You’ve been diagnosed with depression. What’s next?
The cornerstone of treatment remains antidepressants, so it’s likely your doctor will prescribe one for you, but which one might be best?
You will join millions around the world who struggle with how to treat the mental health disorder. An estimated 3.8% of the global population experiences depression, according to the World Health Organization. The numbers are staggering, but when depression is left untreated, it can impair daily functioning, raise the risk of suicide and lower quality of life.
Fortunately, there are many different types of antidepressants available, each with unique mechanisms of action, benefits and potential side effects. Here, experts will explore the most commonly prescribed depression medications, how they work and their common side effects.
Dr. Abid Nazeer, founder, chief medical officer and medical director of Advanced Psych Solutions in Naperville, Ill., stated, “If you don’t treat depression, there’s a risk that you may get through the day, but it will feel like a struggle. If it’s been adequately treated, you can have a much better day.”
Meanwhile, Pardis Khosravi, a psychologist and clinical director at Children’s Health Council in California, said, “Depression is not something you can ‘power through’ or think your way out of with positive thoughts. It is a medical illness that left untreated can have a profound impact on your health, quality of life and daily functioning. Untreated depression increases the likelihood of risky behaviors such as substance use, self-harm and suicidal ideation and/or behaviors.”
Although alternative therapies can be successful in treating depression, medication might become necessary in certain situations when other treatments have failed, depression symptoms interfere considerably with daily life, there is a history of mental health issues, or when a person feels too exhausted to pursue non-medication treatments.
Here are some of the most common depression medications:
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are a class of medications used to treat depression by elevating serotonin levels in the brain, a crucial neurotransmitter that facilitates communication between nerve cells. The Mayo Clinic indicates that SSRIs prevent serotonin reabsorption into neurons, ensuring that more of the chemical messenger remains available to enhance signaling between brain cells. Additionally, SSRIs are known as selective agents because they primarily impact serotonin rather than other neurotransmitters.
These SSRIs have received approval from the U.S. Food and Drug Administration for the treatment of depression:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil, Pexeva)
- Sertraline (Zoloft)
While SSRIs effectively treat depression, they may also cause various side effects. Per an article published in the Primary Care Companion to the Journal of Clinic Psychology, SSRIs’ most common side effects include gastrointestinal problems, sexual dysfunction, weight gain and sleep disturbances.
Gastrointestinal side effects include nausea, diarrhea and abdominal pain, while sexual dysfunction includes decreased libido, erectile dysfunction and difficulty achieving orgasm.
In rare cases, SSRIs may increase the risk of suicidal ideation, particularly in young people, some research has shown.
SSRIs are not the only medications for depression: Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) work by affecting other neurotransmitters.
SSRIs generally have fewer side effects than these older antidepressants and are typically the first-line treatment for depression. However, the choice of medication depends on individual needs, and health care providers may recommend different types of antidepressants based on the patient’s specific symptoms and medical history.
Monoamine oxidase inhibitors (MAOIs)
MAOIs are another type of antidepressant medication that blocks the enzyme monoamine oxidase, which breaks down neurotransmitters such as serotonin, norepinephrine and dopamine. By increasing the levels of these neurotransmitters, MAOIs can alleviate symptoms of depression.
Some of the most common MAOIs include:
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Isocarboxazid (Marplan)
- Selegiline (Emsam) — available as a transdermal patch
These medications can be effective in treating depression. However, the Mayo Clinic states that they are generally not considered first-line therapy due to their potential for serious side effects and interactions with certain foods and medications.
According to Mental Health America, atypical antidepressants are a diverse class of medications used to treat depression that do not fit neatly into other categories of antidepressants. They work by targeting multiple neurotransmitters in the brain, including serotonin, norepinephrine and dopamine, to improve mood and ease symptoms of depression. Some of the most commonly used atypical antidepressants include:
- Bupropion (Wellbutrin)
- Mirtazapine (Remeron)
- Trazodone (Desyrel)
- Vilazodone (Viibryd)
- Vortioxetine (Trintellix)
Bupropion is known for its unique mechanism of action, which involves increasing the levels of norepinephrine and dopamine in the brain. Mirtazapine works by increasing the release of both serotonin and norepinephrine, while trazodone primarily affects serotonin levels. Vilazodone and vortioxetine are newer medications that target multiple neurotransmitters and effectively treat depression.
These medications may be useful for individuals who have not responded to other types of antidepressants or who experience side effects from other medications.