Depression is a common, but serious mental health condition that negatively impacts how you feel, think, and handle daily activities. Depression makes it hard to function and enjoy life. The feelings of depression persist for weeks, months or years and can return repeatedly. Depression isn’t a weakness, and getting treatment is important and beneficial. Medication is one treatment option for depression that can be highly effective. Here is an overview of the most commonly prescribed antidepressant medications and how they work.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are the most commonly prescribed antidepressants. SSRIs work by increasing levels of serotonin in the brain. Serotonin is one of the neurotransmitters that carries signals between brain cells. Higher levels of serotonin can improve mood. Some commonly prescribed SSRIs include:
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- Sertraline (Zoloft)
- Escitalopram (Lexapro)
- Paroxetine (Paxil)
SSRIs are generally well-tolerated with mild side effects that often improve after the first few weeks. Common side effects can include nausea, headache, insomnia and drowsiness. SSRIs take 4-6 weeks to reach their full effect. SSRIs are also used to treat anxiety disorders.
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
SNRIs are a class of antidepressant similar to SSRIs. SNRIs increase serotonin and also norepinephrine in the brain. Increasing both neurotransmitters can further help stabilize mood. Examples of SNRIs include:
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Desvenlafaxine (Pristiq)
SNRIs are considered as effective as SSRIs with similar side effects. Fatigue and nausea are more common when first starting an SNRI compared to an SSRI. SNRIs may also slightly raise blood pressure.
Atypical antidepressants
Atypical antidepressants don’t fit neatly into other drug classes but can still help treat depression. These include:
- Bupropion (Wellbutrin)
- Mirtazapine (Remeron)
- Trazodone
Bupropion can boost motivation and concentration. Mirtazapine may be helpful if depression causes insomnia or weight loss. Trazodone treats depression but is more commonly used for sleep disturbances. Side effects differ for each medication.
Monoamine oxidase inhibitors (MAOIs)
MAOIs prevent the breakdown of serotonin, norepinephrine and dopamine in the brain. This allows higher levels of these mood-influencing neurotransmitters. MAOIs have significant side effects. They also interact with foods. Because of these issues, doctors usually only prescribe MAOIs later. Doctors first try other options. The side effects and food interactions make MAOIs less ideal. Doctors save MAOIs as a last option if needed. MAOIs include:
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
MAOIs need you to follow a strict diet. This is to avoid dangerous spikes in blood pressure. The spikes come from tyramine-containing foods. Tyramine is in aged cheeses, wine, processed meat, and fermented soy products. If you eat those foods with MAOIs, your blood pressure could spike. That spike would be very dangerous. So you must avoid those foods completely when taking MAOIs. That strict diet lowers the risk of the blood pressure spiking.
Other factors influencing antidepressant choice
There are many effective antidepressant options to treat depression. A psychiatrist considers many factors when choosing medication:
- Symptoms – Certain drugs may help more with low energy, insomnia, or anxiety symptoms that accompany depression.
- Other medical conditions – Antidepressants can worsen some conditions like glaucoma or high blood pressure.
- Family history and genetics – A family history of good response to a certain drug may influence choice. Genetic testing can also help predict medication metabolism.
- Side effects – Those prone to weight gain, fatigue, or sexual side effects may want to start with medications less likely to cause those reactions.
- Cost and insurance coverage – Affordability and insurance formulary restrictions play a role in medication selection.
- Interactions – Taking other prescription or over-the-counter medications may rule out options that could interact.
Working closely with your doctor is key to finding the right antidepressant medication and dosage to effectively treat your depression with minimal side effects. Be patient, as it may take some trial and error. Never stop antidepressant medication suddenly without medical supervision. With the right treatment, depression can be managed successfully long-term. There are many reasons to feel hopeful about finding relief through medication and other therapies.
Conclusion
Depression is a highly treatable condition. Antidepressant medications are one pillar of treatment for depression. The most commonly prescribed antidepressants include SSRIs, SNRIs, and atypical antidepressants. These medications increase brain levels of mood-regulating neurotransmitters like serotonin. MAOIs may also be used in severe, treatment-resistant depression. There are many factors that influence which antidepressant is the best match for an individual. Working closely with your psychiatrist to find the most effective medication with tolerable side effects can help you gain control over depression symptoms and improve your quality of life. Consistently taking antidepressants as prescribed is key to maintaining recovery.