A Guide to Antidepressants

If you're among the 17 million Americans suffering from depression, a condition in which prolonged feelings of sadness and hopelessness interfere with the ability to function normally, you may be feeling overwhelmed by the alphabet soup of medications--SSRIs, SNRIs, NDRIs, TCAs, MAOIs--from which to choose. How can you determine which one is right for you? The first, most important step is to consult with a medical professional, who will not only help you decide and write a prescription, but also offer additional treatment if needed. Before you visit a doctor, here's a summary of the four primary classes of antidepressants.

Selective Serotonin
Reuptake Inhibitors (SSRIs).
Because they trigger fewer side effects, SSRIs are the most prescribed antidepressants, according to the National Institutes of Mental Health (NIMH). They prevent the reabsorption of serotonin by the nerve cells that send messages, making the neurotransmitter more available to the synapse and the recipient cells and thus stimulating them. Most commonly known by the names Paxil, Prozac, and Zoloft, SSRIs can also trigger some side effects, such as anxiety, insomnia, nausea, decreased sex drive, and headaches.

Atypical Antidepressants.
Atypical antidepressants, which act much like SSRIs by suppressing reuptake activity in the nerve cells, include both serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor, and norepinephrine-dopamine reuptake inhibitors (NDRIs), such as Wellbutrin. The newest group of depression medications, they allow for greater levels of norepinephrine and serotonin or norepinephrine and dopamine in the brain. Raising the availability of all three neurotransmitters has been shown to help alleviate the symptoms of depression.

Tricyclic Antidepressants (TCAs).
First prescribed in the 1950s to treat depression, TCAs also curb the reuptake process but are much more apt to produce side effects such as drowsiness, dry mouth, constipation, and blurred vision. They're often prescribed when treatments with SSRIs and atypical antidepressants prove ineffective.

Monoamine Oxidase Inhibitors (MAOIs).
The oldest class of antidepressants, which stop the breakdown of monoamine neurotransmitters, MAOIs are often the last medication doctors turn to because of their powerful interaction with food and beverages containing tryamine, such as wine, chocolate, and several types of cheeses. Consuming such items while taking an MAOI can lead to sudden spike in blood pressure, putting you at a greater risk for a heart attack or stroke.

The Next Steps

Once you and your doctor have determined the best course of pharmacological treatment, it's important to keep a list of the drug's side effects on hand, take careful note of changes in your eating or sleeping habits, and contact your doctor immediately if you start to have any suicidal thoughts. About 60 percent of people diagnosed with depression will have success with the first antidepressant they try, according to the NIMH. If you're not among them, don't get discouraged: Additional NIMH-funded research has established that those who did not get well after taking one antidepressant increased their chances of relieving their symptoms when they switched to a different medication or combined it with another.

Since many antidepressants require anywhere from two to six weeks to take effect, patience is key, as is an open line of communication with your doctor; in addition to any side effects you may experience, he or she should also be aware of all prescriptions and over-the-counter supplements or medicines you might be taking (e.g., serotonin syndrome can occur when some antidepressants are mixed with triptan-based migraine medications or herbal supplements). Most importantly, you should combine whatever form of medication you choose with a method of talk therapy. A University of Pennsylvania study published in 2005 found that when medication and cognitive therapy were used in tandem to treat depression, the relapse rate significantly decreased.