Selective Serotonin Reuptake Inhibitors (SSRI's) enhance serotonin levels in the brain. The first SSRI, Prozac (fluoxetine), caused such a sensation because it was the first truly new treatment for depression. It is less sedating than the TCA's, and the increased serotonin levels gave many people a sense of well-being. As with any medication, there were side effects such as weight gain and loss of sex drive. Some people claimed that Prozac made them feel suicidal and sought to sue the manufacturer, but the judges dismissed the suits in all cases. The newest and "cleanest" SSRI is Lexapro (escitalopram), which has fewer side effects and also appears to "work" more quickly than some of the others. Loss of sex drive is pretty much inherent with SSRI's, however, including Lexapro.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRI's) affect both norepinephrine and serotonin levels in the brain. The first was Effexor (venlafaxine), which has proved efficacious for agitated or anxious depressions, though it has a withdrawal syndrome and must be withdrawn gradually.
There seem to be quite a few unique action or one-of-a-kind antidepressants available. One, Desyrel (trazodone), is one of the older ones and is quite sedating, so nowadays it is most frequently used for treating insomnia. Remeron (mirtazapine) seems to be a good choice for anxious depressions or even for PTSD (post traumatic stress disorder). Its drawbacks are weight gain and sedation. Wellbutrin (bupropion) affects norepinephrine levels in the brain, and is the only antidepressant that directly affects dopamine levels. It works well for depressions in which the person sleeps a lot, has little energy, and eats a lot. Unlike most other antidepressants, weight gain and loss of sex drive are not a problem with Wellbutrin whose side effects include nausea and anxiety.
There are some things that all people should know about antidepressants:
They all have the potential for side effects, though not everyone who takes them experiences side effects.
Most antidepressants are effective for about 70-80% of people with depression. That means that, if you're one of the 20-30% whose depression doesn't respond to antidepressant A, it has a good chance of responding to another antidepressant.
Benzodiazepines - Valium (diazepam), Ativan (lorazepam), Xanax (alprazolam), etc. - are not antidepressants. They are anxiolytics - used for treating anxiety. High doses and long-term use of benzodiazepines can worsen depression, as well as lead to addiction.
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