is right for you?
Figuring out the right medication for depression for any individual is an individualized process. Doctors usually start with the lowest possible dose of a medication with a low side-effect profile, that works for the majority of people. To best treat your depression, it will be important to have an honest conversation with your provider about how you’re feeling. If you try an antidepressant and your symptoms aren’t controlled, don’t be afraid to let your provider know. They’ll work with you to help you find a form of treatment that works better for you. Also, because these medications do come with possible side effects, be vigilant about scheduling and showing up for follow-up appointments as recommended. That way, if you experience any side effects, you can address them right away.
Read more
Sources
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Kristeen Cherney. “Depression Medications List.” Healthline. Healthline Media, Jun 23 2016. Web.
- Mayo Clinic Staff. “Antidepressants: Selecting one that’s right for you.” MayoClinic. Mayo Foundation for Medical Education and Research, Nov 25 2014. Web.
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Chantal Moret and Mike Briley. “The importance of norepinephrine in depression.” Neuropsychiatr Dis Treat. 7(Suppl 1): 9–13. Web. May 31 2011.
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“Depression: Types of Antidepressants.” FamilyDoctor. American Academy of Family Physicians, Sep 2012. Web.
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“Using Antidepressants to Treat Depression: Comparing Effectiveness, Safety, and Price.” ConsumerHealthChoices. Consumers Union of U.S., Inc., Sep 2013. Web.
