Depression isn’t the same for everyone: Multiple types exist, and people experience this treatable illness in varying degrees of severity. For some people with depression, nonpharmacological interventions like psychotherapy , lifestyle changes, and self-care may be enough to lift the cloud and improve symptoms. But for many other people, these steps aren’t enough, and medication is needed. About 13 percent of U.S. adults take antidepressants, according to national survey data.e60dc2a1-f33c-4a05-9b50-8e3e8e597629046f2563-a510-401e-a1d4-55c6eb1d75e5 Numerous depression medications are available today. If you’re struggling with depression, talk to your primary care doctor or a mental health professional, such as a psychiatrist, to learn whether an antidepressant may be right for you. Here’s what to know about the types of antidepressants out there.
SSRIs: The Most Frequently Prescribed Antidepressants SSRIs Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant class. Although it’s not clear how SSRIs treat depression , these drugs are known to inhibit the uptake of serotonin (a kind of chemical messenger called a neurotransmitter that helps regulate mood). This means they prevent the body from breaking down serotonin, which in turn helps increase levels of this neurotransmitter in the body.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299092b253-ed69-4de2-be62-8be204138f04 The following SSRIs are approved by the FDA to treat depression:e60dc2a1-f33c-4a05-9b50-8e3e8e5976294e0f662d-0259-4306-aa03-e61d579c3563 Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac, Sarafem, Symbyax) Paroxetine (Paxil, Paxil CR, Pexeva) Sertraline (Zoloft) Vilazodone (Viibryd) Vortioxetine (Trintellix) The most common side effects of SSRIs include: Nausea and vomiting Dry mouth Weight changes, more commonly weight gain Diarrhea Drowsiness Sexual problems Headache or dizziness Drowsiness or insomnia Agitation, restlessness, or nervousness
SNRIs Work by Blocking Reuptake of Two Brain Chemicals SNRIs Another class of antidepressants, serotonin and norepinephrine reuptake inhibitors (SNRIs), block the reabsorption of the neurotransmitters serotonin and norepinephrine, making them more available to your brain.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f9235ebc-bb22-47ab-941a-dacd6824a64d SNRIs that are approved by the FDA to treat depression include: Duloxetine (Cymbalta) Venlafaxine (Effexor, Effexor XR) Levomilnacipran (Fetzima) Desvenlafaxine (Pristiq) The most common side effects of SNRIs include: Dizziness Dry mouth Excessive sweating Headache Nausea Other possible side effects of SNRIs are: Constipation Insomnia Loss of appetite Sexual dysfunction Tiredness
Cyclic Antidepressants: Prone to Causing Side Effects Cyclics Tricyclic and tetracyclic antidepressants are older drugs that work by blocking the reabsorption of serotonin and norepinephrine through a different mechanism than SNRIs.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295b380c04-3850-40ed-bce2-0d8126799874 These drugs are not widely used today because they can cause a range of side effects, some of which may be serious, such as disorientation or confusion, but they are sometimes prescribed when other antidepressants don’t work. Examples of FDA-approved tricyclics are: Amoxapine (Asendin) Amitriptyline (Elavil) Nortriptyline (Aventyl, Pamelor) Desipramine (Norpramin) Doxepin (Sinequan, Silenor) Imipramine (Tofranil) Protriptyline (Vivactil) Trimipramine (Surmontil) The tetracyclic maprotiline (Ludiomil) is also approved by the FDA for the treatment of depression. Common side effects of cyclic antidepressants include: Blurred vision Constipation Drop in blood pressure that can cause lightheadedness when going from a seated position to a standing position Drowsiness Dry mouth Urine retention
MAOIs: The Oldest Antidepressants MAOIs The oldest class of antidepressants, monoamine oxidase inhibitors (MAOIs) , works by blocking the enzyme monoamine oxidase, which breaks down various neurotransmitters in the brain, including serotonin, norepinephrine, and dopamine .e60dc2a1-f33c-4a05-9b50-8e3e8e59762967bdc605-0e6c-4682-9917-12d193c90876 Examples of MAOIs include: Selegiline (Emsam), a skin patch that may cause fewer side effects than MAOIs taken by mouth Isocarboxazid (Marplan) Phenelzine (Nardil) Tranylcypromine (Parnate) Although MAOIs can sometimes help people with depression that does not respond to other antidepressants, they are not widely used today because of their potential side effects and interactions with certain foods and beverages as well as other drugs. For example, for people taking MAOIs, ingesting large amounts of the compound tyramine (found in aged cheeses, cured meats, draft beer, sauerkraut, and fermented soy products like miso, tofu, and soy sauce) could cause your blood pressure to rise to a dangerously high level. You may also experience serious reactions if you take an MAOI with various medications, including: Other prescription antidepressants Certain pain relievers Cold and allergy drugs Herbal supplements On rare occasions, MAOIs and other serotonin-containing drugs can cause a potentially life-threatening condition called serotonin syndrome . You may be at risk if you take too much of a serotonin-containing antidepressant or if you combine an MAOI with another prescription antidepressant, certain pain or headache medications, or St. John’s wort (an herbal supplement sometimes used as a home remedy for depression).
Atypical Antidepressants: Unique Medications That Work in Different Ways Atypical Antidepressants Medications that don’t fit into the classes listed above may also treat depression by altering levels of different neurotransmitters in the brain. A well-known medication called bupropion (Wellbutrin) targets norepinephrine and dopamine and is categorized as a norepinephrine-dopamine reuptake inhibitor. This antidepressant causes fewer sexual side effects than many other antidepressants.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c035726d-bd4f-4b3e-8a82-822316fdea83 Other so-called atypical medications include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762924393f03-7069-492d-a7b0-647e62ea722b Trazodone (Desyrel) Nefazodone (Serzone) Mirtazapine (Remeron) Vilazodone (Viibryd) For most atypical antidepressants, the most common side effects include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762900bd35e1-b28c-448d-bd48-81d6f49e8bf2 Blurry vision Constipation Dizziness Drowsiness Dry mouth
N-Methyl D-Aspartate (NMDA) Receptor Antagonists May Offer Quicker Relief NDMAs While many traditional antidepressants affect levels of serotonin, norepinephrine, or dopamine, a newer class of antidepressants called NMDA receptor antagonists work by helping maintain the balance of glutamate and gamma-aminobutyric acid (GABA). These two neurotransmitters have opposite actions in the body, and the brain typically functions best when they’re balanced. NMDA receptor antagonists can help people whose symptoms haven’t improved with typical treatments and usually offer more rapid relief than most antidepressants. The FDA recently approved the following NMDA antidepressants:e60dc2a1-f33c-4a05-9b50-8e3e8e597629cd214539-992a-46bf-9ab6-f544a1331532 Esketamine (Spravato), a nasal spray that’s used in combination with an oral antidepressant Dextromethorphan-bupropion (Auvelity) Common side effects of Spravato may include: Dissociation or feeling drunk Dizziness Feelings of anxiety Lack of energy or drowsiness Increased blood pressure Nausea or vomiting Decreased sensations of touch or other senses Common side effects of Auvelity could include: Dizziness Diarrhea Drowsiness Dry mouth Excessive sweating Headache Sexual problems
Neuroactive Steroids: Another Fast-Acting Option Neuroactive Steroids Neuroactive steroids are a newer class of medicines that are thought to work by affecting levels of the neurotransmitter GABA in the body. Like NMDA receptor antagonists, they tend to work more quickly than most other antidepressants.e60dc2a1-f33c-4a05-9b50-8e3e8e59762943bd5f9b-ce34-4078-90d4-195feec53929 The FDA recently approved the following neuroactive steroids for postpartum depression :e60dc2a1-f33c-4a05-9b50-8e3e8e597629deeb76a5-f3c1-45c6-9358-f1e4108518fa Brexanolone (Zulresso), a continuous infusion administered under medical supervision Zuranolone (Zurzuvae) Zulresso is administered over 2.5 days by a healthcare provider in a certified healthcare facility. It’s only available under a special program because of the side effects it can cause.e60dc2a1-f33c-4a05-9b50-8e3e8e59762952d64fd7-d0a0-45aa-b482-9a075dfc7783 The most common ones are:e60dc2a1-f33c-4a05-9b50-8e3e8e597629955f23b2-f2e0-47d6-ac90-982b23a1bc1c Dry mouth Flushing Loss of consciousness Tiredness or sedation Zurzuvae is an oral medication to be taken with a fat-containing meal once daily in the evening for 2 weeks. The most common side effects of Zurzuvae include: Burning or pain while urinating Cold symptoms like sneezing, sore throat, or stuffy nose Diarrhea Dizziness Weakness, tiredness, or drowsiness
Serotonin Receptor Agonists: A New Antidepressant Class Serotonin Receptor Agonists A new class of antidepressants called serotonin receptor agonists are believed to work by targeting certain serotonin receptors, such as the 5-HT1A receptor, in the brain. These receptors help regulate mood and emotions.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295b074aaf-0dc9-477b-a6aa-b8a95fcc1d6f The FDA recently approved the serotonin receptor agonist gepirone ER (Exxua) to treat depression.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c39c3abb-90a0-45e7-b47a-32952c7673f5 The most common side effects of Exxua are:e60dc2a1-f33c-4a05-9b50-8e3e8e5976294bcf49e7-b7de-4278-a44d-e90e3ac134d1 Dizziness Headache Nausea Sleep problems Stomach pain and upset
Atypical Antipsychotics: Approved for Use With Antidepressants Antipsychotics Atypical antipsychotics aren’t considered antidepressants. However, several atypical antipsychotics are FDA-approved to treat depression in combination with antidepressants. Doctors sometimes prescribe these drugs to people whose depression hasn’t improved with other treatments. They include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976298246c36e-e70a-43e2-96d0-7a8732efb5c0 Brexpiprazole (Rexulti) Aripiprazole (Abilify) Cariprazine (Vraylar) Quetiapine (Seroquel XR) Fluoxetine And Olanzapine (Symbyax) Common side effects of atypical antipsychotics, especially when taken long-term, include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e8e34966-4a8d-4eba-81ad-612b91b14758 Weight gain Metabolic dysfunction Extrapyramidal symptoms (involuntary movements) Tardive dyskinesia
Antidepressant Safety and Side Effects Safety & Side Effects Most antidepressants are generally safe, but some people — especially children, teenagers, and young adults under age 25 — may experience an increase in suicidal thoughts , especially during the first few months of treatment or when their dosage goes up or down.e60dc2a1-f33c-4a05-9b50-8e3e8e59762989524c42-fbe7-4a8d-ac2e-5d7a2b357017 If this happens to you or someone you know, immediately contact a doctor or seek emergency help by contacting the Suicide and Crisis Lifeline (988) or, if the risk is imminent, call 911. As mentioned, many antidepressants come with side effects, which can vary by type. They usually improve after a couple weeks, but if they don’t, let your doctor know. Your doctor could change the timing or dosage of your antidepressant to help lessen side effects, or they may switch you to another antidepressant and see if that works better for you.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298e8665e3-c3f3-458c-9428-9f12bc6870a6 Once you’ve begun taking antidepressants, don’t stop without your doctor’s assistance; discontinuing the medication too soon means your depressive symptoms might come back. When the time is right, your doctor can help you gradually taper your usage. While antidepressants aren’t generally addictive, stopping them abruptly can lead to withdrawal symptoms .e60dc2a1-f33c-4a05-9b50-8e3e8e59762976a795d2-85eb-4cd6-9115-8a59b1a65704
The Takeaway Depression can present differently in different people, and various treatments are available. While many find relief through therapy and lifestyle adjustments, some require medication to manage their symptoms effectively. If you’re exploring different treatments, your doctor can guide you in finding what might work best for you.
Resources We Trust Mayo Clinic: Antidepressants: Selecting One That’s Right for YouCleveland Clinic: AntidepressantsMayo Clinic: Antidepressants: Get Tips to Cope With Side EffectsMedlinePlus: AntidepressantsNational Health Service: Overview — Antidepressants
