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Top 5 antidepressants to treat depression

The top 5 antidepressants to treat depression include SSRIs, SNRIs, atypical antidepressants, serotonin modulators, and cyclic antidepressants.

Antidepressants are prescription medicines used to treat depression. They are often used for treating other psychological disorders, such as anxiety disorders.

There are different types of antidepressants based on the way they work (mechanism of action), which include the following:

1. Selective serotonin reuptake inhibitors (SSRIs)

The most prescribed antidepressants by physicians are due to the low side effects experienced with these drugs.

SSRIs work by increasing the serotonin levels in the brain that are comparatively low during the depression. Serotonin is a hormone that stabilizes moods and causes feelings of well-being and happiness.

Other functions of serotonin include:

• Regulates sleep and wake cycle
• Reduces anxiety

Once the serotonin exhibits its function, the nerve cells reabsorb (reuptake) the serotonin to terminate their action. When serotonin levels are low, reuptake can restrict the amount of serotonin being circulated actively in the brain. SSRIs prevent serotonin reuptake, thereby increasing the serotonin levels circulating in the brain.

Some of the commonly prescribed SSRIs include:

• Citalopram
• Escitalopram
• Fluoxetine
• Fluvoxamine
• Paroxetine
• Sertraline

Common side effects observed with SSRIs include:

• Dry mouth
• Nausea
• Headaches
• Nervousness
• Restlessness
• Trouble sleeping
• Sexual problems

2. Serotonin and norepinephrine reuptake inhibitors (SNRIs)

They are often prescribed due to their superior efficacy and safety profile. SNRIs work by increasing serotonin and norepinephrine levels in the brain. Norepinephrine is a hormone and a neurotransmitter responsible for transmitting signals across nerve endings.

Some of the functions of norepinephrine in the brain include:

• Regulating sleep and wake cycle
• Increasing attention
• Memory storage
• Improving focus while performing a task
• Improves alertness and energy

Norepinephrine and serotonin are responsible for preventing depression symptoms. SNRIs prevent the reuptake of serotonin and norepinephrine by the nerve cells, thus increasing their level in the brain.

Some of the common SNRIs include:

• Duloxetine
• Venlafaxine
• Desvenlafaxine

Common side effects of SNRIs include:

• Trouble sleeping
• Lack of energy
• Dry mouth
• Constipation
• Weight loss
• Nausea (especially in the first two weeks)
• Loss of appetite
• Anxiety and nervousness
• Headaches
• Sexual problems
• Increased heart rate
• Increased cholesterol levels

3. Atypical antidepressants

Atypical depressants, as the name suggests, are not typical antidepressants due to their distinct mechanism of action.

Atypical antidepressants increase dopamine, serotonin, or norepinephrine levels in the brain. They have multiple mechanisms of action and are commonly prescribed when other antidepressants do not improve depression symptoms.

Some of the common atypical antidepressants include:

• Wellbutrin SR, Wellbutrin XL, others (bupropion)
• Remeron (mirtazapine)
• Nefazodone
• Trazodone
• Viibryd (vilazodone)
• Trintellix (vortioxetine)

Some of the common side effects of atypical antidepressants include:

• Dry mouth
• Dizziness
• Light-headedness
• Nausea
• Fatigue
• Nervousness
• Diarrhea
• Headache

4. Serotonin modulators

These involve drugs that work to improve serotonin levels in the brain. They work by modifying one or more serotonin receptors and inhibiting the reuptake of serotonin.

Some of the commonly used serotonin modulators include:

• Nefazodone
• Trazodone
• Vilazodone
• Vortioxetine

Some of the side effects of serotonin modulators include:

• Nausea
• Dry mouth
• Dizziness
• Constipation
• Blurred vision
• Weakness
• Sleepiness

5. Cyclic antidepressants

There are two types of cyclic antidepressants depending on their structure: tricyclic and tetracyclic antidepressants. They prevent the reuptake of serotonin and norepinephrine in the brain, thus elevating mood and alertness.

Tetracyclic and tricyclic antidepressants prevent the reuptake of norepinephrine and serotonin into the nerves. It increases the level of norepinephrine and serotonin in the blood. They affect several other chemicals in the brain, thereby increasing the risk of side effects. Hence, they are not generally preferred by doctors to treat depression.

Some of the commonly used cyclic antidepressants are:

• Tetracyclic antidepressants
  • Maprotiline
  • Mirtazapine
• Tricyclic antidepressants
  • Amitriptyline
  • Desipramine
  • Doxepin

Common side effects of tetracyclic and tricyclic antidepressants include:

• Drowsiness
• Increased appetite
• Weight gain
• Dizziness
• Elevated cholesterol levels
• Dry mouth
• Constipation

Other antidepressant rankings

6 most effective antidepressants sold in the United States

1. Amitriptyline
2. Effexor (venlafaxine)
3. Lexapro (escitalopram)
4. Paxil (paroxetine)
5. Remeron (mirtazapine)
6. Trintellix (vortioxetine)

5 most tolerated antidepressants

1. Celexa (citalopram)
2. Lexapro (escitalopram)
3. Prozac (fluoxetine)
4. Trintellix (vortioxetine)
5. Zoloft (sertraline)

3 least effective antidepressants sold in the United States

1. Luvox (fluvoxamine)
2. Oleptro (trazodone)
3. Prozac (fluoxetine)

6 least tolerated antidepressants sold in the United States

1. Amitriptyline
2. Anafranil (clomipramine)
3. Cymbalta (duloxetine)
4. Effexor (venlafaxine)
5. Luvox (fluvoxamine)
6. Oleptro (trazodone)

Side effects of various antidepressants

Table. The side effect profile for the top five antidepressants Generic name Brand name

• Dry mouth
• Blurred vision
• Trouble urinating
• Constipation
• Dizziness

Drowsiness Trouble sleeping, Jitteriness Nausea, Vomiting, Diarrhea Weight gain Sexual problems Selective serotonin reuptake inhibitors (SSRIs)

Citalopram
Celexa
None
None
Very low
Very low
Very low
Moderate

Escitalopram
Lexapro
None
None
Very low
Very low
Very low
Moderate

Fluoxetine
Prozac, Sarafem
None
None
Low
Very low
Very low
Moderate

Fluvoxamine
Luvox (only sold as generic in the United States)
None
Very low
Very low
Very low
Very low
Moderate

Paroxetine
Paxil, Pexeva, others
Very low
Very low
Very low
Very low
Low
High

Sertraline
Zoloft
None
None
Low
Low
Very low
Moderate

Atypical agents

Bupropion
Wellbutrin, Aplenzin, others
None
None

Quick-release: Low

Sustained-release: Very low
Very low
None
None

Mirtazapine
Remeron
Very low
High
None
None
High
Very low

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Desvenlafaxine
Pristiq, Khedezla
None
Very low
Low
Very low (after week 1)
None
Moderate

Duloxetine
Cymbalta
None
None
Low
Low
None
Moderate

Levomilnacipran
Fetzima
Very low
None
Very low
Low
None
Low

Milnacipran
Savella
None
Very low
None
Low
None
Low

Venlafaxine
Effexor
None
Very low
Low

Quick-release: Low

Extended-release: Very low
None
Moderate

Serotonin modulators

Trazodone
Desyrel
None
High
None

Sleep-aid dose: Very low

Antidepressant dose: Moderate

Sleep-aid dose: None

Antidepressant dose: Very low
Very low

Vilazodone
Viibryd
None
None
Low
High
None
Low

Vortioxetine
Trintellix
None
None
Very low
Very low
Very low
Low

Cyclic antidepressants

Amoxapine
Asendin
Low
Low
Low
None
Low
Unknown

Maprotiline
Ludiomil
Low
Moderate
None
None
Low
Unknown

Mirtazapine
Remeron
Low
Moderate
None
None
Very low
None