Antidepressants are the most commonly prescribed meds for depression, but they’re used to treat a number of other conditions as well.
Antidepressants are some of the world’s most prescribed medications.
These meds can be used for a variety of mental health conditions, such as depression and anxiety, but they may also be prescribed to treat pain or sleeping problems.
But with so many types available, how do you know which antidepressant is right for you?
There are several medications used to treat depression, but antidepressants are the most popular.
Antidepressants are one of the primary treatments for depression and one of the most commonly prescribed types of meds in the United States.
Like the name suggests, antidepressants can help relieve symptoms of depression and may stop them from coming back.
The exact way antidepressants work isn’t totally understood, but they’re believed to work by correcting imbalances of chemicals (aka neurotransmitters) in the brain.
Neurotransmitters regulate our moods and emotions by transmitting nerve signals to receptors in the brain. There are three neurotransmitters that are believed to be specific to depression:
- Serotonin: regulates mood, appetite, sleep, memory, social behavior, and sexual desire
- Dopamine: influences motivation, arousal, decision-making, and pleasure
- Norepinephrine (or noradrenaline): affects alertness and helps the body respond to stress
When you have depression, you may have lower levels of these neurotransmitters in your brain. Antidepressants can help increase the availability of one or more of these neurotransmitters over time.
How they do that, though, depends on what type of antidepressant you’re prescribed.
There are several major types (or classes) of antidepressant medications. Each class works in a slightly different way.
The types of antidepressants include:
- selective serotonin reuptake inhibitors
- serotonin-norepinephrine reuptake inhibitors
- tricyclic antidepressants
- monoamine oxidase inhibitors
- noradrenergic and specific serotonergic antidepressants
- atypical antidepressants
Selective serotonin reuptake inhibitors
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed type of antidepressant. They’re often the first type tried for people who are newly diagnosed with depression.
First developed in the 1970s, SSRIs work by regulating serotonin levels in the brain.
When a neurotransmitter isn’t taken up by other neurons, it’s reabsorbed by the neuron that released it in a process called “reuptake.”
As the name suggests, an SSRI inhibits the reabsorption of serotonin. In other words, it blocks serotonin from quickly leaving your brain. This raises serotonin levels so more is available and active to help regulate your emotions.
Common SSRIs include:
- fluoxetine (Prozac)
- sertraline (Zoloft)
- escitalopram (Lexapro)
- paroxetine (Paxil)
- citalopram (Celexa)
- fluvoxamine (Luvox)
- vilazodone (Viibryd)
SSRIs are often more tolerated than other antidepressants because they tend to have fewer side effects. However, they can have side effects such as:
- stomach upset or nausea
- insomnia or other sleep issues
- weight changes
- sexual dysfunction
Serotonin-norepinephrine reuptake inhibitors
Serotonin-norepinephrine reuptake inhibitors (SNRIs) work similarly to SSRIs, but they inhibit the reuptake of both serotonin and norepinephrine.
SNRIs can have the same benefits as SSRIs, but since they also raise levels of norepinephrine, they may help more with stress and anxiety.
SNRIs are a newer class of drugs — the first SNRI was approved by the Food and Drug Administration (FDA) in 1993. They’re approved for use in treating depression, anxiety disorders, and conditions related to chronic pain.
Common SNRIs include:
The increased levels of norepinephrine can cause side effects like:
- increased heart rate
- high blood pressure
- heart palpitations
Other common side effects include:
- stomach upset or nausea
- appetite changes
- dry mouth
- sexual dysfunction
These can become severe for some individuals, so you’ll want to keep your doctor informed of any side effects you have.
Developed in the 1950s, tricyclic antidepressants (TCAs or tricyclics) were one of the first drugs used to treat depression. The name tricyclic comes from its chemical structure that’s made up of three connected rings of atoms.
Tricyclics work by reducing the reabsorption of serotonin and norepinephrine. They also block another neurotransmitter called acetylcholine, which plays a role in muscle movement, heart rate, thinking, and learning.
Common tricyclics include:
- clomipramine (Anafranil)
- amitriptyline (Elavil)
- desipramine (Norpramin)
- nortriptyline (Pamelor)
- doxepin (Sinequan)
- trimipramine (Surmontil)
- imipramine (Tofranil)
- protriptyline (Vivactil)
Prescribing tricyclics is less common now because they have more severe side effects than SSRIs and SNRIs.
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The most common side effects of tricyclics are:
- weight gain
- urinary retention (when your bladder doesn’t fully empty)
- dry mouth
- blurred vision or dry eyes
Abruptly stopping tricyclics or missing a couple of doses can lead to withdrawal or discontinuation symptoms. This is why it’s helpful to create a tapering schedule with your doctor.
Monoamine oxidase inhibitors
Another drug type introduced in the 1950s, monoamine oxidase inhibitors (MAOIs) were one of the first types of antidepressants developed.
MAOIs inhibit the brain enzyme called monoamine oxidase, which is responsible for breaking down neurotransmitters. This leads to higher levels of serotonin, dopamine, and norepinephrine in the brain.
They may also be prescribed for depression in bipolar disorder, borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), agoraphobia, social phobia, and bulimia.
Some common MAOIs are:
- selegiline (Emsam)
- isocarboxazid (Marplan)
- phenelzine (Nardil)
- tranylcypromine (Parnate)
MAOIs aren’t often prescribed as much today as they were in the past due to side effects and potential interactions.
If you’re prescribed an MAOI, you’ll be required to follow a special diet. This is because monoamine oxidase regulates the breakdown of tyramine, a compound found in food.
You’ll need to limit foods with tyramine — like aged cheeses, cured or smoked meats, or fermented foods — since MAOIs can cause tyramine levels to rise.
If tyramine levels are too high, it can lead to dangerously high blood pressure. Limiting tyramine-rich foods can help prevent hypertensive crisis, which is when your blood pressure gets too high, increasing your chances of having a heart attack or stroke.
MAOIs also tend to have a lot of other interactions so you can’t mix them with certain meds such as:
- other types of antidepressants
- herbal remedies like St. John’s wort
- central nervous system stimulants (for example, Adderall)
- certain meds for pain, cold, and allergies
Common side effects of MAOIs include:
- trouble sleeping
- dry mouth
- diarrhea or constipation
- skin reactions if using the patch
Noradrenergic and specific serotonergic antidepressants
Noradrenergic and specific serotonergic antidepressants (NaSSAs) are a newer class of drugs that affect serotonin and norepinephrine levels in your brain. They block receptors of the stress hormone epinephrine (adrenaline).
They’re often prescribed for depression, as well as anxiety and personality disorders.
The most common NaSSA is mirtazapine (Remeron).
Possible side effects can include:
- dry mouth
- weight gain
- blurred vision
Atypical antidepressants are those that don’t particularly fit into any other classes. They affect serotonin, norepinephrine, and dopamine levels in the brain.
Common atypical antidepressants include:
Each one works differently.
For example, bupropion inhibits the reuptake of dopamine, serotonin, and norepinephrine, raising the levels of all three hormones in the brain. It’s often used to treat depression or depression related to seasonal changes (aka seasonal depression). It can also be used to help someone quit smoking.
Meanwhile, trazodone and vortioxetine both inhibit serotonin reuptake. They’re known as serotonin antagonist and reuptake inhibitors (SARIs).
Symbax is a combination drug that includes an SSRI (fluoxetine) and an antipsychotic (olanzapine).
The primary use of antidepressants is to treat the symptoms of depression, ranging from mild to severe. This includes postpartum depression.
However, antidepressants can also be prescribed to help manage symptoms of other conditions, including:
- anxiety disorders
- phobias, such as specific phobias and agoraphobia
- eating disorders
- panic disorder
Antidepressants may also have “off-label” uses, meaning these aren’t approved by the FDA for these conditions but may still be effective.
Some off-label uses of antidepressants include:
Antidepressants are most commonly taken in tablet or capsule form, but there are some that can be taken in liquid form.
How often you take your antidepressant will be based on your specific needs and can vary from one to three tablets a day. Some antidepressants will be prescribed in extended release form so you won’t have to take as many pills throughout the day.
You’ll often be started on the lowest dose, then given a plan to gradually increase the dose so your body has time to react and adjust to the med. This can also help prevent sudden side effects.
Each class of antidepressants has different side effects, ranging from mild to more severe.
However, the most common side effects across all antidepressants are:
- dry mouth
- weight changes
- sexual issues
In severe instances, antidepressants may lead to an increased likelihood of suicidal thoughts and actions.
For this reason, the FDA has a black box warning on antidepressants for people under the age of 24.
What does a black box warning mean?
A black box warning is the most stringent warning issued by the FDA for drugs and medical devices.
They make the public and healthcare professionals aware that this particular product may cause serious side effects, such as injury or death.
Any medication that has a black box warning must also have a warning label that’s clearly visible to users.
The side effects of antidepressants can feel like a barrier to some people, but it’s important to remember that you may only have one or two of them, or none at all.
Sometimes, side effects are only temporary until your body adjusts to the med, in which case the side effects will be reduced or entirely disappear after the first few weeks of treatment.
In general, if you’re having side effects that last for several weeks without improvement, or you’re concerned that a side effect is having a strong or dangerous impact on your health, reach out to your doctor immediately. They’ll be able to assess what’s happening and plan next steps.
Antidepressants can sometimes interact with other drugs.
In severe cases, drug interactions can lead to serotonin syndrome, which can be dangerous. To avoid this, make sure your doctor is aware of any and all drugs you’re taking, including over-the-counter medications and nutritional supplements.
What is serotonin syndrome?
Most antidepressants affect serotonin levels in your brain. Having too much of this neurotransmitter can cause a medical emergency called serotonin syndrome. This can occur when you mix an antidepressant with other meds, supplements, or drugs that have an effect on serotonin.
Symptoms of serotonin syndrome can include:
- rapid heart rate
- high blood pressure
- increased sweating
- twitching or muscle spasms
To avoid serotonin syndrome, you’ll want to carefully check medication and supplement labels, and tell your doctor about everything you’re taking. If you need to take something over the counter — like a cold medicine — you can always ask a pharmacist if there are any interactions with your meds.
When choosing the best antidepressant treatment for you, remember that there isn’t one type that’s specifically better or more effective than another.
Since each type does something different, consider talking with a healthcare professional who has experience prescribing antidepressants so they can help find one that will address your specific symptoms.
Taking antidepressants when breastfeeding or pregnant is mostly safe but you may also want to discuss your options with your health team.
Study up on antidepressants
Take the time to research and learn about the different types of antidepressants and how they work, especially before you start taking one. By having a better understanding of how they work, you’ll have a better understanding of what’s happening in your body.
Take notes and jot down any questions you may have to discuss at your next appointment.
Questions to ask your doctor:
- Will this interfere with any other medications I’m taking?
- Is it covered by my insurance? Is there a specific brand or type that’s covered?
- What side effects does this antidepressant have, and will it make another condition I have worse?
- Can it also help treat another health issue I’m having?
- How long do you think I’ll be taking this? What’s the process for ending my treatment?
Track your side effects
It’s always a good idea to check in with yourself to see how you’re feeling while taking an antidepressant.
For example, if you’re feeling increasingly dizzy or start having more headaches, write it down and share it with your doctor.
The more information your doctor has, the better they can adjust your medication or dosage.
Give it some time
It’s important to remember that changes in your mood will be gradual when you start using antidepressants. This is because antidepressants take time to build up their effectiveness.
So don’t expect instantaneous results. Allow some time to start seeing a change.
It can take several weeks to fully feel the effects of most antidepressants.
Don’t give up after the first week just because you don’t feel better right away, and try not to get discouraged if you don’t see fast improvements.
Stay on a schedule
Missing doses or quitting for even short periods of time will slow down your progress and, in some cases, cause you to go through withdrawal symptoms.
Consider taking antidepressants at a time when you know you’ll more reliably take them, like in the morning before work or school. You can also create a phone reminder or leave a note blocking your door if that helps.
Living with depression can feel overwhelming at times, and it’s hard to know where to even start looking for help. You may feel bad about needing to ask for help in the first place or admitting that you’re not feeling well.
But there’s nothing to feel bad or ashamed about. You’re not alone. There are numerous resources available for managing your mental health and depression.
Consider talking to a mental health professional since they can discuss treatment options. Be honest about how you’ve been feeling and what changes you hope to see.
Depending on your symptoms, they may not even prescribe antidepressants for you. It’s possible that talk therapy alone could be just as effective.
Ultimately, you don’t have to make the decision to go on antidepressants alone. A doctor will be there to help you talk through the treatment options that are right for you.