9 Common Types of Antidepressants and How They Work

Depressed lady with a dog lying down on a mattress on the floor.

Antidepressants are commonly used to treat depression, a serious mental health disorder that causes persistent feelings of sadness and loss of interest in once pleasurable activities. Depression impacts how you think, feel, and act and if left untreated it can have a major impact on your overall quality of life. While it is not a cure for depression, antidepressants can help reduce depression symptoms by helping to stabilize and balance neurochemicals. Each drug works in a slightly different way, and if one medication type does not relieve your symptoms, there are others or combinations of medications that may have more success. 

What Are the Symptoms of Depression?

Before learning about the types of antidepressant options available and how they work, it is important to understand the signs and symptoms of depression. Depression is a common condition and can occur at any time and at any age. In fact, about one in 15 adults experience depression in any given year, and according to the American Psychiatric Association, one in six people will experience depression at some point in their life. 

Symptoms of depression include:

  • Insomnia or excessive sleep
  • Having a short temper, irritability
  • Loss of interest in hobbies once enjoyed
  • Complete hopelessness
  • Persistent thoughts of something bad happening
  • Thoughts of death, self-harm, or suicide attempts
  • Inability to care for oneself and carry out daily responsibilities 
  • Psychotic symptoms, including delusion or hallucinations

If these symptoms last two or more weeks and represent a significant change from your previous level of functioning, it is possible that you are experiencing symptoms of severe depression. If these symptoms persist over many years, you may be experiencing a chronic form of depression. 

How Is Depression Treated?

Depression may make you feel hopeless, but even in severe cases, depression is treatable. The key? The earlier treatment begins, the more effective it often is. The most common treatments for depression include medication, psychotherapy, or a combination of the two. Treatment doesn’t necessarily mean you need to take medication for the rest of your life, as therapy and lifestyle modifications also play a crucial role in managing depression symptoms. You should know, however, that there is no shame in taking medication for depression.

There are also strategies to help prevent depression through lifestyle choices that can be used in combination with therapy and medication. Try to take steps to control stress and, in times of crisis, reach out to family and friends for support. Seek treatment at the earliest signs of a problem to prevent depression from worsening, while also sticking with long-term maintenance or treatments prescribed by medical professionals. These steps can help lessen the severity of depression and help you move past feelings of paralysis.

Finding the Right Antidepressant

When lifestyle changes and mitigation strategies fail to improve your depression symptoms, your psychiatrist may prescribe an antidepressant. This is a common and proven treatment for depression, with more than 13 percent of American adults regularly taking antidepressants. While there are a number of pharmaceutical options available, different antidepressants work in different ways to ease your depression symptoms and some come with different side effects. According to the Mayo Clinic, when a doctor prescribes you an antidepressant, the following factors are most often considered:

  • Individual symptoms. Depression symptoms vary and certain antidepressants relieve certain types of symptoms better than others. For instance, if you have trouble sleeping, an antidepressant that’s slightly sedating may be the best option. 
  • Possible side effects. Depending on the medication and the person, side effects can vary. More uncomfortable side effects such as dry mouth, weight gain, or sexual dysfunction can make treatment more challenging, but discuss side effects with your doctor to find the option that works best for you.
  • Interaction with other medications. Certain antidepressants can cause potentially dangerous reactions when combined with other medications. Talk to your psychiatrist about medications you’re currently taking. 
  • Pregnancy or breast-feeding. There are risks to taking some antidepressants during pregnancy, and it is important to work with your doctor to determine the best way to manage depression while you’re expecting or planning on becoming pregnant.
  • Underlying health conditions. While some antidepressants can cause issues if you have certain mental or physical health conditions, there are antidepressants that are used to treat multiple physical or mental health conditions in addition to depression.

Types of Antidepressants

Typical antidepressant medications aim to ease your depression symptoms by regulating primary chemical processes that contribute to depression symptoms. Each type, or class, of antidepressant impacts different neurotransmitters associated with depression and commonly fall into the following categories:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants (TCAs)
  • Tetracyclic antidepressant
  • Monoamine oxidase inhibitors (MAOIs)
  • Dopamine reuptake blocker
  • 5-HT1A receptor antagonist
  • 5-HT2 receptor antagonists
  • 5-HT3 receptor antagonist

It is important to note there are less common antidepressant treatments that do not fall into these specific drug classes. Your doctor may also recommend combining two antidepressants or adding other medications to help enhance the antidepressant’s impact. For more information about how these drugs work and their side effects, consult resources provided by the National Institute of Mental Health.

Selective serotonin reuptake inhibitors (SSRIs)

This type of antidepressant is the most commonly prescribed and tends to cause fewer uncomfortable side effects. This medication works by decreasing serotonin reuptake in your brain, leaving more serotonin available. Reuptake is the processes by which secreted neurotransmitters are reabsorbed by a nerve cell, as opposed to by body cells. SSRIs target the reuptake of serotonin, the “feel good” hormone, to boost the body’s serotonin levels and decrease depression symptoms. Common types of SSRIs include: fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs help improve your serotonin and norepinephrine levels in your brain to help limit depression symptoms. Unlike SSRIs, there are some common side effects, including nausea, drowsiness, fatigue, and dry mouth. Examples of SNRI medications include: duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima).

Tricyclic antidepressants (TCAs)

Due to side effects, tricyclic antidepressants are less commonly prescribed unless other antidepressants are not working for you. TCAs also block the reuptake of serotonin and norepinephrine to relieve depression symptoms. Some examples of TCAs include: imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, and desipramine (Norpramin).

Tetracyclic antidepressant

Maprotiline is the best example of this type of medication and is used to treat depression and anxiety. It works by balancing neurotransmitters to ease symptoms of depression.

Monoamine oxidase inhibitors (MAOIs)

Because of potentially serious side effects, MAOIs are often prescribed when other medications have not worked. MAOIs treat depression by stopping the breakdown of norepinephrine, dopamine, and serotonin, and because of how MAOIs negatively interact with other prescription medications, nonprescription drugs, and certain foods, taking them can be more difficult. Examples of this medication include: Tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan).

Dopamine reuptake blocker

This mild dopamine and norepinephrine reuptake blocker is used to treat depression and seasonal affective disorder, as well as helping people quit smoking. Common examples of this type of antidepressant include Wellbutrin, Forfivo, and Aplenzin.

5-HT1A receptor antagonist

This medication is rarely used as a first-line treatment for depression, but it works by balancing serotonin levels and other neurotransmitters. The most common drug in this class is vilazodone (Viibryd), and it is generally only prescribed when other medications do not work or cause troubling side effects.

5-HT2 receptor antagonists

These are considered older drugs and work by altering chemicals in your brain to help prevent depression symptoms. Two 5-HT2 receptor antagonists, nefazodone and trazodone (Oleptro), are primarily used to treat depression.

5-HT3 receptor antagonist

This type of antidepressant treats depression symptoms by changing brain chemical activity, with common side effects including sexual dysfunction and nausea. The best example of a prescribed 5-HT3 receptor antagonist is vortioxetine (Brintellix). 

Possible Side Effects of Antidepressants

Antidepressant side effects can vary depending on the type of medication you are prescribed, and you may need to try several different antidepressants before finding one that improves your symptoms and causes manageable side effects. According to the Food and Drug Administration (FDA), the most common side effects of depression medication include:

  • Nausea
  • Tremor (shaking) 
  • Nervousness 
  • Problems sleeping 
  • Sexual problems
  • Sweating
  • Weight gain
  • Agitation
  • Feeling tired
  • Dry mouth

Although less common, there are more serious and worrying side effects of some antidepressants, and it is important to contact your psychiatrist or doctor immediately if you experience any of the following:

  • Thoughts of suicide 
  • Suicide attempts
  • New or worsening depression
  • New or worsening anxiety
  • Feeling very agitated or restless
  • Panic attacks
  • Trouble sleeping or insomnia
  • New or worsening irritability
  • Acting aggressively, being angry, or violent
  • Increases in blood pressure
  • Acting on dangerous impulses
  • An extreme increase in activity and talking (mania)
  • Other unusual changes in behavior or mood

Antidepressants are considered safe, but it is important to monitor anyone taking an antidepressant for worsening depression or unusual behavior. If you or someone you know experiences suicidal thoughts or ideation while taking an antidepressant, seek emergency help. Over the long-term, antidepressants are thought to reduce suicide risk by improving a person’s mood.

Take The First Step

While not a cure for depression, antidepressants can help reduce depression symptoms by balancing and regulating neurochemicals. Each drug works in slightly different ways, and if one does not relieve your symptoms, there are others available that may work better. When your psychiatrist prescribes antidepressants, they will advise at least six weeks for the medication to work to its full extent. They will also work with you to manage any side effects you may experience. As much as possible, be patient and seek help and treatment for your depression symptoms while antidepressants take effect.

If you’re looking for help with depression symptoms, consider Talkspace Psychiatry — a convenient and inexpensive way to start feeling better.

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