Your Guide to Every Antidepressant: SSRIs, SNRIs, TCAs & More

June 7, 2024

Antidepressants: the most common prescription medication among cool people like artists, fictional type As, film protagonists and yourself.

If you’ve been diagnosed with depression, your healthcare provider may have suggested antidepressant medication to relieve symptoms like sadness, emptiness, insomnia, fatigue and more.

Antidepressants work by changing the balance of certain neurotransmitters in your brain, but which ones they affect and how they affect them varies from one antidepressant to another — and there are many different classes of antidepressants.

You’re almost certain to be overwhelmed by the variety (we often are), and for people navigating the management of a depressive disorder, it can be quite difficult to sort through the effects, side effects and performance of these drugs.

Help is on the way. To make it easier to understand this wide world of treatments, we’ve covered the most common types of antidepressants below, including:

Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants (TCAs)
Tetracyclic antidepressants (TeCAs)
Monoamine oxidase inhibitors (MAOIs)
Others that don’t fit into the above categories

We’ve included information about popular brand names, the conditions for which each medication is typically prescribed, the potential side effects and the amount of time it may take for each antidepressant to start providing relief.

So let’s jump right into our list of antidepressants, starting with the most common antidepressants on the market today: SSRIs.

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Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors, or SSRIs, are indeed the most common type of antidepressant prescribed in the United States, and they have been ranked number one for several decades.

First developed in the 1970s, SSRIs are so popular because they’re generally effective and have fewer drug interactions, safety issues and side effects than older antidepressants. Because of this, it’s common for healthcare professionals to use SSRIs as first-line treatments for depression.

Some SSRIs are also prescribed to treat mental health issues like anxiety disorders and other mood disorders.

Serotonin regulates certain aspects of your mood, including feelings of happiness, and SSRIs increase the amount of serotonin in your brain by blocking your brain cells from reabsorbing (or reuptaking) existing serotonin. Most of the time, SSRIs produce a noticeable improvement in people affected by depression within about two to four weeks.

If you’ve recently been diagnosed with a form of depression, it’s very likely that your healthcare provider will discuss using an SSRI first.

SSRIs may cause certain side effects.

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List of SSRIs

Currently, several different SSRI antidepressants are used to treat depression, anxiety disorders and other conditions. They include:

Citalopram (Celexa) is an SSRI used to treat depression. It was first approved in 1998 by the FDA. Citalopram is one of the most commonly prescribed medications in the United States.

Escitalopram (Lexapro) is used to treat depression and generalized anxiety disorder in adults. It was approved by the FDA as a treatment for major depressive disorder (MDD) in 2002 and later as a treatment for generalized anxiety disorder. As with many other SSRIs, escitalopram is one of the most commonly prescribed medications in the United States.

Fluoxetine (Prozac) is used to treat depression, obsessive-compulsive disorder (OCD), panic disorder and bulimia nervosa (an eating disorder). It’s also used in combination with other medications to treat depressive episodes in people with bipolar disorder and treatment-resistant depression. Under the brand name Prozac, fluoxetine was the first SSRI to receive approval from the FDA in the United States, in 1987. Today, it remains one of the most widely prescribed medications in the United States.

Fluvoxamine (Luvox) is slightly different from other SSRIs, which are primarily used to treat depression. Instead, fluvoxamine is typically prescribed to treat obsessive-compulsive disorder. Fluvoxamine may also be prescribed to treat certain anxiety disorders, such as social anxiety disorder, and can be prescribed as an off-label medication to treat depression and post-traumatic stress disorder (PTSD).

Paroxetine (Paxil) is used to treat depression, obsessive-compulsive disorder, PTSD and several anxiety disorders, including social anxiety disorder (SAD), generalized anxiety disorder (GAD) and panic disorder. It may also be prescribed off-label for premenstrual dysphoric disorder (PMDD). Paroxetine was approved by the FDA in 2001. As with other SSRIs, it’s a common medication that’s one of the most widely used prescription drugs in the country.

Sertraline (Zoloft) is used to treat depression, OCD, PTSD, premenstrual dysphoric disorder and anxiety disorders such as social anxiety disorder and panic disorder. It’s also occasionally prescribed off-label to treat premature ejaculation (PE). Sertraline was first approved by the FDA for use as a treatment for depression in 1991. As of 2018, not only was sertraline the most commonly prescribed SSRI antidepressant, but it was also the most widely used psychiatric medication in the United States.

Vilazodone (Viibryd) is a slightly newer medication used to treat depression. Because it’s only been around for a relatively short amount of time (it was approved in 2011), vilazodone is less widely used for treating depression than other SSRIs.

Vortioxetine (Trintellix) gained its FDA approval in 2013. Because Trintellix is a newer SSRI on the market, it’s not available as an affordable generic, and so it’s not yet considered a first-line treatment.

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Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin–norepinephrine reuptake inhibitors, or SNRIs, are a common type of antidepressant used to treat depression, as well as some anxiety and nerve pain disorders.

SNRIs work similarly to SSRIs by blocking the reabsorption of serotonin to increase the level of this neurotransmitter that’s active in your brain and body. But they perform a sort of dual function by also blocking the reabsorption of a different neurotransmitter — norepinephrine.

Low levels of norepinephrine have been closely linked to depression symptoms like difficulty concentrating, lethargy and issues related to your sleep-wake cycle. Despite their dual action, SNRIs have not been shown to be substantially superior to SSRIs. Nevertheless, some people who don’t respond to an SSRI will do well on an SNRI.

SNRI drugs are widely prescribed throughout the United States to treat depression accompanied by chronic pain. Like SSRIs, the side effects of SNRIs are generally mild and often disappear after several weeks of use.

(Related: Who Can Prescribe Antidepressants?)

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List of SNRIs

Numerous SNRI antidepressants are currently prescribed to treat depression, as well as other mood disorders. They include:

Desvenlafaxine (Pristiq) has been used as a treatment for depression since its approval in 2008. It may also be prescribed off-label to treat certain symptoms in menopausal women, such as hot flashes.

Duloxetine (Cymbalta) is prescribed to treat depression and generalized anxiety disorder. Duloxetine has become one of the most widely prescribed medications in the United States since it was approved by the FDA in 2004. It’s also approved by the FDA for the treatment of fibromyalgia, chronic musculoskeletal pain and diabetic peripheral neuropathy.

Levomilnacipran (Fetzima) is a relatively new medication used to treat depression. It was first approved by the FDA in 2009.

Venlafaxine (Effexor) is prescribed to treat depression and — in its extended-release form — is also used to treat anxiety disorders, including generalized anxiety disorder, social anxiety disorder and panic disorder. Venlafaxine may be used off-label to treat other conditions such as diabetic neuropathy, fibromyalgia, complex pain syndromes and premenstrual dysphoric disorder, and as a preventive medication for migraines.

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Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants, or TCAs, are an older class of antidepressants. They first came onto the market in the mid-20th century as treatments for depression and certain anxiety and pain disorders.

TCAs increase the amounts of serotonin and norepinephrine in your brain, and are about equally as effective as SSRIs. However, they’re used much less commonly these days due to their higher risk of side effects and drug interactions.

Tricyclic antidepressants are occasionally used as second-line antidepressants when newer treatments such as SSRIs or SNRIs don’t work or cause unwanted side effects.

Since some tricyclic antidepressant drugs have sedating effects, they may be used in very low doses off-label as sleep aids for people who struggle with insomnia.

If you’re prescribed a tricyclic antidepressant, it’s important to be aware of the side effects of antidepressants in this class, as well as their potential drug interactions.

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List of Tricyclic Antidepressants

Currently, a variety of tricyclic antidepressants are used to treat depression, anxiety disorders and other conditions. They include:

Amitriptyline (Elavil) is FDA-approved for the treatment of depression in adults. Off-label, it may be prescribed to treat everything from sleep disorders to chronic pain to PTSD.

Desipramine (Norpramin) is prescribed to treat depression. Desipramine is slightly less likely to cause certain side effects compared to other tricyclic antidepressants. It may also be prescribed off-label to treat neuropathic pain, bulimia nervosa, irritable bowel syndrome and several other conditions.

Doxepin is prescribed to treat depression and certain forms of anxiety. It may also be used off-label to treat other conditions, such as migraines and neuropathic pain. At a much lower dose, doxepin is approved for use as a sleeping pill sold under the brand name Silenor. It was once sold as Sinequan, but this was discontinued.

Imipramine (Tofranil) is used as a treatment for depression and, occasionally, as a second-line medication to treat depression with melancholic and atypical features. It can also be used to treat bedwetting in children, and may be used off-label for panic disorder and neuropathic pain.

Nortriptyline (Pamelor) is another TCA used to treat depression, but is also prescribed off-label for chronic pain, myofascial pain, orofacial pain, diabetic neuropathy and postherpetic neuralgia (a potential complication of shingles).

Protriptyline treats depression, and is also used to treat certain forms of anxiety, as well as headaches and attention deficit hyperactivity disorder (ADHD). Protriptyline may also be prescribed off-label for treatment-resistant depression, sleep apnea, cocaine dependence, as a local anesthetic and as a support medication for people trying to quit smoking. It was previously sold under the brand name Vivactil, but this has since been discontinued.

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Tetracyclic Antidepressants (TeCAs)

Tetracyclic antidepressants (TeCAs) are another older class of antidepressants. They were introduced in the 1970s and 1980s and work similarly to tricyclic antidepressants.

Like other antidepressants, tetracyclic antidepressants work by increasing the levels of certain neurotransmitters (including serotonin and norepinephrine) affected in people with depression or anxiety disorders.

While they’re less commonly used for depression than newer antidepressants such as SSRIs and SNRIs, some tetracyclic antidepressants are used to treat people who have depression at the same time as issues such as anxiety or difficulty sleeping.

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Mirtazapine (Remeron)

Mirtazapine (Remeron) is a TeCA used to treat depression. It’s also used off-label as a treatment for headaches and migraines, insomnia and anxiety disorders.

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitors, or MAOIs, are another older class of antidepressants first introduced in the 1950s.

MAOIs work by blocking the enzyme monoamine oxidase, which breaks down neurotransmitters such as serotonin, norepinephrine, dopamine and tyramine. By stopping these chemicals from being broken down, MAOIs help to increase neurotransmitter levels in the brain — it’s basically like unplugging a Roomba and letting the dust collect, except the dust is crucial neurotransmitters that you need for better mental health.

Although MAOIs are effective, they have a considerable risk of interacting with other medications and with certain foods — foods that contain tyramine, for example, can potentially cause a sudden, life-threatening increase in blood pressure when mixed with MAOIs.

Because of this, people who use MAOIs need to carefully monitor not just their use of different medications, but also their diet. That’s one of the main reasons that MAOIs are rarely used today except in certain circumstances, such as when other medications for depression aren’t effective.

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List of Monoamine Oxidase Inhibitors

MAOIs prescribed to treat certain forms of depression include the following:

Phenelzine (Nardil) is prescribed to treat depression, treatment-resistant depression, social anxiety disorder and certain anxiety disorders, such as panic disorder and social anxiety disorder.

Isocarboxazid (Marplan) is used to treat depression in people who haven’t shown improvement with other antidepressants.

Selegiline (Emsam) is a transdermal patch prescribed to treat depression. It’s also sold in pill form — under brand names Eldepryl and Zelapar — as a combination therapy with the drugs levodopa and carbidopa to help people manage symptoms of Parkinson’s disease.

Tranylcypromine (Parnate) is prescribed for treatment-resistant depression and may also be used off-label for treatment-resistant anxiety disorders, including social anxiety disorder and panic disorder.

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Other Antidepressants

As much as we’d like to keep this list neat and tidy, some antidepressants don’t fit clearly into the drug classes listed above.

Medications like this may be referred to as “atypical” antidepressants and include:

Bupropion (generic for Wellbutrin XL) is an atypical antidepressant often used to treat depression and seasonal affective disorder. It’s also approved for smoking cessation under the brand name Zyban. In some cases, bupropion may be used off-label to treat arousal dysfunction caused by other antidepressants. Unlike SSRIs and SNRIs, bupropion doesn’t increase serotonin, so it doesn’t have the side effects, like arousal dysfunction, caused by excessive serotonin. It primarily boosts the neurotransmitter dopamine, which can lead to more energy, motivation, and interest. The disadvantage is that it doesn’t treat anxiety.

Trazodone, sold under the brand name Desyrel, is rarely used to treat MDD. Trazodone is most often prescribed off-label to help people with insomnia.

Esketamine (Spravato) is a nasal spray antidepressant with limited approval by the FDA for treatment-resistant depression and MDD in adults.

Some atypical antidepressants, such as nefazodone, opipramol, agomelatine and others, may be used to treat certain forms of depression but are either discontinued or not approved in the United States.

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Antidepressants List: Which Is Right for Me?

The reality of medicine in the modern era is that while it’s helpful to know everything we’ve shared with you here, you don’t need to memorize all of these facts before accepting a prescription for a new antidepressant.

A healthcare professional will be able to help you navigate questions and concerns and, if necessary, manage any side effects.

Whether you’re about to start a new medication or just beginning your depression treatment journey, what’s important for you now is to talk to someone about what you’re dealing with.

The major takeaways that will help you speed up the process are:

There are many different types of antidepressants on the market today, and each one may help different people in different ways.
Older medications tend to cause more side effects for the average user, but may also offer benefits if first line medications like SSRIs don’t work for you.
Side effects from all antidepressants can affect anyone, so if you’re struggling with anything from (mild) dry mouth to (serious) suicidal thoughts, talk to your healthcare provider immediately.
If you’re feeling depressed, it’s essential that you get the help you need. Our mental health resources provide effective strategies from licensed therapists that you can use to understand, recognize and help alleviate the symptoms of depression and anxiety.

This article originally appeared on Forhers.com and was syndicated by MediaFeed.org.

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