Depression has two primary clinical treatments: psychotherapy, otherwise known as talk therapy; and pharmacotherapy, or the use of prescription medication. While therapy can help you by giving you the skills to cope with your depression and manage your symptoms, medication can help to reduce symptoms by correcting the chemical imbalance that causes medication.
Research has shown that just as there are patients who respond to therapy better than they do medication, there are also patients who respond better to medication than therapy.1 Others might need some combination of the two. But if you’re interested in antidepressants to treat your depression, where do you start?
Let’s go over some of the options available.
Selective Serotonin Reuptake Inhibitors (SSRI)
SSRIs are the most common types of depression medications. They are designed to increase levels of serotonin in the brain, which can be of great help for conditions like depression or anxiety, where there is a deficiency of serotonin. Some examples of SSRIs include:
- Celexa (citalopram)
- Lexapro (escitalopram)
- Paxil, Paxil CR, or Pexeva (paroxetine)
- Prozac, Prozac Weekly (fluoxetine)
- Trintellix (vortioxetine)
- Viibryd (vilazodone)
- Zoloft (sertraline)
Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)
SNRIs increase levels of serotonin and norepinephrine. Because norepinephrine is used to activate the body’s flight-or-fight response, SNRIs are often prescribed for those who have more severe symptoms of depression, particularly lethargy and a lack of motivation to move. SNRIs include:
- Cymbalta (duloxetine)
- Effexor, Effexor XR (venlafaxine)
- Fetzima (levomilnacipran)
- Pristiq, Khedezla (desvenlafaxine)
Cyclic Antidepressants
Cyclic antidepressants inhibit serotonin and norepinephrine reuptake into neurons by use of presynaptic terminals. This leads to an increase of serotonin and norepinephrine in the synaptic cleft, leading to greater concentration and motivation. Tricyclic antidepressants have three rings within their chemical structure, while tetracyclic antidepressants have four. These are:
- Asendin (amoxapine)
- Elavil (amitriptyline)
- Ludiomil (maprotiline)
- Norpramin (desipramine)
- Pamelor (nortriptyline)
- Sinequan (doxepin)
- Surmontil (trimipramine)
- Tofranil (imipramine)
- Vivactil (protriptyline)
Atypical Antidepressants
- Desyrel (trazodone)
- Serzone (nefazodone)
- Remeron (mirtazapine)
- Wellbutrin, Wellbutrin SR, Wellbutrin XL (bupropion)
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine oxidase is an enzyme that is often responsible for removing serotonin, dopamine, and norepinephrine from the brain. MAOIs work by inhibiting the creation of monoamine oxidase, thus allowing serotonin, dopamine, and norepinephrine to send messages to the brain as normal. Some MAOIs include:
- Emsam (skin patch) (selegiline)
- Marplan (isocarboxazid)
- Nardil (phenelzine)
- Parnate (tranylcypromine)
How To Find the Right Antidepressant For You
Once you’ve received a depression diagnosis, a psychiatrist or nurse practitioner is the ideal person to consult with to help formulate an ideal treatment plan. When you meet with them, bring up your interest in trying antidepressants and explain a bit about your symptoms. Your psychiatrist or nurse practitioner will work with you and prescribe an antidepressant that they believe would best be able to help you. They may start you on a low dosage to begin with. They will also go over some of the possible side effects.
One side effect that can occur with any antidepressants that increase levels of serotonin is serotonin syndrome. Serotonin syndrome is rare and typically only occurs when there is a poor interaction with other medications. This is why it’s important to talk to your psychiatrist about other medications you’re currently taking. Symptoms of serotonin syndrome include:
- Agitation and restlessness
- Increased anxiety
- Disorientation
- Headaches
- Tremors
- Confusion
- Rapid heart rate
- Dilated pupils
- High blood pressure
- Muscle rigidity
Once you’ve started taking your medication, you will schedule follow up appointments with your psychiatrist. During this time, you’ll go over your symptoms and decide with your psychiatrist or nurse practitioner whether to continue the medication as normal, increase or decrease the dosage, or switch to a different medication.
Never go off of antidepressant medications without first speaking to your psychiatrist or nurse practitioner. The withdrawal caused by quitting your medication can lead to an intense return of symptoms which can leave many patients feeling unstable.
If you’re interested in treating your depression with antidepressants, Rivia Mind can help. Visit our medication management page to learn more about this treatment plan and our philosophy care.
Contact us today to learn more or visit our provider page to schedule an appointment.
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