When people hear the word antidepressant, they often think of drugs like Zoloft and Prozac. These names have been around for years and are often referenced on TV and in the movies, but there are many more medications now available for the treatment of depression. So, just to review the classic antidepressants, and don’t get me wrong, they’re classics for a reason because of their long history of use and efficacy. When you find the right medication for you, it can make all the difference, so this isn’t a comparison of which is better than the other. Instead, think of this as a menu of possibilities. 

1. SSRIs: (Selective Serotonin Reuptake Inhibitors) Prozac, Zoloft, Paxil, Celexa, Lexapro, and Fluvox. This class is FDA approved for the treatment of depression and anxiety. Some of these medications also have secondary approval for OCD, PTSD, and premenstrual distress disorder.
2. SNRIs: (Selective Norepinephrine Reuptake Inhibitor) Cymbalta, Effexor, Pristiq, Fetzima. This class is FDA approved for depression, and some are approved for anxiety, social anxiety, and neuropathic pain (Cymbalta). 
3. TCAs: (Tricyclic Antidepressants) Amitriptyline, Anafranil, Pamelor, Imipramine
4. MAOIs: (Monoamine Oxidase Inhibitors) Marplan, Nardil, Emsam, Parnate. These are not commonly used due to side effects 
5. Others: Medications that don’t fall into one of the classes listed above but have been used as antidepressants for a long time include Wellbutrin (dopamine and norepinephrine receptor uptake inhibitor), Remeron and Trazodone (used more for sleep). 

The medications listed above are some of the older and more common antidepressants that you may have heard of or even tried. Even though some medications may be listed in the same family, you may not react the same to each medication. This can often add to the frustration around treatment for depression. It can often take 4 to 6 weeks for medications to reach their full potential, including any side effects depending on the specific medication. Switching medications can take time which can often add to the length of time that it may take to feel better. 

Today, newer medications and older medications with updated FDA approval can allow for adjunct or combination treatment for depression, including: 

1. Rexulit (brexpiprazole)
2. Abilify (aripiprazole)
3. Vraylar  (cariprazine) 
4. Seroquel (quetiapine) 
5. Symbyax (olanzapine combined with fluoxetine) – used for treatment resistant depression

In 2011 and 2013 two other medications were released for the treatment of depression, Viibryd (vilazodone) and Trintellix (vortioxetine). These two medications also fall into a different class of serotonin medications called multimodal—they work on serotonin in several different ways and may work better or have less side effects compared to other medications. Once more, finding the right medication can be a process, but I often encourage patients not to give up on feeling better. There are still many unknowns when it comes to depression and anxiety so as the research continues, so do the treatments. 

Research that has been in the headlines more recently involves psychedelics. One medication that has been FDA approved for treatment resistant depression (or depression that does not seem to improve no matter how many different medication combinations a patient has tried) and depression with suicidal ideation is Spravato, or esketamine. Most people are more familiar with ketamine, a medication that is used as an anesthetic. Ketamine, also known as racemic ketamine, is made from a combination of two molecules—“R” and “S” ketamine. Spravato only uses the “S” molecule and can be administered as a nasal spray. Ketamine itself has not been FDA approved for treatment resistant depression or depression with suicidal ideation due to lack of research. There have been several research studies that have demonstrated safety and benefits of Spravato. In order to receive this treatment, you must qualify as a candidate and must enroll in a REMS program (Risk Evaluation and Mitigation Strategy). This means that you will be closely monitored during treatment through a standardized protocol. 

The other treatment that is taking up more news headlines is psilocybin-assisted treatment. Some people might not be as familiar with the word psilocybin as they are with where it comes from, psychedelic mushrooms. Even though the use of psychedelic mushrooms dates back to ancient civilizations such as the Aztec and Maya, it wasn’t until the last several years that research was permitted into its therapeutic qualities. As of today Oregon is the only state to fully decriminalize its use. There are treatment centers still researching its benefits, however this includes a lot of preparation and structured support from therapists and trained clinicians. The research so far does seem encouraging with the effects of this treatment lasting for up to 12 months after treatment. 

Taken altogether, modern medicine offers a wide variety of both old and new antidepressants that are both safe and effective. Working closely with your healthcare provider to find the right medication or combination of medications will give you the best chance of mitigating or managing your depression as you journey on your path to healing. 

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