Let’s Talk About Antidepressants—Which Ones May Be Right for You?

Good To Know: 

• Antidepressants are medications that can help relieve symptoms of depression and anxiety disorders. 
• There are five main types of antidepressants, all of which work in slightly different ways to ease symptoms of depression. 
• If you are taking an antidepressant for the first time or have switched medications, it can take up to several weeks to feel the effects of the new medication, so it’s important to meet regularly with a healthcare professional who can monitor your progress. 
• You will need to work with your doctor to find the right antidepressant for you. 

Antidepressants are medications that are a popular treatment choice for those who are navigating depression. In fact, the American Psychological Association reports that 12.7 percent of the American population uses antidepressants. While you and your healthcare provider should ultimately work together on a comprehensive treatment plan to manage your depression, antidepressants may reduce some of your symptoms. 

But there are a number of different antidepressants available, and it might take some time to find the one that’s right for you. Whether you’re considering going on antidepressants for the first time or are simply thinking about making a change, you can work with your doc to explore your options—as well as what to expect when it comes to side effects, interactions, and more.

What are antidepressants? 

Antidepressants are medications that can help relieve symptoms of depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and dysthymia, or mild chronic depression, and a number of other conditions. 

These medications work by balancing certain chemicals in your brain called neurotransmitters. But there are different types of antidepressants, and they all work in slightly different ways to ease symptoms of depression. 

Fast Facts: There has been a 64% increase in the percentage of people using antidepressants between 1999 and 2014. 

What are the different types of antidepressants? 

Antidepressants fall into five main types: 

• selective serotonin reuptake inhibitors (SSRIs)
• serotonin-norepinephrine reuptake inhibitors (SNRIs)
• tricyclic antidepressants (TCAs)
• monoamine oxidase inhibitors (MAOIs)
• noradrenaline and specific serotoninergic antidepressants (NASSAs)

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the most commonly prescribed class of antidepressants. According to one theory, an imbalance of serotonin in the brain may play a role in causing depression symptoms. SSRIs address this imbalance by decreasing serotonin reuptake in the brain, leaving more serotonin in the bloodstream and available for use by your brain. 

SSRIs are called “selective” because they mainly seem to affect serotonin and not other neurotransmitters. They are also known to typically carry fewer side effects than other antidepressants. 

SSRIs include:

• sertraline (Zoloft)
• fluoxetine (Prozac, Sarafem)
• citalopram (Celexa)
• escitalopram (Lexapro)
• paroxetine (Paxil, Pexeva, Brisdelle)
• fluvoxamine (Luvox)

Common side effects of SSRIs include:

• nausea
• trouble sleeping
• nervousness
• tremors
• sexual problems

Fast Facts: Zoloft is the most commonly prescribed antidepressant; nearly 17% of those surveyed in the 2017 antidepressant use study reported that they had taken this medication. 

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs are used to treat major depression and mood disorders. They may also possibly, but less commonly, help treat attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety disorders, menopausal symptoms, fibromyalgia, and chronic neuropathic pain. 

SNRIs raise the levels of two neurotransmitters in the brain, serotonin and norepinephrine, which is how they are believed to reduce depression symptoms. 

SNRIs include: 

• desvenlafaxine (Pristiq, Khedezla)
• duloxetine (Cymbalta)
• levomilnacipran (Fetzima)
• venlafaxine (Effexor)

It’s important to note that duloxetine (Cymbalta) may also help relieve pain. Not only can chronic pain lead to depression, depression can also make you more aware of aches and pains. If you experience both chronic pain and depression, you could consider talking to your doctor about Cymbalta. 

Common side effects of SNRIs include:

• nausea
• drowsiness
• fatigue
• constipation
• dry mouth

Tricyclic antidepressants (TCAs) 

TCAs are so named because there are three rings in the chemical structure of these medications. They are most often prescribed when treatment with SNRIs and SSRIs does not work. They are used to treat depression, fibromyalgia, some types of anxiety, and they can help control chronic pain as well. 

TCAs include:

• amitriptyline (Elavil)
• amoxapine (Asendin)
• clomipramine (Anafranil)
• desipramine (Norpramin)
• doxepin (Silenor)
• imipramine (Tofranil)
• nortriptyline (Pamelor)
• protriptyline (Vivactil)
• trimipramine (Surmontil)

Common side effects of TCAs can include:

• constipation
• dry mouth
• fatigue
• blurred vision

TCAs can also cause more serious side effects, which include: 

• low blood pressure
• irregular heart rate
• seizures 

Fast Facts: Women are twice as likely as men to take antidepressant medication (16.5 percent compared with 8.6 percent). 

Monoamine oxidase inhibitors (MAOIs)

MAOIs are older drugs that were used to treat depression before the introduction of SSRIs and SNRIs. They work by stopping the breakdown of three different neurotransmitters: norepinephrine, dopamine, and serotonin. You will likely only be prescribed an MAOI if treatment with other antidepressants isn’t effective because these medications interact with prescription drugs, nonprescription drugs, and some foods, and they can’t be combined with stimulants or other antidepressants. 

MAOIs include:

• isocarboxazid (Marplan)
• phenelzine (Nardil)
• selegiline (Emsam), which comes as a transdermal patch
• tranylcypromine (Parnate)

The many side effects of MAOIs can include: 

• nausea
• dizziness
• drowsiness
• trouble sleeping
• restlessness

Noradrenaline and specific serotoninergic antidepressants (NASSAs)

NASSAs are used to treat anxiety disorders, some personality disorders, and depression.

NASSAs include: 

• Mianserin (Tolvon)
• Mirtazapine (Remeron, Avanza, Zispin)

Possible side effects of NASSAs include:

• constipation
• dry mouth
• weight gain
• drowsiness and sedation
• blurred vision
• dizziness 

How effective are antidepressants? 

Antidepressants have been shown to be effective in treating moderate, severe and chronic depression, but are less effective when it comes to mild cases. While there is a certain amount of controversy surrounding their effectiveness, many studies have shown that a number of people do achieve relief from depression symptoms with the appropriate antidepressant medication.  

If you are taking antidepressants for the first time or starting a new type of antidepressant, you should know that it may take several weeks for you to notice any effects of the medication. When taking an antidepressant, it’s very important to keep in regular contact with a healthcare provider who can monitor your symptoms and progress. With regular checkups and appointments, they can help you with dosage needs or medication changes that will improve your chances of the drug working. 

Which antidepressant is right for me? 

It’s important to work with your healthcare provider to discover which antidepressant is right for you. This may involve a bit of trial and error, along with close monitoring by your doctor, before you find the right medication that works for you and your symptoms. Each person will experience each medication differently, so work with your doctor to consider the following information: 

• Your symptoms. Not all depression symptoms are the same, and some antidepressants are better for certain symptoms than others. You might want to try a sedating medication, for example, if you have trouble sleeping. 
• Possible side effects. Not only do side effects differ for each medication, they also differ for each person. Before taking an antidepressant, discuss possible side effects with your doctor or pharmacist. 
• Family history. Do you have a family member or close relative who takes an antidepressant? If they found relief from their symptoms with a certain medication, that could be an indication that it will work well for you too. Similarly, if you took an antidepressant that worked well in the past, bring this up to your doctor as well. 
• Other prescription medications. Make sure you tell your doctor about other prescription medications you are on, as some antidepressants can cause dangerous reactions when taken with other medications.
• Your pregnancy status. If you’re pregnant or breastfeeding, it’s important to have a careful conversation with your healthcare provider about the risks and benefits of taking an antidepressant. While the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is low, there are certain antidepressants, such as paroxetine (Paxil, Pexeva), that are discouraged during pregnancy. If you’re expecting or breastfeeding, talk with your doctor about your options. 
• Your health history. When deciding on an antidepressant, it’s important to keep in mind what other health conditions you currently have, as these medications can both exacerbate and treat other health problems you may have. 
• Cost and insurance coverage. If the medication you’ve been prescribed is too expensive, you can always ask your healthcare provider if there is a generic version available and inquire about its effectiveness. You can also find out whether your health insurance covers antidepressants and if there are any limitations on which ones are covered before or after you visit your doctor. 

If you feel the antidepressant you’re on is no longer working for you, talk to your doctor before making any sudden changes. If you stop your antidepressant suddenly, it can cause serious side effects.

With the number of available antidepressants available, there’s a good chance you can find one that’s right for you. However, it’s important to be patient throughout the process, as finding the right medication treatment can take time. You might need to try a few different medications, and it could take time to determine the therapeutic dose that works for you. But by keeping in close contact with your doctor, he or she will be able to closely monitor your progress and help you find the medication that’s right for you. 

Sources 

• Winerman, L. (2017, November). By the numbers: Antidepressant use on the rise. Monitor on Psychology, 48(10). https://www.apa.org/monitor/2017/11/numbers. 
• NHS. (2022, February 18). Overview – Antidepressants.
• NHS. (2022a, February 17). Duloxetine. 
• InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361016/
• Hengartner, M. P., Jakobsen, J. C., Sørensen, A., & Plöderl, M. (2020). Efficacy of new-generation antidepressants assessed with the Montgomery-Asberg Depression Rating Scale, the gold standard clinician rating scale: A meta-analysis of randomised placebo-controlled trials. PloS one, 15(2), e0229381. https://doi.org/10.1371/journal.pone.0229381. 
• Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should antidepressants be used for major depressive disorder?. BMJ evidence-based medicine, 25(4), 130. https://doi.org/10.1136/bmjebm-2019-111238.