Types of antidepressants

Many mental health experts believe that certain brain chemicals called neurotransmitters are associated with depression — particularly serotonin (ser-o-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-meen). Most antidepressants help relieve depression by affecting these neurotransmitters, sometimes called chemical messengers, which aid in communication between brain cells. Each type of antidepressant affects these neurotransmitters in slightly different ways.

Many types of antidepressants are available to treat depression, including:

• Selective serotonin reuptake inhibitors (SSRIs). Health care providers often start by prescribing an SSRI. These antidepressants generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs include duloxetine (Cymbalta, Drizalma Sprinkle), venlafaxine (Effexor XR), desvenlafaxine (Pristiq) and levomilnacipran (Fetzima).
• Atypical antidepressants. These antidepressants are called atypical because they don't fit neatly into any of the other antidepressant categories. More-commonly prescribed antidepressants in this category include trazodone, mirtazapine (Remeron), vortioxetine (Trintellix), vilazodone (Viibryd) and bupropion (Forfivo XL, Wellbutrin SR, others). Bupropion is one of the few antidepressants not frequently associated with sexual side effects.
• Tricyclic antidepressants. Tricyclic antidepressants — such as imipramine, nortriptyline (Pamelor), amitriptyline, doxepin and desipramine (Norpramin) — tend to cause more side effects than newer antidepressants. So tricyclic antidepressants generally aren't prescribed unless you've tried other antidepressants first without improvement.
• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, often when other medicines haven't worked. This is because they can have serious side effects. Using an MAOI requires a strict diet because of dangerous (or even deadly) interactions with foods that contain tyramine — such as certain cheeses, pickles and wines — and some medicines, including pain medicines, decongestants and certain herbal supplements. Selegiline (Emsam), an MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs. These medicines can't be combined with SSRIs or other medicines that increase serotonin.
• Other medications. Your health care provider may recommend combining two antidepressants. Or your provider may add other medicines to improve antidepressant effects. This is called augmentation. Examples of antidepressant augmentation medicines include aripiprazole (Abilify), quetiapine (Seroquel) and lithium (Lithobid).