Antidepressants

Many antidepressants operate through diverse mechanisms, targeting various neurotransmitters such as serotonin, norepinephrine, and dopamine. When prescribing a medication for depression a psychiatrist may consider:

• Symptoms: Symptoms of depression can vary widely among individuals and may even fluctuate within the same person over time. Certain antidepressants may alleviate specific symptoms better than others. For instance, individuals experiencing difficulty falling asleep may benefit from a sedating antidepressant. It’s important to recognize that antidepressants within the same class can have varying efficacy, highlighting the need for personalized treatment.
• Family History: The response of a close relative, such as a parent or sibling, to a particular medication can provide valuable insight into its potential effectiveness. Considering family genetics can inform treatment decisions, as medications that have been effective for relatives may also work well for the individual.
• Pregnancy or Breastfeeding: When considering antidepressant use during pregnancy or breastfeeding, the decision is made by weighing the potential risks and benefits. While there is a low risk of birth defects associated with antidepressant use during pregnancy, expecting mothers should make this decision in consultation with their psychiatrist, considering individual circumstances.
• Other Health Conditions: Antidepressants may interact differently with various mental and physical health conditions. Some antidepressants may exacerbate certain symptoms, while others can alleviate both depression and co-existing health issues. For example, venlafaxine (Effexor XR) may help manage anxiety disorders or menopausal symptoms, while bupropion aids in smoking cessation. Additionally, duloxetine (Cymbalta) is known to alleviate neuropathic pain and fibromyalgia symptoms.
• Cost and Insurance Coverage: Considering cost and insurance coverage is essential in antidepressant selection. Factors such as insurance coverage for brand-name medications, ease of administration (e.g., once-daily dosing vs. multiple doses), and individual financial circumstances should be taken into account during treatment planning.

Various neurotransmitters in the brain, including serotonin, norepinephrine, and dopamine, are linked to depression. Antidepressants primarily function by influencing one or more of these neurotransmitters, which are essentially chemical messengers facilitating communication between brain cells. Different classes of antidepressants act on these neurotransmitters in distinct ways to alleviate depression symptoms.

Many types of antidepressant medications are available to treat depression, including:

• Selective serotonin reuptake inhibitors (SSRIs): Doctors often start by prescribing an SSRI. These medications in general cause fewer side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants are. They are very safe and also indicated for Anxiety disorder as well. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), Fluvoxamine (luvox),  sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs): SNRI medications include duloxetine (Cymbalta), venlafaxine (Effexor XR) and desvenlafaxine (Pristiq)
• Atypical antidepressants: Atypical antidepressants are medications that don’t into a particular category by mechanism alone. Antidepressants in this category include mirtazapine (Remeron), vortioxetine (Trintellix), vilazodone (Viibryd), trazodone and bupropion (Wellbutrin XL). Bupropion is one of the few antidepressants not associated with sexual side effects as it does not target serotonin.
• Tricyclic antidepressants: Tricyclic antidepressants include imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin and desipramine. They tend to cause more side effects than newer antidepressants including sedation and blurry vision. Tricyclic antidepressants usually aren’t prescribed unless the SSRIS have failed
• Monoamine oxidase inhibitors (MAOI): MAOIs such as tranylcypromine (Parnate) and Phenelzine (Nardil) may be prescribed, but often when a multitude of other medications have failed. This can be due to serious side effects and the absolute utilization of a strict diet because of dangerous interactions with certain foods. These medications cannot be combined with SSRIs.
• Other medications: A psychiatrist may recommend combining two antidepressants with two different mechanisms to enhance antidepressant effects.