What meds treat depression?

medication info

Several types of medications can be used to treat depression. Most of these are called antidepressants. They work by restoring the balance of the chemicals in your brain.

How do antidepressants work?

There are a few different types (or “classes”) of antidepressants. They each work by restoring the balance of the chemicals in your brain, but each medication works on different chemicals and affects them differently.

The brain chemicals we’re talking about are called neurotransmitters. They send messages from one brain cell to the next. Different neurotransmitters send different types of messages. The most important ones for understanding antidepressants are:

  • Serotonin, which affects your mood, energy level, appetite, and sleep [1]
  • Dopamine, which affects motivation and pleasure—sometimes called the “feel good chemical” [2]
  • Norepinephrine, which affects your energy level, focus and attention. Related to adrenaline and has similar effects [3]

Now we’ll look at the different types of antidepressants, and how each affects these neurotransmitters:

Selective Serotonin Reuptake Inhibitors (SSRIs)

This is the most commonly prescribed type of antidepressant. Chances are, if you go to your family doctor and say you are depressed, they will prescribe you an SSRI. Other types of antidepressants are usually given if SSRIs don’t seem to help.

SSRIs lift your mood by boosting the serotonin levels in your brain. They can be used to treat many mental health conditions, including depression, anxiety, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) [4].

Examples of SSRIs include:

Generic name

Brand name(s)

Citalopram

Celexa

Escitalopram

Lexapro

Fluoxetine

Prozac, Sarafem, Symbyax

Fluvoxamine

Luvox

Paroxetine

Paxil, Pexeva

Sertraline

Zoloft

Vilazodone

Viibryd

For more information, check out our full article on SSRIs.

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are similar to SSRIs, except that in addition to serotonin, they also boost norepinephrine. In addition to depression and anxiety, SNRIs can also treat chronic pain [5] and ADHD [6].

Generic name

Brand name(s)

Desvenlafaxine

Pristiq

Duloxetine

Cymbalta

Levomilnacipran

Fetzima

Milnacipran

Savella

Venlafaxine

Effexor

For more information, check out our full article on SNRIs.

Tricyclic Antidepressants (TCAs)

TCAs are an older class of antidepressants. They are now less common than SSRIs and SNRIs, but they are still used if other types of antidepressants don’t seem to be working. They can also be an option for ADHD [7].

Generic name

Brand name(s)

Amitriptyline

Elavil

Amoxapine

Asendin

Clomipramine

Anfranil

Desipramine

Norpramin

Doxepin

Sinequan

Imipramine

Tofranil

Nortriptyline

Pamelor

Protriptyline

Vivactil

For more information, check out our full article on TCAs.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs are the oldest type of antidepressants on this list. MAOIs can interact with food, so being on them often involves dietary restrictions. They also interact with a lot of other medications. For these reasons, they’re no longer used very commonly [8].

Still, MAOIs can be helpful if other types of antidepressants haven’t worked. They are sometimes used to treat bipolar disorder, or to treat neurological conditions such as Parkinson’s disease.

They can also be helpful with atypical depression, or “depression with atypical features.”

Generic name

Brand name(s)

Isocarboxazid

Marplan

Phenelzine

Nardil

Selegiline

EMSAM (taken as a skin patch)

Tranylcypromine

Parnate

For more information, check out our full article on MAOIs.

Atypical antidepressants

There are several medications that don’t fit into any of the above categories. They are commonly used to target specific symptoms, to avoid side effects, or when other antidepressants don’t seem to be working. Most of them are less likely to cause sexual side effects than other types of antidepressants.

  • Buproprion (brand names: Wellbutrin, Zyban) boosts dopamine and norepinephrine. Unlike most antidepressants, it has no effect on serotonin. It is often prescribed to target specific symptoms, like oversleeping, weight gain, fatigue, and trouble concentrating [9][10], or to counteract the side effects of other antidepressants.
  • Trazodone is an antidepressant, but it’s also commonly prescribed for people who have trouble sleeping or who experience nightmares due to PTSD [11].
  • Mirtazapine (brand name: Remeron) is also prescribed as a sleep aid. It can cause an increase in appetite and weight gain, which can be a negative side effect—or a plus, for people who are underweight or have an eating disorder [12].
  • Vortioxetine (brand names: Trintellix, Brintellix) is similar to other antidepressants that work by boosting serotonin levels in the brain [14].
  • Ketamine and esketamine are medications that have mainly been used for anesthesia and pain management. In recent years, these have begun to be used to treat severe or treatment-resistant depression (TRD).

For more information, check out our full article on atypical antidepressants.

Other treatments for depression

In addition to antidepressants, there are other types of medications that can sometimes help with depression. Many of these are designed to treat other conditions, such as anxiety or bipolar disorder. Atypical antipsychotics are a common example [14]. Many people who have been diagnosed with depression also have symptoms of other mental and physical health conditions. Treating these other conditions can help with depression as well.

Medication is also not the only treatment for depression. Therapy is helpful for many people. Life style changes can also help: getting more sleep, eating foods that help you feel energized and healthy, doing enjoyable activities, and getting more exercise are good places to start.


How do I take an antidepressant?

Antidepressants are taken daily. They often take several weeks before they have a noticeable effect. You can’t just take an antidepressant every once in a while, on days where you feel especially depressed.

You might be tempted to stop taking them as soon as you feel better, thinking that you’ve been cured. Unfortunately, antidepressants are not a cure for depression—they are a way of managing it, not a way of making it go away permanently. Some people are able to eventually stop taking antidepressants, but there's no shame in taking them for long periods of time or even for your whole life! 

If you do decide to stop taking an antidepressant, it’s best to talk to your doctor first. Your doctor can help you reduce the dosage gradually, which will reduce withdrawal symptoms. (You can often do this by cutting your tablets in half for a few weeks, then into fourths for a few more weeks.) They may also help you find an alternative that has fewer side effects or is more effective.

Side effects

All mental health medications have the potential for side effects [15]. Each medication is different—for information about the side effects of a specific type of antidepressant, read the articles on SSRIs, SNRIs, TCAs, MOAIs, and/or atypical antidepressants.

Common side effects of antidepressants include:

  • Changes in your sleep, appetite, weight, or sex drive
  • Feeling nauseous or dizzy
  • Headaches

In rare cases, antidepressants can actually make you feel more depressed, or have suicidal thoughts. If  this happens, talk to your doctor right away. If you are having uncontrollable suicidal thoughts or a plan, reach out to someone you trust that can help you, call 1-800-273-TALK (1-800-273-8255), or text "MHA" to 741741 to talk with someone anonymously who can help you through these thoughts.

Most antidepressants have the potential to cause serotonin syndrome, which is rare but serious. Serotonin syndrome happens when the serotonin levels in your brain get too high. It usually happens when you are taking more than one medication or supplement that boosts serotonin. Symptoms include:

  • Feeling confused and agitated
  • Twitching muscles
  • Sweating or shivering
  • Diarrhea

In the most severe cases, it can include:

  • Seizures
  • Irregular heartbeat
  • Loss of consciousness

Serotonin syndrome is a medical emergency. If you experience it, seek emergency medical care or call 911.

References:

  1. Frazer & Hensler. (1999). Serotonin Involvement in Physiological Function and Behavior. In Siegel et al. (Eds.), Basic Neurochemistry: Molecular, Cellular and Medical Aspects (6th ed.). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK27940/
  2. Belujon & Grace. (2017). Dopamine System Dysregulation in Major Depressive Disorders. International Journal of Neuropsychopharmacology 20(12), pp. 1036-1046. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716179/
  3. Moret & Briley. (2011). The importance of norepinephrine in depression. Neuropsychiatric Disease and Treatment 7(Suppl 1), pp. 9-13. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131098/
  4. National Health Services (NHS). (2015). “Overview: Selective Serotonin Reuptake Inhibitors (SSRIs).” NHS. Retrieved from https://www.nhs.uk/conditions/ssri-antidepressants/
  5. Stahl et al. (2005). SNRIs: The Pharmacology, Clinical Efficacy, and Tolerability in Comparison with Other Classes of Antidepressants. CNS Spectrums, 10(9), pp. 732-747. Retrieved from https://doi.org/10.1017/S1092852900019726
  6. Antshel et al. (2011). Advances in understanding and treating ADHD. BMC Medicine 9, p. 72. Retrieved from https://doi.org/10.1186/1741-7015-9-72
  7. Budur et al. (2005). Non-Stimulant Treatment for Attention Deficit Hyperactivity Disorder. Psychiatry (Edgmont), 2(7), 44–48. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000197/
  8. Fiedorowicz & Swartz. (2004). The Role of Monoamine Oxidase Inhibitors in Current Psychiatric Practice. Journal of Psychiatric Practice 10(4), pp. 239-248. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2075358/
  9. Patel et al. (2016). Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Therapeutic Advances in Psychopharmacology 6(2), pp. 99–144. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837968/
  10. Acheson & de Wit. (2008). Bupropion improves attention but does not affect impulsive behavior in healthy young adults. Experimental and Clinical Psychopharmacology, 16(2), 113–123. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270475/
  11. Shin and Saadabadi. (2020). Trazodone. StatPearls Publishing, Treasure Island, Florida. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470560/
  12. Croom, et al. (2009). Mirtazapine: A Review of its Use in Major Depression and Other Psychiatric Disorders. CNS Drugs 23, pp. 427-452. Retrieved from https://doi.org/10.2165/00023210-200923050-00006
  13. D’Agostino, et al. (2015). Vortioxetine (Brintellix): A New Serotonergic Antidepressant. Pharmacy and Therapeutics, 40(1), pp. 36-40. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296590/
  14. Nemeroff. (2004). Use of atypical antipsychotics in refractory depression and anxiety. The Journal of Clinical Psychiatry 66 Suppl 8, pp. 13-21. Retrieved from https://europepmc.org/article/med/16336032 https://europepmc.org/article/med/16336032
  15. National Health Services (NHS). (2015). “Side effects: Antidepressants.” NHS. Retrieved from https://www.nhs.uk/conditions/antidepressants/side-effects/

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