Antidepressants are drugs for the treatment of depression . Despite their name, they are often used to treat a wide range of other conditions, on- or off-label , for conditions such as anxiety disorders , obsessive compulsive disorder , eating disorders , chronic pain , neuropathic pain , and some hormone-mediated disorders such as dysmenorrhea , and for snoring , migraines , attention-deficit hyperactivity disorder (ADHD), substance abuse , and occasionally even insomnia or other sleep disorders . Antidepressants can be used both alone or combination with other medications. Most antidepressants have a delayed onset of action (2–6 weeks) but for those who respond well to a given drug, some degree of efficacy is often seen after one week. Many off-label or recreational drugs can produce an antidepressant effect, but their use is controversial.
Serotonin–norepinephrine reuptake inhibitors ( SNRIs ) are a class of antidepressant drugs used in the treatment of major depression and other mood disorders . They are sometimes also used to treat anxiety disorders , obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), chronic neuropathic pain , fibromyalgia syndrome (FMS), and for the relief of menopausal symptoms. SNRIs act upon, and increase, the levels of two neurotransmitters in the brain known to play an important part in mood: serotonin , and norepinephrine .
Venlafaxine ( brand name : Effexor or Efexor ) is an antidepressant of the serotonin-norepinephrine reuptake inhibitor (SNRI) class. [ 2 ] [ 3 ] [ 4 ] First introduced by Wyeth in 1993, now marketed by Pfizer , it is licensed for the treatment of major depressive disorder (MDD), as a treatment for generalized anxiety disorder , and comorbid indications in certain anxiety disorders with depression. In 2007, venlafaxine was the sixth most commonly prescribed antidepressant on the U.S. retail market, with 17.2 million prescriptions. [ 5 ] [ edit ] Medical uses Venlafaxine is used primarily for the treatment of depression , general anxiety disorder , social phobia , panic disorder , and vasomotor symptoms . [ 6 ] At low doses (<150 mg/day), it acts only on serotonergic transmission.
Chemical structure of the prototypical NaSSA mirtazapine (Remeron). Noradrenergic and specific serotonergic antidepressants ( NaSSAs ) are a class of psychiatric drugs used primarily as antidepressants . [ 1 ] They act by antagonizing the α 2 -adrenergic receptor and certain serotonin receptors such as 5-HT 2A and 5-HT 2C , [ 1 ] but also 5-HT 3 , [ 1 ] 5-HT 6 , and/or 5-HT 7 in some cases. By blocking α 2 -adrenergic autoreceptors and heteroreceptors , NaSSAs enhance adrenergic and serotonergic neurotransmission in the brain involved in mood regulation, [ 1 ] notably 5-HT 1A -mediated transmission. [ 2 ] In addition, due to their blockade of certain serotonin receptors, serotonergic neurotransmission is not facilitated in unwanted areas, which prevents the incidence of many side effects often associated with selective serotonin reuptake inhibitor (SSRI) antidepressants; [ 1 ] [ 3 ] hence, in part, the " specific serotonergic " label of NaSSAs. [ 2 ] [ edit ] List of NaSSAs
Mirtazapine ( Remeron , Avanza , Zispin ) is a noradrenergic and specific serotonergic antidepressant (NaSSA) which was introduced by Organon International in the United States in 1990 and is used primarily in the treatment of depression . It is also commonly used as an anxiolytic , hypnotic , antiemetic , and appetite stimulant . Structurally, mirtazapine can also be classified as a tetracyclic antidepressant (TeCA). It is broadly classified as a centrally acting α 2 -adrenergic receptor antagonist.
Mianserin Mianserin ( Bolvidon , Depnon , Norval , Tolvon , Lerivon ) is a psychoactive drug of the tetracyclic antidepressant (TeCA) therapeutic family. It is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA) and has antidepressant , anxiolytic , hypnotic , antiemetic , orexigenic , and antihistamine effects. It was previously available internationally, however in most markets it has been phased out in favor of its analogue and successor mirtazapine (Remeron).
Milnacipran ( Ixel , Savella , Dalcipran , Toledomin ) is a serotonin–norepinephrine reuptake inhibitor (SNRI) used in the clinical treatment of fibromyalgia . It is not approved for the clinical treatment of major depressive disorder in the USA, but it is in other countries. [ edit ] History Milnacipran was first approved for the treatment of major depressive episodes in France in December 1996. It is currently marketed (as Ixel ) for this indication in over 45 countries worldwide including several European countries such as Austria , Bulgaria , Finland , France , Portugal , and Russia . It is also available in Japan (as Toledomin ) and Mexico (as Dalcipran ).
Duloxetine (sold under the brand names Cymbalta , Ariclaim , Xeristar , Yentreve , Duzela ) is a serotonin-norepinephrine reuptake inhibitor (SNRI) manufactured and marketed by Eli Lilly . It is effective for major depressive disorder and generalized anxiety disorder (GAD). Duloxetine failed the US approval for stress urinary incontinence amidst concerns over liver toxicity and suicidal events; however, it was approved for this indication in Europe, where it is recommended as an add-on medication in stress urinary incontinence instead of surgery. [ 1 ] It can also relieve the symptoms of painful peripheral neuropathy , particularly diabetic neuropathy , [ 2 ] [ 3 ] and it is used to control the symptoms of fibromyalgia . [ edit ] Medical uses
Desvenlafaxine ( brand name : Pristiq ), also known as O -desmethylvenlafaxine , is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class developed and marketed by Wyeth (now part of Pfizer ). Desvenlafaxine is a synthetic form of the major active metabolite of venlafaxine (sold under the brand names Effexor and Efexor). It is being targeted as the first non-hormonal based treatment for menopause . [ 1 ] [ edit ] Approval status
A norepinephrine-dopamine reuptake inhibitor ( NDRI ) is a drug that acts as a reuptake inhibitor for the neurotransmitters norepinephrine and dopamine by blocking the action of the norepinephrine transporter (NET) and the dopamine transporter (DAT), respectively. [ 1 ] This in turn leads to increased extracellular concentrations of both norepinephrine and dopamine and, therefore, an increase in adrenergic and dopaminergic neurotransmission . [ 1 ] [ edit ] Uses Norepinephrine-dopamine reuptake inhibitors are used for Clinical depression , ADD , ADHD , Narcolepsy , and as antiparkinson agents. [ edit ] List of NDRIs
Bupropion ( / b juː ˈ p r oʊ p i . ɒ n / bew- PROH -pee-on ; [ 1 ] marketed as Wellbutrin , Zyban , Voxra , Budeprion , Prexaton , Elontril or Aplenzin ; and formerly known as amfebutamone [ 2 ] ) is an atypical antidepressant and smoking cessation aid. Its chemical name is 3- chloro - N - tert -butyl-β-ketoamphetamine, a substituted cathinone (β-ketoamphetamine), as well as substituted amphetamine . The drug therefore is a mild psychostimulant.
Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor [ 1 ] ( SSRIs ) are a class of compounds typically used as antidepressants in the treatment of depression , anxiety disorders , and some personality disorders . SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by inhibiting its reuptake into the presynaptic cell , increasing the level of serotonin in the synaptic cleft available to bind to the postsynaptic receptor . They have varying degrees of selectivity for the other monoamine transporters , with pure SSRIs having only weak affinity for the noradrenaline and dopamine transporter .
Sertraline hydrochloride (trade names Zoloft , Lustral ) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It was introduced to the market by Pfizer in 1991. Sertraline is primarily used to treat major depressive disorder in adult outpatients as well as obsessive–compulsive , panic , and social anxiety disorders in both adults and children.
Paroxetine (also known by the trade names Aropax , Paxil , Pexeva , Seroxat , Sereupin ) is an antidepressant drug of the SSRI type. Paroxetine is used to treat major depression , obsessive-compulsive disorder , panic disorder , social anxiety , posttraumatic stress disorder and generalized anxiety disorder [ 1 ] in adult outpatients . Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham , now GlaxoSmithKline . Generic formulations have been available since 2003 when the patent expired. [ 2 ] In adults, the efficacy of paroxetine for depression is comparable to that of older tricyclic antidepressants , with fewer side effects and lower toxicity. [ 3 ] [ 4 ] Differences with newer antidepressants are subtler and mostly confined to side effects. It shares the common side effects and contraindications of other SSRIs, with high rates of nausea, somnolence , and sexual side effects.
Fluvoxamine (Luvox) is an antidepressant which functions as a selective serotonin reuptake inhibitor (SSRI) and σ1 receptor agonist . Fluvoxamine is used for the treatment of major depressive disorder (MDD), obsessive compulsive disorder (OCD), [ 1 ] and anxiety disorders such as panic disorder and post-traumatic stress disorder (PTSD). [ 2 ] Fluvoxamine CR (controlled release) is approved to treat social anxiety disorder . [ 3 ] The FDA has added a Black box warning for this drug in reference to increased risks of suicidal thinking and behavior in young adults and children. A study from the Institute for Safe Medication Practices identified Luvox as being 8.4 times more likely than other medications to be associated with violence. [ 4 ]