Medications for Depression: The Main Groups Explained

Why there are so many depression medicines

MedlinePlus describes antidepressants as prescription medicines to treat depression, and says there are many types that each work differently. Our bodies and brains differ too, so one medicine will not suit everyone. That is why a list of options is good news: if one group does not fit, there are others to discuss.

A prescriber weighs several things when thinking about a first choice. MedlinePlus lists the symptoms that bother you most, the other medicines and supplements you take, whether a medicine helped a close relative, your other health conditions, and whether you are pregnant, planning a pregnancy or breastfeeding.

The commonly prescribed groups

The National Institute of Mental Health (NIMH) names three commonly prescribed types. It says they improve the symptoms of a broad group of depressive and anxiety disorders and are associated with fewer side effects than older antidepressants.

• SSRIs, or selective serotonin reuptake inhibitors. Sertraline is one example. Its label approves it for major depressive disorder and several other conditions, including panic disorder and posttraumatic stress disorder.
• SNRIs, or serotonin and norepinephrine reuptake inhibitors. Venlafaxine extended-release capsules are one example. The label approves them for adults with major depressive disorder and three anxiety disorders.
• NDRIs, or norepinephrine-dopamine reuptake inhibitors. NIMH lists this as the third type. Bupropion is presumed to act on norepinephrine and dopamine, according to its label, and does not block the reuptake of serotonin.

Atypical and older antidepressants

MedlinePlus describes atypical antidepressants as newer medicines that do not fit the other groups. Our medicine library has a page for each one and says what each is approved for.

The older types include tricyclic antidepressants, tetracyclics and monoamine oxidase inhibitors (MAOIs). MedlinePlus says a provider might suggest one of these if newer medicines have not helped. They may cause more serious side effects, though the benefits may outweigh the risks for some people. NIMH makes the same point: older medicines are associated with more side effects, and they may be the best option for some.

MAOIs also come with a safety rule for other antidepressants. The sertraline label says it must not be taken with an MAOI or within 14 days of stopping one, because of an increased risk of serotonin syndrome. That is one of many reasons to tell a prescriber everything you take.

Combination and specialized options

Some people need more than one approach. MedlinePlus says a provider may suggest combining two antidepressants, using another kind of medicine with an antidepressant, or adding talk therapy. NIMH notes that atypical antipsychotics are sometimes used for depression in people who have not responded to an antidepressant alone, and that mood stabilizers may sometimes be prescribed to boost the effect of depression medicines. Whether a given use is FDA-approved or off-label depends on the medicine, and our medicine pages spell that out.

Esketamine works differently. NIMH describes it as an FDA-approved nasal spray for treatment-resistant depression, which may be diagnosed when symptoms do not improve after trying at least two antidepressants. The label says it is only available through a restricted program, is a Schedule III medicine, and is given in certified healthcare settings, with monitoring for at least two hours afterward. It is not something an online visit can provide.

What every group has in common

NIMH says antidepressants take time to work, usually 4 to 8 weeks, and common side effects of SSRIs and other antidepressants include upset stomach, headache and sexual dysfunction. These are generally mild and tend to go away with time, though everyone responds differently.

Antidepressant labels carry a boxed warning. It says these medicines increased the risk of suicidal thoughts and behaviors in children, teens and young adults, and that everyone taking one should be closely monitored for worsening or new suicidal thoughts. NIMH says this watching matters at every age, especially in the first few weeks.

How we can help

A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine with more than three decades of practice, offers online depression treatment by secure video for people physically located in Pennsylvania or New York during each visit. Whether any medicine is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, using our medication care contact form.

Our therapists do not prescribe. They see clients in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York, and you can read about depression therapy with them.

If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services.