Antidepressants come in a variety of types, and it's important to be aware of the differences if your psychiatrist or physician suggests you try one. Most people taking antidepressants may find they have to go through trial and error to find the right one, although some people are lucky and get a very effective one on the first try. Each type may affect each individual differently, and within classes of antidepressants, one medication may be more or less effective than another. The basic types of antidepressants are the following: Monoamine oxidase inhibitors (MAOIs), Tricyclics, Selective Serotonin Reuptake Inhibitors (SSRIs), and Atypical antidepressants.
MAOIs were the first developed of the antidepressants, and they are not used as often as the other classes. They include Phenelzine (Nardil®), Isocarboxazid (Marplan®), Selegiline (Emsam®), and Tranylcypromine (Parnate®). As a class' MAOIs can be somewhat challenging since they are associated with a higher rate of negative drug interactions, and even may create problems when you eat certain foods that contain tyramine. They are also associated with sexual dysfunction, headaches, weight gain, and sleepiness, so they are usually not the first choice for prescribing doctors.
Tricyclics were the next developed group and are still used. These include a number of medications, among them amitryptiline (Elavil®), amoxipine (Asendin®), nortriptyline (Pamelor®) and imipramine (Tofranil®). Tricyclics are still not the first choice of most prescribing doctors because they usually have more side effects than do atypicals and SSRIs. In particular they can cause a great deal of sleepiness. For suicidal patients they may not be the first choice medication because overdose on tricyclics is exceptionally dangerous. They do, however, appear to work well for many people since they help to increase the available amount of serotonin and norepinephrine, two of the brain chemicals that in insufficient supply may result in depression.
SSRIs also work to create more available serotonin and they are some of the most frequently prescribed antidepressants today. They include Setraline (Zoloft®), Paroxetine (Paxil®), Escitalopram (Lexapro®), Fluvoxamine (Luvox®) and Fluoxetine (Prozac®). SSRIs tend to have fewer side effects than older classes but they are not without problems. They can be associated with increasing anxiety and suicidal thoughts, and some people gain weight, find sex drive diminished, or suffer stomach problems or sleeplessness while taking them. It should be noted that many people take them without experiencing more than transient side effects.
Atypical antidepressants are the most recent group, and many work to increase available norepinephrine, dopamine and serotonin. In some respects they are similar to tricyclics but with fewer side effects. These medications include Bupropion (Wellbutrin®), Nefazodone (Serzone®), Trazodone (Desyrel®), Venlafaxine (Effexor®), Mirtazapine (Remeron®), and Dulexetine (Cymbalta®). Some people favor these medications because they to be less indicated in causing diminished sexual drive, especially wellbutrin. Like SSRIs, side effects can include things like headache and upset stomach, and some medications are associated with significant weight gain, like Remeron®. Despite some side effects, these medications may be effective where SSRIs fail to work.
The most important thing to consider when taking an antidepressant is the following: Is it working? Second: Does it cause dangerous or unmanageable side effects? If you take an older class antidepressant with more potential risks you may want to speak to your prescribing doctor about upgrading to a newer class medication. It’s also okay not to change, particularly if you had a hard time finding an effective medication when you were first diagnosed with depression. What is good to know is that the different classes of antidepressants tend to mean more people will find successful treatment within one of the types.
