Depression Medication: Types, Side Effects, and More
Depression isn’t the same for everyone: Multiple types exist, and people experience this treatable illness in varying degrees of severity.
For some people with depression, nonpharmacological interventions like psychotherapy, lifestyle changes, and self-care may be enough to lift the cloud and improve symptoms.
But for many other people, these steps aren’t enough, and medication is needed. About 13 percent of U.S. adults take antidepressants, according to national survey data.
Numerous depression medications are available today. If you’re struggling with depression, talk to your primary care doctor or a mental health professional, such as a psychiatrist, to learn whether an antidepressant may be right for you.
Here’s what to know about the types of antidepressants out there.
Although it’s not clear how SSRIs treat depression, these drugs are known to inhibit the uptake of serotonin (a kind of chemical messenger called a neurotransmitter that helps regulate mood). This means they prevent the body from breaking down serotonin, which in turn helps increase levels of this neurotransmitter in the body.
The following SSRIs are approved by the U.S. Food and Drug Administration (FDA) to treat depression:
citalopram (Celexa)
escitalopram (Lexapro)
fluoxetine (Prozac, Sarafem, Symbyax)
paroxetine (Paxil, Paxil CR, Pexeva)
sertraline (Zoloft)
vilazodone (Viibryd)
vortioxetine (Trintellix)
The most common side effects of SSRIs include:
Nausea
Headache
Sleep problems
Nervousness
Agitation
Shaking (tremors)
Sweating
Fatigue or sleepiness
Sexual side effects
Weight gain
Another class of antidepressants, serotonin and norepinephrine reuptake inhibitors (SNRIs), block the reabsorption of the neurotransmitters serotonin and norepinephrine, making them more available to your brain.
SNRIs that are approved by the FDA to treat depression include:
Tricyclic and tetracyclic antidepressants are older drugs that work by blocking the reabsorption of serotonin and norepinephrine through a different mechanism than SNRIs.
These drugs are not widely used today because they can cause a range of side effects, some of which may be serious, such as disorientation or confusion, but they are sometimes prescribed when other antidepressants don’t work.
Examples of FDA-approved tricyclics are:
amoxapine (Asendin)
amitriptyline (Elavil)
nortriptyline (Aventyl, Pamelor)
desipramine (Norpramin)
doxepin (Sinequan, Silenor)
imipramine (Tofranil)
protriptyline (Vivactil)
trimipramine (Surmontil)
The tetracyclic maprotiline (Ludiomil) is also approved by the FDA for the treatment of depression.
Common side effects of cyclic antidepressants include:
Blurred vision
Constipation
Drop in blood pressure that can cause lightheadedness when going from a seated position to a standing position
Drowsiness
Dry mouth
Urine retention
The oldest class of antidepressants, monoamine oxidase inhibitors (MAOIs), works by blocking the enzyme monoamine oxidase, which breaks down various neurotransmitters in the brain, including serotonin, norepinephrine, and dopamine.
Examples of MAOIs include:
selegiline (Emsam), a skin patch that may cause fewer side effects than MAOIs taken by mouth
isocarboxazid (Marplan)
phenelzine (Nardil)
tranylcypromine (Parnate)
Although MAOIs can sometimes help people with depression that does not respond to other antidepressants, they are not widely used today because of their potential side effects and interactions with certain foods and beverages as well as other drugs.
For example, for people taking MAOIs, ingesting large amounts of the compound tyramine (found in aged cheeses, cured meats, draft beer, sauerkraut, and fermented soy products like miso, tofu, and soy sauce) could cause your blood pressure to rise to a dangerously high level.
You may also experience serious reactions if you take an MAOI with various medications, including:
On rare occasions, MAOIs and other serotonin-containing drugs can cause a potentially life-threatening condition called serotonin syndrome. You may be at risk if you take too much of a serotonin-containing antidepressant or if you combine an MAOI with another prescription antidepressant, certain pain or headache medications, or St. John’s wort (an herbal supplement sometimes used as a home remedy for depression).
Medications that don’t fit into the classes listed above may also treat depression by altering levels of different neurotransmitters in the brain.
A well-known medication called bupropion (Wellbutrin) targets norepinephrine and dopamine and is categorized as a norepinephrine-dopamine reuptake inhibitor. This antidepressant causes fewer sexual side effects than many other antidepressants.
Other so-called atypical medications include:
trazodone (Desyrel)
mirtazapine (Remeron)
vilazodone (Viibryd)
For most atypical antidepressants, the most common side effects include:
Drowsiness
Increased appetite
Blurry vision
Constipation
Dizziness
Dry mouth
While many traditional antidepressants affect levels of serotonin, norepinephrine, or dopamine, a newer class of antidepressants called NMDA receptor antagonists work by helping maintain the balance of glutamate and gamma-aminobutyric acid (GABA). These two neurotransmitters have opposite actions in the body, and the brain typically functions best when they’re balanced.
NMDA receptor antagonists can help people whose symptoms haven’t improved with typical treatments and usually offer more rapid relief than most antidepressants.
The FDA recently approved the following NMDA antidepressants:
esketamine (Spravato), a nasal spray that’s used either alone or in combination with an oral antidepressant
dextromethorphan-bupropion (Auvelity)
Common side effects of Spravato may include:
Feeling disconnected from reality or intoxicated
Dizziness
Feelings of anxiety
Lack of energy or drowsiness
Increased blood pressure
Nausea or vomiting
Decreased sensations of touch or other senses
Common side effects of Auvelity could include:
Dizziness
Diarrhea
Drowsiness
Dry mouth
Excessive sweating
Headache
Sexual problems
Anxiety
Neuroactive steroids are a newer class of medicines that are thought to work by affecting levels of the neurotransmitter GABA in the body. Like NMDA receptor antagonists, they tend to work more quickly than most other antidepressants.
The FDA recently approved the following neuroactive steroids for postpartum depression:
brexanolone (Zulresso), a continuous infusion administered under medical supervision
zuranolone (Zurzuvae)
Zulresso is administered over 2.5 days by a healthcare provider in a certified healthcare facility. It’s only available under a special program because of the side effects it can cause. The most common ones are:
Dry mouth
Flushing
Loss of consciousness
Fatigue or sedation
Zurzuvae is an oral medication to be taken with a fat-containing meal once daily in the evening for 2 weeks. The most common side effects of Zurzuvae include:
Burning or pain while urinating
Cold symptoms like sneezing, sore throat, or stuffy nose
Diarrhea
Dizziness
Weakness, fatigue, or drowsiness
A new class of antidepressants called serotonin receptor agonists are believed to work by targeting certain serotonin receptors, such as the 5-HT1A receptor, in the brain. These receptors help regulate mood and emotions.
The FDA recently approved the serotonin receptor agonist gepirone ER (Exxua) to treat depression.
The most common side effects of Exxua are:
Dizziness
Headache
Nausea
Sleep problems
Stomach pain and upset
Atypical antipsychotics aren’t considered antidepressants. However, several atypical antipsychotics are FDA-approved to treat depression in combination with antidepressants. Doctors sometimes prescribe these drugs to people whose depression hasn’t improved with other treatments. They include:
brexpiprazole (Rexulti)
aripiprazole (Abilify)
cariprazine (Vraylar)
quetiapine (Seroquel XR)
fluoxetine And olanzapine (Symbyax)
Common side effects of atypical antipsychotics, especially when taken long-term, include:
Weight gain
Metabolic dysfunction (a combination of abdominal obesity, high blood pressure, high blood sugar, and elevated triglycerides)
Extrapyramidal symptoms (involuntary movements)
Tardive dyskinesia
Most antidepressants are generally safe, but some people — especially children, teenagers, and young adults under age 25 — may experience an increase in suicidal thoughts, especially during the first few months of treatment or when their dosage goes up or down.
If this happens to you or someone you know, immediately contact a doctor or seek emergency help by contacting the Suicide and Crisis Lifeline (988) or, if the risk is imminent, call 911.
As mentioned, many antidepressants come with side effects, which can vary by type. They usually improve after a couple weeks, but if they don’t, let your doctor know. Your doctor could change the timing or dosage of your antidepressant to help lessen side effects, or they may switch you to another antidepressant and see if that works better for you.
Once you’ve begun taking antidepressants, don’t stop without your doctor’s assistance; discontinuing the medication too soon means your depressive symptoms might come back. When the time is right, your doctor can help you gradually taper your usage. While antidepressants aren’t generally addictive, stopping them abruptly can lead to withdrawal symptoms.
Depression can appear differently in different people, and various treatments are available.
While many find relief through therapy and lifestyle adjustments, some require medication to manage their symptoms effectively.
If you’re considering different treatments, your doctor can guide you in finding what might work best for you.
