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Antidepressants 101

August 24, 2022

Antidepressants 101

Antidepressants are used to treat depression and anxiety, although higher doses are often required for anxiety. Between 70-80% of people feel much better when they take an antidepressant. There are many good options available, and new ones are always coming onto the market.


How Do Antidepressants Work?

Depression or anxiety emerges when there is an imbalance of important brain chemicals, including serotonin and norepinephrine and sometimes dopamine. Antidepressants help you feel better because they rebalance your brain chemicals to normal levels. Different medications target different chemicals.


Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors are the most commonly prescribed class of antidepressants for PPD and depression in general. They have been around since the late 1980s, and target the brain chemical serotonin, which regulates your mood and anxiety level. Too little serotonin is thought to result in depression and anxiety. These drugs enable more serotonin to bathe the brain in places where it needs to be. The drugs do not create serotonin, but they prevent it from being taken away from key brain regions. The medications in this class are: sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Cipralex, Lexapro). 


Other Antidepressants

Venlafaxine (Effexor) and duloxetine (Cymbalta) are in the class of drugs called selective serotonin/norepinephrine reuptake inhibitors (SNRIs). These medications act on two main brain chemicals or neurotransmitters, serotonin and norepinephrine. Venlafaxine may become more effective as the dose is increased because it also acts on the brain chemical dopamine at high doses. Duloxetine is also used as a medication for pain disorders.

Bupropion (Wellbutrin) is an antidepressant that acts on norepinephrine and dopamine. It is good for depression and may help ADHD, but may not be as good for anxiety disorders.

Mirtazapine (Remeron) is an antidepressant that works on norepinephrine and serotonin and works well for depression and anxiety. It is often helpful for treating insomnia related to PPD.

Vortioxetine (Trintellix) works by having direct effects on various serotonin receptors as well as inhibiting serotonin reuptake. It aims to reduce depressive symptoms and prevent them from returning.


Tricyclic Antidepressants 

Tricyclics, which are good drugs for depression and anxiety, have been in use since the 1950s and were commonly used until SSRIs entered the market. Most TCAs work primarily on norepinephrine, but they also affect serotonin and dopamine. These drugs are as effective as SSRIs, but have become less popular because of their many side effects (weight gain, constipation, sedation, dry mouth, blurred vision, low blood pressure, and urinary retention) and the danger they pose if taken as an overdose. They are also unsafe for women with certain heart problems. TCAs are not commonly prescribed today unless the newer antidepressants have been tried and found to be ineffective. They are more commonly prescribed for chronic pain and sometimes used for insomnia.

Drugs in this class include: amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), nortriptylene (Aventyl, Pamelor), and doxepin (Sinequan). 


Monoamine Oxidase Inhibitors

Monoamine oxidase inhibitors is an older class of antidepressants that work on serotonin, norepinephrine, and dopamine. Although these are very effective antidepressants and anti-anxiety drugs, they are rarely prescribed unless absolutely necessary because they can have very dangerous interactions with certain types of medications and food. Tyramine-containing foods — such as aged and fermented cheeses, smoked meats, favs pecans, soy products, and some beers — should be avoided when taking MAOIs. MAOIS are not commonly used by women with PPD and there is limited data about safety during breastfeeding. For these reasons, and because of the dietary and drug limitations required with MAOIs, they are reserved for women who do not improve with other medications. The drugs in this class include phenelzine (Nardil) and tranylcypromine (Parnate).

Please speak to your primary care physician or psychiatrist to get more details about which medication is the best option to suit your needs.


Written By:

Dr. Ariel Dalfen

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