Antidepressants are drugs used for the treatment of depression, as well as other conditions. Because each type of antidepressant works a little differently and has its own list of potential side effects, finding the right fit for each individual can be complicated.
Types of Antidepressants
Depression is associated with certain brain chemicals called neurotransmitters. The primary ones are serotonin, norepinephrine, and dopamine. Most antidepressants are targeted toward affecting these neurotransmitters, each type in slightly different ways.
Many types of antidepressant medications are available to treat depression, including:
Selective serotonin reuptake inhibitors (SSRIs) – launched in the mid to late 1980s and now the most commonly used class of antidepressants for depression, SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by limiting its reuptake, which is the absorption by a presynaptic nerve ending of a neurotransmitter that it has secreted. Due to less negative side effects, this is where doctors often start in their quest to find the right fit for the patient. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).
Serotonin and norepinephrine reuptake inhibitors (SNRIs) – Serotonin-norepinephrine reuptake inhibitors (SNRIs) are powerful inhibitors of the reuptake of serotonin and norepinephrine, which are believed to play an important role in mood. SNRIs can be contrasted with the more widely used selective serotonin reuptake inhibitors (SSRIs), which “selects” serotonin to act only on it as much as possible. SNRI medications include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran (Fetzima).
Tricyclic antidepressants – Tricyclic antidepressants, discovered in the early 1950s, were some of the first medications used to treat depression but are currently not the first choice to prescribe because they tend to come with more undesirable side effects than newer drugs. These include imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin and desipramine (Norpramin).
Monoamine oxidase inhibitors (MAOIs) – MAOIs, the first class of antidepressants to be developed, elevate the levels of norepinephrine, serotonin, and dopamine by inhibiting an enzyme called monoamine oxidase. Because of potentially dangerous (or even deadly) interactions with foods — like some cheeses, pickles and wines, other medications — including birth control pills and decongestants, as well as certain herbal supplements, MAOIs are now prescribed only when other medications haven’t worked. Examples include tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan).
Atypical antidepressants – other antidepressants that do not fit neatly into the other categories, include:
Bupropion (Wellbutrin, Aplenzin) – bupropion is unique in that it is believed to affect the brain chemicals norepinephrine and dopamine and, at the same time, have mild side effects. It may also cause fewer sexual side effects, which are common with other antidepressants.
Mirtazapine (Remeron) – also with milder side effects, mirtazapine is thought to affect mainly serotonin and norepinephrine through different brain receptors than other medicines.
Trazodone (Desyrel) – used primarily to treat depression, trazodone is also believed to improve mood, appetite, and energy level, as well as decrease anxiety and insomnia related to depression.
Making the Most of Antidepressants
Once your doctor has determined the best type of antidepressant for you, it can be very effective in helping to relieve symptoms of depressions. Make sure you make the most of them by following these good practice suggestions:
- Monitor your moods and behavior
- Create a positive support system
- Stick with the prescribed treatment
- Work with a psychologist
- Develop good habits taking medication on time, every time
- Don’t ignore side effects
- Communicate with your doctor, especially with regard to other medications you may be taking
- Do NOT stop taking depression medicine without your doctor’s permission
- Do not assume that you can stop taking your depression medicine when you feel better