Antidepressants are often the first treatment prescribed for depression. However, finding the right medication to treat depression can be a complicated process, since no single antidepressant drug has been found to be the best treatment for every patient. Each person is unique, and therefore treatment varies from person to person based on his or her individual needs.
What is an antidepressant?
Antidepressants are a group of drugs used in the treatment of depression, and are prescribed by a doctor. Although they do not cure depression, antidepressants are usually effective at relieving its symptoms and improving mood.
How do antidepressants work?
Antidepressants work by increasing levels of chemicals in your brain called neurotransmitters, such as serotonin, dopamine or noradrenaline, which are related to mood and emotions. There are several classes of antidepressants with different side effects and modes of action.
Some antidepressants work better for certain people than others, and your doctor will choose which antidepressant drug is best for you based on your profile. That being said, you may need to try more than one antidepressant to find the right one.
If the first antidepressant prescribed for you does not improve your mood, your doctor may try to change the dose, prescribe another drug from the same class, or try something new from a different class. In some cases, your doctor may even recommend more than one medication.
What are the different types of antidepressants?
There are different classes of antidepressants available. These are the most widely used antidepressants:
1. Selective serotonin reuptake inhibitors (SSRIs):
Citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Pexeva), sertraline (Zoloft)
This class of antidepressants is the most common and the most prescribed for depression. They are usually preferred because they cause fewer side effects than some of the older classes of antidepressants.
SSRIs work by balancing the levels of serotonin in the brain, a neurotransmitter that helps to regulate your mood. It is believed that people with depression often have low levels of serotonin.
2. Serotonin and noradrenaline reuptake inhibitors (SNRIs):
Venlafaxine (Effexor), desvenlafaxine (Pristiq, Khedezla), duloxetine (Cymbalta), levomilnacipran (Fetzima)
SNRIs are a newer type of antidepressant. Their action is similar to SSRIs, but they act on noradrenaline as well as serotonin. Since they have a selective action on these chemicals, they also cause few side effects.
3. Tricyclic antidepressants (TCAs)
Amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), trimipramine (Surmontil)
Tricyclic antidepressants are one of the oldest types of medications used to treat depression. They work by regulating the levels of noradrenaline and serotonin in the brain. However, they have many side effects, such as dizziness, dry mouth and weight gain.
Since they tend to cause more side effects compared with other types of antidepressants, they aren’t usually the preferred form of treatment for depression. However, they may be prescribed if you have already tried other antidepressants without feeling any improvements.
4. Monoamine oxidase inhibitors (MAOIs)
Isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and transdermal selegiline (Emsam), that you stick on your skin as a patch
Monoamine oxidase inhibitors are also one of the earliest treatments for depression. Nowadays, they are not prescribed often due to their serious, or even deadly interactions with other medications and certain foods.
These antidepressants work by blocking an enzyme called monoamine oxidase. This enzyme breaks down noradrenaline and serotonin, inactivating their action in the body. By inhibiting the action of this enzyme, MAOIs allows noradrenaline and serotonin to stay active in the body for a longer period of time, resulting in an antidepressant effect.
MAOIs have dangerous interactions with some kinds of food, such as certain cheeses, meats or wines, and some medications, including birth control pills and herbal supplements. Therefore, your doctor will only prescribe you a drug from this class if you have already ruled out other types of antidepressants through trial and error.
5. Other antidepressants (also called atypical antidepressants)
Bupropion (Wellbutrin, Aplenzin), Mirtazapine (Remeron), Trazodone (Desyrel), Vortioxetine (Trintellix)
These are medications with unique modes of action that are not included in any of the other previous categories. They are also effective and can be prescribed to you, depending on your symptoms or other health conditions you may have.
What should I know before starting an antidepressant?
Antidepressants can take up to eight weeks before you start feeling significant effects. Always take your depression medicine exactly as prescribed, and never skip a dose or quit treatment without consulting with your doctor. If you are taking an antidepressant for more than four weeks without feeling any benefit, tell your doctor how you feel. He or she will work with you and select the best antidepressant treatment for you. Stick with it, and although it sometimes requires patience, eventually you will find a winning combination that will have you feeling better.