Medication Treatments for Depression
There are a number of helpful medications for depression. These medications are separated into different classes based on how they work in the brain to help alleviate the symptoms of depression. I will describe these classes below. The majority of them are very safe with few side effects. Choosing which one to start with involves a careful evaluation and weighing out the pros and cons to each one. All medications have about the same effectiveness for patients; all medications have the same likelihood of alleviating symptoms alone and with psychotherapy.
There are some claims that doing genetic testing can help to choose the right antidepressant for an individual patient but the evidence behind those claims has been modest. Pharmacogenetic testing can tell you what medications you might metabolize normally and which ones you may metabolize abnormally. This can give a prescribing clinician some insight into possible risks of side effects but little information about which medication will be best or what doctor’s call “most efficacious.”
As a psychiatrist, the most important piece of information I want to get out there is that while there is a large (almost overwhelming) number of medications, but there are only a handful of classes of medications. If you have tried and not responded to one, maybe two, medications in a particular class, there is no reason to continue to try other medications in that same class. I see too many patients that have been on 4 or 5 medications from the same class without any benefit. It is hard to get insurance to pay for something like esketamine or Transcranial Magnetic Stimulation (TMS). If only one class of medications has been tried.
These are the classes of antidepressants that are used for Depression:
- Selective Serotonin Reuptake Inhibitors (SSRI): Zoloft (sertraline), Prozac (fluoxetine), Lexapro (escitalopram), Celexa (citalopram), Paxil (paroxetine), Luvox (fluvoxamine)
- Serotonin/Norepinephrine Reuptake Inhibitors (SNRI): Effexor (venlafaxine), Cymbalta (duloxetine), Pristiq (desvenlafaxine), Fetzima (levomilnacipran)
- Dopamine/Norepinephrine Reuptake Inhibitors (DNRI): Wellbutrin (bupropion)
- Tricyclic Antidepressants (TCA): Pamelor (nortriptyline), Elavil (amitriptyline), Anafranil (clomipramine), Topramine (imipramine), Norpramin (desipramine)
- Monoamine Oxidase Inhibitors (MAOI): Parnate (tranylcypromine), Nardil (phenelzine), Emsam (selegiline)
- Other – these don’t fit into other classes: Remeron (mirtazapine), Viibryd (vilazodone), Trintellix (vortioxetine), Deseryl (trazodone)
In addition to classes of antidepressants, sometimes medications are added to antidepressants to make them work better; these drugs are called augmentation agents: Abilify (aripiprazole), Rexulti (brexpiprazole), Eskalith (lithium), Cyomel (liothyronine), Stimulants, Buspar (buspirone)
It is important to note that the TCA, MAOIs, and augmentation agents carry significantly more side effects and risks with them than the SSRIs, SNRIs, DNRI, and “other” classes of medications. The “other” class of medications all work through modulating serotonin and norepinephrine but in unique ways. There are also some medications not listed that are sometimes used as “off label” treatments.
A typical strategy is to start with SSRIs or bupropion then move on to SNRIs or the “other” class. TCA and MAOIs are often reserved for people who have not responded to the previously listed classes due to their side effect profile. Realistically, though, after failing to receive symptom benefits from two different class medications, it is time to consider something like TMS which has a higher probability of getting someone well.
At the NeuroScience & TMS Treatment Center, we have several treatment options we can use, beyond common medications and therapy, to aggressively treat you for brain diseases. Learn more about our treatments and services on our Comprehensive Behavioral Health Page.
Blog Post Authors
Michelle Cochran, MD, DFAPA
Founder & Chief Medical Officer • Medical Director, Nashville Locations
Dr. Cochran has been living and working in the Nashville area for over 25 years. She supervises the skilled Nurse Practitioners who work in our clinics. She has been offering TMS services since 2011 and lectures and consults nationally and internationally about TMS. She is Board Certified and is a Distinguished Fellow of the American Psychiatric Association. Learn more about Dr. Cochran.
Jonathan Becker, DO
Medical Director, Brentwood Locations
Dr. Becker is a native of Tennessee, born in Memphis. He completed his undergraduate and master’s degrees in Developmental Psychology at Tulane University in New Orleans before attending Des Moines University for Medical School. He completed his psychiatry residency program at Vanderbilt University and served as a faculty member there for 7 years before transitioning to our office. While at Vanderbilt, Dr. Becker served as the medical director of the neuromodulation service from 2017-2020. Dr. Becker has also published many psychiatric articles. Learn more about Dr. Becker.