Antidepressants Types

The different types of antidepressants vary greatly. In general, they are grouped into classes according to which neurotransmitters they affect and how they affect these neurotransmitters. Monoamine oxidase inhibitors (MAOIs) were the first antidepressants to be developed. They work by blocking monoamine oxidase enzymes (the chemicals that break down neurotransmitters). Currently, MAOIs are rarely prescribed to a patient initially because newer antidepressants have fewer side effects. However, MAOIs remain quite effective for certain disorders, especially when other antidepressants do not work. MAOIs include:

Generic Name

Brand Name

isocarboxazid
Marplan
phenelzine
Nardil
tranylcypromine
Parnate

Tricyclic antidepressants (TCAs) were the only alternatives to MAOIs available for many decades. TCAs block the reuptake of the neurotransmitters norepinephrine, serotonin and, to lesser degrees, dopamine in the brain. In general, physicians and mental health professionals are prescribing TCAs less often as the first course of treatment because the newer antidepressants have fewer side effects. Tricyclic antidepressants include:

Generic Name

Brand Name(s)

amitriptyline
Elavil, Endep
amoxapine
Asendin
clomipramine
Anafranil
desipramine
Norpramin
doxepin
Sinequan, Adapin
imipramine
Tofranil
maprotiline
Ludiomil
nortriptyline
Aventyl, Pamelor
protriptyline
Vivactil
trimipramine
Surmontil

Selective serotonin reuptake inhibitors (SSRIs) are newer antidepressants that have fewer side effects than MAOIs or TCAs. They work by specifically blocking the reuptake of serotonin without affecting levels of norepinephrine or dopamine. SSRIs include:

Generic Name

Brand Name(s)

citalopram
Celexa
escitalopram
Lexapro
fluoxetine
Prozac, Sarafem
fluvoxamine
Luvox
paroxetine
Paxil
sertraline
Zoloft

Norepinephrine and dopamine reuptake inhibitors (NDRIs) work by blocking the reabsorption of dopamine and norepinephrine without affecting serotonin levels. This allows the medications to avoid many serotonin-related side effects (e.g., sexual side effects). The only DNRI available in the United States is bupropion (Wellbutrin, Zyban). Serotonin and norepinephrine reuptake inhibitors (SNRIs) block the reuptake of serotonin and norepinephrine without affecting dopamine levels. These include duloxetine (Cymbalta) and venlafaxine (Effexor). Norepinephrine-serotonin modulators block certain receptors that accept serotonin and norepinephrine. The only medication in this class available in the United States is mirtazapine (Remeron). Some antidepressants specifically block both the reuptake and receptors of serotonin. These serotonin modulators include nefazodone (Serzone) and trazodone (Desyrel).

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