What Drugs Are Used to Treat Depression?

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Question:  What drugs are used to treat depression?

Answer:  Depression is generally treated with a type of drug called an antidepressant. 

Antidepressants are medications which affect the brain's levels of substances called neurotransmitters.  Neurotransmitters are chemical messengers in the brain and dpression is believed to occur when certain neurotransmitters are in short supply.  It may be that antidepressants relieve depression by making more of these chemical messengers available for use.

Generallly, antidepressants are sorted into classes based upon which particular neurotransmitters they affect, although an older class of antidepressants called tricyclics are classified based upon their chemical structure.

The classes of antidepressants include:

  • Selective serotonin reuptake inhibitors (SSRIs) - SSRIs are believed to work by temporarily preventing nerve cells from reabsorbing serotonin, allowing more of it to be available.  Examples of SSRIs include: citalopram (Celexa), fluoxetine (Prozac) and paroxetine (Paxil, Seroxat).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) - SNRIs work in a similar manner to SSRIs, but are also able to block the reabsorption of norepinephrine.  Examples include:  desvenlafaxine (Pristiq), duloxetine (Cymbalta) and venlafaxine (Effexor).
  • Monoamine oxidase inhibitors (MAOIs) - MAOIs exert their antidepressant effect by inhibiting the monoamine oxidase enzyme.  When it is blocked, the neurotransmitters dopamine, serotonin, and norepinephrine cannot be broken down, causing more of these chemicals to be available.  MAOIs can be either reversible or irreversible, depending upon whether they are capable of permanently blocking monoamine oxidase.  The irreversible type of MAOI is now less commonly prescribed due to its potential to produce a sometimes fatal interaction with tyramine, a substance which is found in certain foods like cured meats and aged cheeses, as well as potentially dangerous interactions with certain other medications.  Examples of irreversible monoamine oxidase inhibitors include:  phenelzine (Nardil), selegiline (Eldepryl, Emsam) and tranylcypromine (Parnate).  The reversible monamine oxidase inhibitors include:  moclobemide (Aurorix, Manerix) and pirlindole (Pirazidol).
  • Tricyclics -Tricyclics block the reabsorption of norepinephrine and serotonin.  The name of this class is derived from the chemical structure of its members, which consist of three interconnected rings of atoms.  This class of antidepressants can be further divided based upon which functional groups, called amines, are attached to them.  Examples of tertiary amine tricyclic antidepressants include:  amitriptyline (Elavil, Endep),  clomipramine (Anafranil) and doxepin (Adapin, Sinequan).  The secondary amine tricyclic antidepressants include:  desipramine (Norpramin), nortriptyline (Pamelor, Aventyl, Noritren) and protriptyline (Vivactil).
  • Others - There are severall antidepressants which have unique modes of action and do not fall within any of the other classes.  Among these antidepressants are:  bupropion (Alpenzin, Budeprion SR, Budeprion XL, Buproban, Wellbutrin, Wellbutrin SR, Wellbutrin XR, Zyban), maprotiline, mirtazapine (Remeron, RemeronSolTab), reboxetine (Edronax, Vestra) and trazodone (Desyrel, DesyrelDividose, Oleptro, Trazodone D).

As with others types of prescription drugs, antidepressants may have certain undesirable side effects.  While side effects will vary with each individual antidepressant, the following are some of the more common ones that many people report:

Sources:

"Drugs, Diseases and Procedures : Drugs, OTC and Herbals: Psychiatrics." Medscape Reference. WebMD LLC. 2013. Accessed: August 28, 2015..

"Recognizing and Treating Depression - Antidepressants to Treat Depression."  WebMD.  WebMD, LLC.  Reviewed by: Joseph Goldberg, MD on January 14, 2015.  Accessed:  August 29, 2015.

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