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Antidepressants play a key role in the treatment of moderate to severe depression. What antidepressants your might your doctor prescribe, and what do you need to know about them?

Antidepressants have a funny backstory — the very first antidepressants were tuberculosis drugs that later, coincidentally, turned out to have a positive effect on mood. Today, there are many different kinds of antidepressants, and about 11 percent of the adult US population will be using one at any given time, for depression as well as other mood disorders and even off-label for conditions such as chronic pain. 

While mild depression can get better by itself, antidepressants play a key role in treating moderate to severe depression — though research shows that a combination of psychotherapy and antidepressant drugs is most effective at helping people recovering from depression... and keeping them from relapsing. 

What do you need to know about antidepressants if you've recently been diagnosed, or you are pretty sure you are depressed and are just about to go to the doctor? We'll take a look at the different kinds of antidepressants available to you, as well as how your doctor decides which one to prescribe. First off, though, it's important to be aware that most antidepressants aren't prescribed by psychiatrists but by other doctors; your family doctor can get you set up with antidepressant therapy, too. 

Types of antidepressants: What you need to know

The different categories of antidepressants all work to improve your brain chemistry in different ways — and though some folks may find their exact mechanism of action fascinating, we'll assume most depressed people would rather have more practical information, so we'll focus on that.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors, or SSRIs, are considered the first choice when it comes to treating depression with medications. They are of a newer generation than some of the other options, and are generally well-tolerated by patients.

Examples include (brand names in brackets):

  • Fluoxetine (Prozac)
  • Paroxetine (Seroxat)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro, Cipralex)
  • Dapoxetine (Priligy, Westoxetin)

More common side effects — which usually subside over time — include blurred vision, nausea, a lowered libido, and feeling restless or irritated

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants, often called TCAs for short, are among the antidepressants that have been on the market the longest. Once revolutionary, they're now used less often because TCAs often cause more side effects than some of the other options on the table. Tricyclic antidepressants may, however, be right for you if other antidepressants haven't offered you the relief you need. 

Examples include:

  • Amitriptyline (Elavil)
  • Desipramine (Norpramin, Pertofrane)
  • Amoxapine (Asendin)
  • Doxepin (Sinequan)
  • Protriptyline (Vivactil)

Not all TCAs will have the same side effects, and people will respond to a particular drug in an individual way. Some of the more common side effects of tricyclic antidepressants are, however, a dry mouth, constipation, drowsiness, lowered blood pressure, an appetite boost, weight gain, weight loss, and a lowered libido. Rarer side effects include confusion, seizures, an an irregular heartbeat. 

Selective serotonin noradrenaline reuptake inhibitors (SSNRIs)

On the market since the 1990s, selective serotonin noradrenaline reuptake inhibitors (SSNRIs) are now among the most commonly prescribed antidepressants, and examples include:

  • Atomoxetine (Strattera)
  • Milnacipran (Savella)
  • Tramadol (Ultram)
  • Duloxetine (Cymbalta)

Side effects may include nausea, irritability, insomnia or fatigue, a higher blood pressure, heart palpitations, tremor, a dry mouth, and a lower sex drive

Other antidepressants

Though TCAs, SSRIs, and SSNRIs are the three kinds of antidepressants most commonly prescribed in the US, many other kinds exist as well — along with antidepressants that do not belong to a particular category. These include monoamine oxidase (MAO) inhibitors, the very first kind of antidepressant discovered. They aren't used so often now due to the high potential of side effects and the need to follow a special diet because of the possibility of dangerously high blood pressure. Then there are alpha-2 blockers, selective noradrenaline reuptake inhibitors, selective noradrenaline/dopamine reuptake inhibitors, and melatonin receptor agonists and serotonin 5-HT2C receptor antagonists. Lithium and trazadone stand alone without belonging to a class of meds. 

How will your doctor decide which antidepressant to prescribe?

Your doctor will consider which antidepressant is most likely to be both safe and effective for you, but your input should be valued in the process. Some things to keep in mind are:

  • Research has found that the following antidepressants are most likely to work well at reducing the symptoms of depression within eight weeks, while also causing relatively few side effects — ​escitalopram​, paroxetine, sertraline​, agomelatine​and mirtazapine. Because they have been found to be better tolerated than other antidepressants, patients are also more likely to stick with them. 
  • You have seen some of the side effects different classes of antidepressants are more likely to cause. This is important, and your doctor will consider the potential side effects when deciding which antidepressant is best for you. If you already have hypertension, for instance, they'll be less likely to prescribe one of the antidepressants that has been linked to a higher blood pressure. 
  • If you have already suffered from depression in the past and taken an antidepressant that worked well then, your doctor will likely suggest you try the same one again. 
  • If the antidepressant you were prescribed does not have the desired effect, you and your doctor can reevaluate. 
  • Always let your doctor know right away if you are experiencing severe side effects. Never stop taking your medication on your own initiative, however, nor adjust the dose.
You will be offered the lowest dose possible to start off with to decrease the potential of side effects, and that can then be adjusted over time if needed. Most antidepressants are taken on a daily basis, and you'll have regular check-ins with your doctor to see how you are doing. Once you are feeling better and are recovering from depression, you will most likely still be asked to continue taking your antidepressants for a good while. This is important to help prevent relapse. 

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