The SSRIs act by inhibiting serotonin reuptake, and are considered the most popular, effective and safe prescription medications. The new prescription SSRIs used to treat depression include citalopram (Celexa), escitalopram oxalate (Lexapro), fluoxetine (Prozac, Prozac Weekly, Sarafem), paroxetine (Paxil, Paxil CR), and sertraline (Zoloft). Citalopram, a chiral compound, has its serotonin reuptake inhibitory activity in the S-enantiomer. Escitalopram, the S-enantiomer of citalopram has demonstrated Antidepressant activity in animal models. Prozac has shown significant success in the treatment of depression and prevention of suicide. It exhibits less potential side effects as compared to TCAs and MAOIs. Paroxetine exhibits anti-cholinergic effect and causes sedation. Zoloft has few drug interactions, but has the side effect of causing diarrhea and male sexual dysfunction.
The currently available SNRIs (desipramine, duloxetine, nefazodone, and venlafaxine) keep both serotonin and norepinephrine at the right level to alleviate depressive symptoms. Nefazodone alleviates anxiety, causes sedation and positively affects sleep. Venlafaxine (Effexor) has significant anticholinergic effects (dry mouth, blurred vision, urinary hesitancy, and constipation), induces sedation and has potential withdrawal effects.
The drug bupropion (Wellbutrin, Wellbutrin SR) is the most commonly used member of the novel Antidepressant class. It is quite unique in its efficiency to inhibit the reuptake of dopamine, serotonin and norepinephrine. Reuptake lowers reception of feel-good brain chemicals. Maprotiline (Ludiomil) and mirtazapine (Remeron) are the two main drugs from the group of tetracyclic Antidepressants. Mirtazapine acts by increasing the amount of noradrenaline and serotonin, and is of benefit in particular for the treatment of depression accompanied with anxiety, agitation and or sleep disturbances.
