Common Medications Used in the Treatment of Depression

Depression is a prevalent mental health condition that affects millions of people worldwide. Clinically, antidepressants are frequently prescribed to manage various forms of depression. These medications include neurotransmitter reuptake inhibitors, classical tricyclic antidepressants, and tetracyclic antidepressants, each offering effective treatment options depending on the patient's specific condition and symptoms.

Neurotransmitter Reuptake Inhibitors

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are considered the first-line treatment for depression due to their effectiveness and relatively mild side effect profile. Common medications in this category include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram. These drugs primarily enhance serotonin levels in the brain, which helps improve mood and emotional stability. The most common adverse effects include gastrointestinal disturbances such as nausea and diarrhea, along with insomnia, anxiety, and sexual dysfunction. However, these side effects are generally manageable and do not typically interfere with ongoing treatment.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Drugs like venlafaxine and duloxetine fall into this category and are known for their dual action on both serotonin and norepinephrine levels. SNRIs are particularly effective for patients experiencing both depression and anxiety. These medications are well-tolerated within therapeutic doses and are not associated with dependency or addiction. Common side effects may include mild nausea, fatigue, and dry mouth, which usually subside over time.

Norepinephrine and Specific Serotonergic Antidepressants (NaSSAs)

Mirtazapine is a prominent example of this class. Its dual mechanism of action—blocking central alpha-2 adrenergic receptors and certain serotonin receptors—may contribute to its relatively fast onset of action. Mirtazapine provides relief from depression, anxiety, and obsessive thoughts, while also offering sedative properties. The most commonly reported side effects are weight gain and drowsiness, which should be monitored during treatment.

Tricyclic Antidepressants (TCAs)

Doxepin

Doxepin, also known as Sinequan, is a non-selective tricyclic antidepressant that helps alleviate symptoms of depression and anxiety. It also has sedative properties, making it useful for patients with insomnia. Common side effects include dry mouth, constipation, drowsiness, fatigue, and blurred vision. These effects are generally dose-dependent and may diminish with continued use.

Amitriptyline

This medication increases the levels of serotonin and norepinephrine in the brain by blocking their reuptake into nerve cells. It is effective in treating major depressive disorder and is also used off-label for chronic pain and sleep disturbances. Side effects may include dry mouth, blurred vision, dizziness, and gastrointestinal discomfort.

Tetracyclic Antidepressants (TeCAs)

Maprotiline

Maprotiline selectively inhibits the reuptake of norepinephrine in both the central and peripheral nervous systems. It is used for treating depression and anxiety, particularly in patients with prominent mood disturbances. Common side effects include blurred vision, urinary retention, dizziness, and tachycardia, which are primarily related to its anticholinergic properties.

Mianserin

Mianserin enhances norepinephrine levels by blocking presynaptic alpha-2 receptors and also acts on histamine (H1) and serotonin (5-HT2) receptors. This combination of actions contributes to its antidepressant, anxiolytic, and sedative effects. Typical side effects include dry mouth, constipation, and daytime drowsiness, which should be considered when initiating therapy.

Conclusion

While there are many effective antidepressant medications available today, it is essential to follow the guidance of a licensed psychiatrist or mental health professional when starting, adjusting, or discontinuing treatment. Proper monitoring ensures optimal therapeutic outcomes and minimizes the risk of adverse effects. Patients should never stop or alter their medication regimen without consulting a healthcare provider.

References

[1] Wang Xianping, Liu Lirong, Luo Qifeng, Zhou Xinmeng, Qi Fangyi, Chen Guang. Research Progress on Adverse Reactions of Commonly Used Antidepressants in Clinical Practice. Journal of Taizhou University, 2022, 44(06):71-77.

[2] Chen Fuxin. Proper Understanding and Standardized Use of Antidepressants (Part I). Family Medicine, 2022(06):24.