Based on "Essential Psychopharmacology"
written by Stephen M. Stahl, MD, PhD
Up-to-date comprehensive listing includes most of the antidepressant medications in the current use. Categorized by type (or biochemical family), generic names are listed first followed by the trade names examples.
Common features of all antidepressants:
- 1. All antidepressants work by increasing the levels of neurotransmitters (chemical messengers) in the brain.
- 2. Antidepressants are NOT controlled substances.
- 3. Antidepressant drugs improve depressive symptoms at about the same rate.
|Generic Name||Brand Name|
|Brexanolone (GABA A receptor modulator)||Zulresso, March 2019|
|Vortioxetine (serotonin modulator and stimulator)||Brintellix, approved September 2013|
|Levomilnacipran (SNRI)||Fetzima, approved July 2013|
|Vilazodone (SSRI)||Viibryd, approved January 2011|
Selective Serotonin Reuptake Inhibitors (SSRIs)
|Fluoxetine||Prozac, Sarafem; Pexeva|
|Paroxetine||Paxil, Paxil CR|
Selective serotonin reuptake inhibitors are the most widely prescribed antidepressants. SSRIs selectively inhibit the reuptake of serotonin resulting in increased serotonin concentration in the brain.
Main beneficial features of SSRIs over older antidepressants (MAOIs and TCAs):
- Low overdose toxicity potential.
- Low risk of severe systemic adverse effects, especially anticholinergic and cardiovascular side effects.
The major drawbacks of SSRIs:
- Sexual dysfunction, which is the most common SSRI-induced side effect that leads to drug discontinuation.
Tricyclic Antidepressants (TCA)
|Amitriptyline||Elavil, Endep, Levate|
|Maprotiline||Deprilept, Ludiomil, Psymion|
|Mianserin||Bolvidon, Norval, Tolvan|
Tricyclic antidepressants represent the oldest class of drugs for depression. Currently TCAs are considered second-line antidepressants in cases when SSRIs are ineffective or as adjunct therapy with newer drugs. TCAs act as non-selective inhibitors of the reuptake of serotonin and norepinephrine.
Advantages of TCAs:
- Proven efficacy.
- Low cost.
Drawbacks of TCAs:
- Adverse effects such as orthostatic hypotension, anticholinergic effects, cardiovascular effects (arrhythmias and tachycardia).
- Overdose toxicity.
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
|Venlafaxine||Effexor, Effexor XR|
Unlike SSRI antidepressants SNRIs block the reuptake of both serotonin and noradrenaline. Generally, SNRIs have side effect profile as SSRIs, but are more likely to produce anticholinergic side effects.
Noradrenergic and Specific Serotonergic Antidepressant (NaSSA)
|Mirtazapine||Remeron, Remeron SolTab|
Mirtazapine enhances the presynaptic release of serotonin and norepinephrine in the brain. It works via antagonist activity in the presynaptic alpha 2-adrenergic receptors.
Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)
|Bupropion||Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban; Aplenzin|
|Atomoxetine (Norepinephrine reuptake Inhibitor)||Strattera|
|Agomelatine (5-HT2C receptor antagonist)||Valdoxan|
(5HT1A receptor agonist)
|Tandospirone (azapirone, 5HT1A receptor agonist)||Sediel|
(Serotonin reuptake enhancer)
(5HT2-receptor antagonist, triazolopyridine-derivative)
|Desyrel, Apo-Trazodone, Oleptro|
(Norepinephrine Reuptake Inhibitor)
|Viloxazine (Norepinephrine Reuptake Inhibitor)||Vivalan|
(Selective serotonin reuptake inhibitor, Serotonin 5HT 1A receptor agonist)
|Serotonin Modulator and Stimulator|
Monoamine Oxidase Inhibitors (MAOIs)
|Selegiline||Emsam (transdermal patch)|
Monoamine Oxidase Inhibitors (MAOIs) are irreversible inhibitors of the enzyme monoamine oxidase. MAOIs inactivate neurotransmitters norepinephrine, serotonin, and dopamine. Currently MAOIs have a place in treating Parkinson's disease, atypical depression, as well as depression that does not respond to other antidepressant drugs.
The main dangers of MAOIs:
- Dietary restrictions. MAOIs have potentially lethal interactions with foods and drugs containing tyramine. Foods containing tyramine include cheese, smoked meats, and red wine.
- Potential to cause a hypertensive crisis and serotonin syndrome.
- Risk of orthostatic hypotension
Advantages of MAOIs:
- Effective for atypical depression.
- Highly effective for mood and anxiety disorders.
- Minimal anticholinergic and antihistamine effects.
Examples of mood stabilizers used to treat depressive symptoms are:
|Lithium||Eskalith, Lithane, Lithobid|
|Quetiapine||Seroquel, Xeroquel, Ketipinor|
Certain atypical antipsychotics licensed to treat depression are:
- 1. New FDA Approved Drugs for Psychiatry/Psychology CenterWatch
- 2. Rexulti® (brexpiprazole) Prescribing Information PDF
Last updated: April 08, 2019