Top 5 antidepressants to treat depression
Antidepressants are prescription medicines used to treat depression. They are often used for treating other psychological disorders, such as anxiety disorders.
There are different types of antidepressants based on the way they work (mechanism of action), which include the following:
1. Selective serotonin reuptake inhibitors (SSRIs)
The most prescribed antidepressants by physicians are due to the low side effects experienced with these drugs.
SSRIs work by increasing the serotonin levels in the brain that are comparatively low during the depression. Serotonin is a hormone that stabilizes moods and causes feelings of well-being and happiness.
Other functions of serotonin include:
Once the serotonin exhibits its function, the nerve cells reabsorb (reuptake) the serotonin to terminate their action. When serotonin levels are low, reuptake can restrict the amount of serotonin being circulated actively in the brain. SSRIs prevent serotonin reuptake, thereby increasing the serotonin levels circulating in the brain.
Some of the commonly prescribed SSRIs include:
Common side effects observed with SSRIs include:
2. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
They are often prescribed due to their superior efficacy and safety profile. SNRIs work by increasing serotonin and norepinephrine levels in the brain. Norepinephrine is a hormone and a neurotransmitter responsible for transmitting signals across nerve endings.
Some of the functions of norepinephrine in the brain include:
- Regulating sleep and wake cycle
- Increasing attention
- Memory storage
- Improving focus while performing a task
- Improves alertness and energy
Norepinephrine and serotonin are responsible for preventing depression symptoms. SNRIs prevent the reuptake of serotonin and norepinephrine by the nerve cells, thus increasing their level in the brain.
Some of the common SNRIs include:
Common side effects of SNRIs include:
- Trouble sleeping
- Lack of energy
- Dry mouth
- Constipation
- Weight loss
- Nausea (especially in the first two weeks)
- Loss of appetite
- Anxiety and nervousness
- Headaches
- Sexual problems
- Increased heart rate
- Increased cholesterol levels
3. Atypical antidepressants
Atypical depressants, as the name suggests, are not typical antidepressants due to their distinct mechanism of action.
Atypical antidepressants increase dopamine, serotonin, or norepinephrine levels in the brain. They have multiple mechanisms of action and are commonly prescribed when other antidepressants do not improve depression symptoms.
Some of the common atypical antidepressants include:
- Wellbutrin SR, Wellbutrin XL, others (bupropion)
- Remeron (mirtazapine)
- Nefazodone
- Trazodone
- Viibryd (vilazodone)
- Trintellix (vortioxetine)
Some of the common side effects of atypical antidepressants include:
4. Serotonin modulators
These involve drugs that work to improve serotonin levels in the brain. They work by modifying one or more serotonin receptors and inhibiting the reuptake of serotonin.
Some of the commonly used serotonin modulators include:
- Nefazodone
- Trazodone
- Vilazodone
- Vortioxetine
Some of the side effects of serotonin modulators include:
- Nausea
- Dry mouth
- Dizziness
- Constipation
- Blurred vision
- Weakness
- Sleepiness
5. Cyclic antidepressants
There are two types of cyclic antidepressants depending on their structure: tricyclic and tetracyclic antidepressants. They prevent the reuptake of serotonin and norepinephrine in the brain, thus elevating mood and alertness.
Tetracyclic and tricyclic antidepressants prevent the reuptake of norepinephrine and serotonin into the nerves. It increases the level of norepinephrine and serotonin in the blood. They affect several other chemicals in the brain, thereby increasing the risk of side effects. Hence, they are not generally preferred by doctors to treat depression.
Some of the commonly used cyclic antidepressants are:
- Tetracyclic antidepressants
- Maprotiline
- Mirtazapine
- Tricyclic antidepressants
Common side effects of tetracyclic and tricyclic antidepressants include:
- Drowsiness
- Increased appetite
- Weight gain
- Dizziness
- Elevated cholesterol levels
- Dry mouth
- Constipation
Other antidepressant rankings
6 most effective antidepressants sold in the United States
- Amitriptyline
- Effexor (venlafaxine)
- Lexapro (escitalopram)
- Paxil (paroxetine)
- Remeron (mirtazapine)
- Trintellix (vortioxetine)
5 most tolerated antidepressants
- Celexa (citalopram)
- Lexapro (escitalopram)
- Prozac (fluoxetine)
- Trintellix (vortioxetine)
- Zoloft (sertraline)
3 least effective antidepressants sold in the United States
- Luvox (fluvoxamine)
- Oleptro (trazodone)
- Prozac (fluoxetine)
6 least tolerated antidepressants sold in the United States
- Amitriptyline
- Anafranil (clomipramine)
- Cymbalta (duloxetine)
- Effexor (venlafaxine)
- Luvox (fluvoxamine)
- Oleptro (trazodone)
Side effects of various antidepressants
| Generic name | Brand name |
|
Drowsiness | Trouble sleeping, Jitteriness | Nausea, Vomiting, Diarrhea | Weight gain | Sexual problems |
|---|---|---|---|---|---|---|---|
| Selective serotonin reuptake inhibitors (SSRIs) | |||||||
| Citalopram | Celexa | None | None | Very low | Very low | Very low | Moderate |
| Escitalopram | Lexapro | None | None | Very low | Very low | Very low | Moderate |
| Fluoxetine | Prozac, Sarafem | None | None | Low | Very low | Very low | Moderate |
| Fluvoxamine | Luvox (only sold as generic in the United States) | None | Very low | Very low | Very low | Very low | Moderate |
| Paroxetine | Paxil, Pexeva, others | Very low | Very low | Very low | Very low | Low | High |
| Sertraline | Zoloft | None | None | Low | Low | Very low | Moderate |
| Atypical agents | |||||||
| Bupropion | Wellbutrin, Aplenzin, others | None | None |
Quick-release: Low Sustained-release: Very low |
Very low | None | None |
| Mirtazapine | Remeron | Very low | High | None | None | High | Very low |
| Serotonin-norepinephrine reuptake inhibitors (SNRIs) | |||||||
| Desvenlafaxine | Pristiq, Khedezla | None | Very low | Low | Very low (after week 1) | None | Moderate |
| Duloxetine | Cymbalta | None | None | Low | Low | None | Moderate |
| Levomilnacipran | Fetzima | Very low | None | Very low | Low | None | Low |
| Milnacipran | Savella | None | Very low | None | Low | None | Low |
| Venlafaxine | Effexor | None | Very low | Low |
Quick-release: Low Extended-release: Very low |
None | Moderate |
| Serotonin modulators | |||||||
| Trazodone | Desyrel | None | High | None |
Sleep-aid dose: Very low Antidepressant dose: Moderate |
Sleep-aid dose: None Antidepressant dose: Very low |
Very low |
| Vilazodone | Viibryd | None | None | Low | High | None | Low |
| Vortioxetine | Trintellix | None | None | Very low | Very low | Very low | Low |
| Cyclic antidepressants | |||||||
| Amoxapine | Asendin | Low | Low | Low | None | Low | Unknown |
| Maprotiline | Ludiomil | Low | Moderate | None | None | Low | Unknown |
| Mirtazapine | Remeron | Low | Moderate | None | None | Very low | None |
SLIDESHOW
Learn to Spot Depression: Symptoms, Warning Signs, Medication See SlideshowHealth Solutions From Our Sponsors
Griffin RM. How Different Antidepressants Work. WebMD. https://www.webmd.com/depression/how-different-antidepressants-work
Gordon S. Antidepressants Do Work, Some Better Than Others. WebMD. https://www.webmd.com/depression/news/20180222/antidepressants-do-work-some-better-than-others
Rush AJ. Patient education: Depression treatment options for adults (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/depression-treatment-options-for-adults-beyond-the-basics
American Academy of Family Physicians. Types of Antidepressants. https://familydoctor.org/types-of-antidepressants/
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