Depression can feel like being trapped under a heavy blanket you can’t shake off. It’s exhausting, isolating, and downright unfair. Fortunately, depression medications can help. They use fascinating mechanisms to improve mood and outlook, making it easier to shake off that heavy blanket. Explore various types of depression medications, how they work, and what it means for your mental health.
How Depression Medications Work
The first thing you should know about depression medications is that there’s still a lot we don’t understand. Brain science is complicated, and the conventional explanations for how antidepressants work are akin to saying a car drives because you press on the accelerator. The statement is true, but it tells us nothing about how the engine works.
All we know are the basics, and there are still a lot of unanswered questions. In a nutshell, antidepressants affect neurotransmitters, which are chemicals in the brain that send messages between nerve cells. A glitch in the system—something that stops messages from being sent, received, or understood—can contribute to depression.
Medications aim to fix these glitches by increasing the availability of certain neurotransmitters or balancing their levels. Antidepressants are also thought to induce neuroplasticity, which alters the brain’s structure by strengthening or weakening connections between neurons. The result is a brain that communicates better, which can lead to improved mood, energy, and outlook on life.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are the most commonly prescribed antidepressants. They’re effective, generally well-tolerated, and have fewer side effects than older classes of medications. SSRIs target serotonin, a neurotransmitter often associated with feelings of happiness and calm. Normally, after serotonin does its job, it gets reabsorbed or “recycled” by your brain cells. SSRIs block this recycling process, leaving more serotonin available to enhance mood.
Some common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro). While they’re a game-changer for many patients, SSRIs aren’t perfect. Side effects like nausea, headaches, and changes in sleep patterns may occur. Plus, it can take several weeks to feel their full effects, which requires patience.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs are a step up from SSRIs, boosting norepinephrine alongside serotonin. This neurotransmitter is tied to alertness and energy, so if your depression comes with fatigue, difficulty concentrating, or low motivation, SNRIs might be a good fit. Targeting two neurotransmitters instead of one provides a more comprehensive approach for some people.
Notable SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta). Like SSRIs, SNRIs take time to work and can cause side effects like dry mouth, dizziness, or increased sweating. But when they work, they make a huge difference.
Tricyclic Antidepressants (TCA)
TCAs have been around since the 1950s and laid the groundwork for modern antidepressants. This might make them sound outdated, but don’t underestimate them. TCAs block serotonin and norepinephrine reuptake, just like SNRIs, but they’re less selective in their actions.
Amitriptyline and nortriptyline (Pamelor) are two examples of TCAs. Their ability to affect numerous neurotransmitters makes them powerful but also prone to more side effects like drowsiness, weight gain, and dry mouth. Because of this, TCAs are usually reserved for cases where newer classes of medication haven’t worked. When nothing else does the trick, TCAs can be life-changing.
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs were among the first medications developed to treat depression, and they work differently than any other class. MAOIs block an enzyme called monoamine oxidase, which breaks down serotonin, dopamine, and norepinephrine. Stopping this enzyme from doing its job increases the availability of these chemicals in the brain.
Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate). The biggest drawback is that they require strict dietary restrictions to avoid dangerous interactions with foods like aged cheese, cured meats, and red wine. For this reason, they’re generally reserved for people who haven’t responded to other treatments.
Atypical Antidepressants
Atypical antidepressants don’t fit neatly into any category because they have unique mechanisms of action or target different neurotransmitters.
Bupropion (Wellbutrin) is one standout that affects dopamine and norepinephrine. Unlike many antidepressants, bupropion doesn’t impact serotonin, which means it avoids side effects like weight gain or sexual dysfunction. It’s also a great option for people who struggle with low energy or focus.
Mirtazapine (Remeron) is another atypical medication that works by enhancing serotonin and norepinephrine activity indirectly. It’s often prescribed for people with insomnia, as it tends to make you sleepy.
Mood Stabilizers
Not all depression medications are strictly antidepressants. Mood stabilizers like lithium and lamotrigine are often used for bipolar disorder but can also help with treatment-resistant depression.
Mood stabilizers don’t directly increase neurotransmitters like serotonin or norepinephrine. Instead, they work on the brain’s electrical signaling to prevent extreme highs and lows. For people with significant mood swings or recurring depressive episodes, mood stabilizers provide the steadying hand that antidepressants alone might not offer.
Finding the Right Treatment
Because the brain is so complex, what works for one person might do nothing for another. This is why finding the right medication often involves some trial and error. Your doctor might suggest starting with an SSRI or SNRI, as these are typically the easiest to tolerate. If that doesn’t help, they might pivot to a TCA, MAOI, or atypical antidepressant. In some cases, combining medications or adding a mood stabilizer can make all the difference. Don’t forget another important factor: therapy. Medication and therapy often work better together than either one alone.
Take the Next Step
At Family Psychiatry and Therapy in New Jersey, we know you might feel overwhelmed at the prospect of starting depression medication. That’s why we’ve made it easy to begin your mental health journey with online therapy services. You’ll meet with the same provider consistently in a comforting, confidential environment. Simply talking things out may be enough to improve your mental outlook, but you and your provider might decide that trying medication is worthwhile. The only way to get depression medication is to speak with a healthcare professional, so book your first session today.
