Antidepressants

What Are Antidepressants?

Antidepressants are a popular treatment for depression and come in many different formulations. These drugs won’t cure depression, but they’ve proven to ease the symptoms of depression.

For many people who struggle with mental health issues, the right antidepressant can be life-changing.

Antidepressant drugs generally target specific neurotransmitters in the brain to improve mood and behavior.

Depression is believed to be caused by an imbalance of certain chemicals in the brain—antidepressant medications are designed to fix this imbalance.

Most antidepressants target one or more of the following neurotransmitters and hormones: 

• Dopamine (feelings of reward and pleasure)
• Serotonin (feelings of satisfaction, happiness, and optimism)
• Norepinephrine (made from dopamine and works with your sleep-wake cycle, mood, memory, and fight or flight response)

What Disorders Can Antidepressants Treat?

Over the years, antidepressants have been shown to help with many disorders, not just depression. As a result, antidepressants have become one of the most prescribed psychiatric medications.

According to the Centers for Disease Control (CDC), 13.2% of adults aged 18 and older used antidepressant medications in the past 30 days during 2015–2018.

Antidepressants can help with the following mental health conditions:

• Clinical depression (major depressive disorder)
• Persistent depressive disorder (PDD)
• Premenstrual dysphoric disorder (PMDD)
• Seasonal depression (seasonal affective disorder)
• Atypical depression
• Cyclothymic disorder
• Bipolar disorder
• Anxiety disorders
• Personality disorders
• Substance use disorder
• Panic disorder
• Insomnia
• Chronic pain
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Suicidal thoughts
• Phobias
• Bulimia

Types of Antidepressants

Doctors prescribe many different types of antidepressants depending on their patient’s unique situation and symptoms.

In many cases, patients can benefit from trying a few different kinds to find which antidepressant works best for them.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective Serotonin Reuptake Inhibitors, or SSRIs, are the most common type of antidepressant.

SRRIs work by increasing serotonin levels in your brain but have little effect on other neurotransmitters like dopamine or norepinephrine.

Medications categorized as SSRIs include:

• Sertraline (Zoloft®)
• Fluvoxamine (Luvox®)
• Fluoxetine (Prozac®)
• Paroxetine (Paxil, Pexeva®)
• Citalopram (Celexa®)
• Escitalopram (Lexapro®)
• Vilazodone (Viibryd®)

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitors, or MAOIs, are a powerful class of antidepressants, the first ever introduced. MAOIs prevent the breakdown of the brain chemicals serotonin, dopamine, and norepinephrine.

MAOIs aren’t used as often anymore due to the risk of interaction with other drugs, but some patients still benefit from them. These days, they are mainly FDA-approved for the treatment of bipolar depression.

Medications categorized as MAOIs include: 

• Selegiline (Emsam®)
• Moclobemide (Manerix®)
• Tranylcypromine (Parnate®)
• Isocarboxazid (Marplan®)
• Phenelzine (Nardil®)

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin/Norepinephrine Reuptake inhibitors, or SNRIs, increase serotonin and norepinephrine levels in your brain.

SNRIs differ from SSRIs because they increase both chemicals rather than focusing only on serotonin as SSRIs do.

Medications categorized as SNRIs include:

• Venlafaxine (Effexor®)
• Levomilnacipran (Fetzima®)
• Desvenlafaxine (Khedezla®, Pristiq®)
• Duloxetine (Cymbalta®, Drizalma®, Irenka®)
• Milnacipran (Savella®)

Serotonin Modulators

Serotonin modulators are similar to SSRIs in that they increase the amount of serotonin in the brain, but they differ by changing the neurotransmitter itself.

The way serotonin modulators work is not fully understood, but many people resistant to SSRIs have found success by taking serotonin modulators.

Medications categorized as serotonin modulators include:

• Vilazodone (Viibryd®)
• Vortioxetine (Brintellix®)

Serotonin Antagonist and Reuptake Inhibitors (SARIs)

Serotonin Antagonist and Reuptake Inhibitors (SARIs) prevent serotonin reuptake in the brain. But they also prevent serotonin particles from binding to unwanted receptors, so the nerve cells function better.

Medications categorized as SARIs include:

• Nefazodone (Serzone®)
• Trazodone (Oleptro®)

Tetracyclic and Tricyclic Antidepressants (TCAs)

Tetracyclic and Tricyclic antidepressants, or TCAs, are an older class of antidepressants.

TCAs are often used only for treatment-resistant depression and anxiety due to increased rates of side effects. These antidepressants mainly focus on serotonin and norepinephrine.

Medications categorized as TCAs include:

• Amitriptyline (Elavil®)
• Clomipramine (Anafranil®)
• Doxepin (Silenor®)
• Imipramine (Tofranil®)
• Trimipramine (Surmontil®)
• Desipramine (Norpramin®)
• Nortriptyline (Pamelor®)
• Protriptyline (Vivactil®)
• Maprotiline (Ludiomil®)
• Amoxapine (Asendin®)

Atypical Antidepressants

As the name would suggest, atypical antidepressants are not typical and don’t fit into other classes of antidepressants.

In addition, while each one affects overall brain chemistry, each medication works in different ways from one another.

Medications categorized as atypical antidepressants include:

• Bupropion (Wellbutrin®)
• Mirtazapine (Remeron®)
• Agomelatine (Valdoxan®)

Possible Side Effects of Antidepressants

One downside to antidepressants is their potential side effects. For many patients, these side effects cause general anxiety or fear of taking antidepressants.

However, as with many psychiatric medications, you have to outweigh the risks with the potential rewards. Specific side effects can vary depending on which class of antidepressant you’re taking.

Common side effects reported for most antidepressants include: 

• Weight gain
• Blood pressure issues
• Upset stomach
• Diarrhea
• Constipation
• Dry mouth
• Blurred vision
• Headache
• Drowsiness
• Blurred vision
• Sexual side effects (e.g., decreased sex drive, less enjoyment from sex)
• Serotonin syndrome (can occur when quitting antidepressants abruptly without tapering off)

Other Treatments for Depression

While antidepressants are often the first-line treatment for depression, a few over-the-counter supplements have been shown to help with the treatment of depression.

If you take other medications, consult your doctor before adding these to your regimen, as there could be interactions.

Common supplements that may help with major depression include:

• John’s Wort
• Fish oil
• Methylfolate
• N-acetylcysteine
• S-adenosylmethionine (SAMe)
• Vitamin D

Find a Mental Healthcare Provider Near You

If you or a loved one is suffering from severe depression, an antidepressant could help you find relief from your symptoms.

While a general physician can prescribe antidepressants, working with a mental health professional can give you more options. In addition, pairing an antidepressant with talk therapy (e.g., cognitive behavioral therapy) increases your chances of finding more relief.

Visit SAMHSA’S Early Serious Mental Illness Treatment Locator to find a mental healthcare provider near you and begin your journey to a happier life.