Research studies suggest that, in general, all antidepressants work equally well. However, certain people may respond better to one antidepressant over another. In addition, some people may experience intolerable side effects to certain antidepressants, but not others. The only way to truly know whether an individual antidepressant medicine will work for you is to try it.
Your healthcare provider will recommend an antidepressant based on your individual situation, after considering things like what other medicines you are taking, what other medical conditions you may have, and whether any particular antidepressant worked well (or didn't work well) for you in the past.
If that antidepressant doesn't adequately control your symptoms, or if it causes intolerable side effects, your healthcare provider might recommend changing to something else. In some cases, a healthcare provider may recommend sticking with the first antidepressant and adding another medicine to give you an extra boost.
There are several different types of antidepressants, which are generally placed into categories based on the way they work in the body. These categories include:
- Monoamine oxidase inhibitors (MAOIs)
- Other serotonin-norepinephrine reuptake inhibitors
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants (TCAs)
- Miscellaneous antidepressants.
Monoamine Oxidase Inhibitors
MAOIs are among the first class of antidepressants. They work by blocking the action of an enzyme called monoamine oxidase that breaks down serotonin, norepinephrine, and dopamine -- brain chemicals (neurotransmitters) that are involved in mood. This increases the levels of these chemicals in the body.
Unfortunately, MAOIs have serious food and drug interactions associated with them. Therefore, they are usually reserved for use after several other medicines have already been tried. Examples of MAOIs used to treat depression include:
- Isocarboxazid (Marplan®)
- Phenelzine (Nardil®)
- Selegiline (Eldepryl®, Emsam®, Zelapar®)
- Tranylcypromine (Parnate®).
Other Serotonin-Norepinephrine Reuptake Inhibitors
Like Fetzima, other SNRIs work by increasing the amount of serotonin and norepinephrine available for brain cells. In general, SNRIs tend to be more stimulating than SSRIs, which means they are more likely to cause insomnia. Some SNRIs are also approved to treat anxiety and pain conditions, such as fibromyalgia and neuropathic pain (nerve pain).
Other available SNRI medicines used to treat depression include:
Milnacipran (Savella®) is another SNRI medicine that is chemically related to Fetzima. Although it is not approved for the treatment of depression, it may be used off-label for this purpose.
It is worth noting that even though they generally work in the same way, the various SNRIs differ in their chemical structures. Therefore, if Fetzima does not work for you, it doesn't necessarily mean another SNRI won't work either.
Selective Serotonin Reuptake Inhibitors
SSRIs work by increasing the amount of serotonin available for brain cells. Because they are generally well tolerated, SSRIs are often chosen as the first medicine to try for treating depression. Most SSRIs are also approved to treat various types of anxiety disorders.
Examples of SSRIs include:
- Citalopram (Celexa®)
- Escitalopram (Lexapro®)
- Fluoxetine (Prozac®, Sarafem®, Selfemra™)
- Fluvoxamine (Luvox®, Luvox® CR)
- Paroxetine (Paxil®, Paxil CR®)
- Sertraline (Zoloft®).
In addition, the medication vilazodone (Viibryd®) works in a similar manner -- by blocking the reuptake of serotonin by neurons, thereby increasing the amount of serotonin available to brain cells. Unlike SSRIs, this drug also partially acts like serotonin by binding to serotonin receptors.
Tricyclic antidepressants are another older class of antidepressants. These medicines work by increasing levels of the brain chemicals dopamine, serotonin, and norepinephrine to varying degrees. Because they are associated with more side effects than other classes of antidepressants, they are generally used when other treatments have failed.
TCAs are also often used to treat several other conditions, such as insomnia, anxiety disorders, and certain types of pain. Available TCAs include:
- Amitriptyline (Elavil®)
- Amoxapine (Asendin®)
- Clomipramine (Anafranil®)
- Desipramine (Norpramin®)
- Doxepin (Sinequan®, Silenor®)
- Imipramine (Tofranil®, Tofranil PM®)
- Maprotiline (Ludiomil®)
- Nortriptyline (Pamelor®)
- Protriptyline (Vivactil®)
- Trimipramine (Surmontil®).
Several other antidepressants are available that do not neatly fit into one of the previously mentioned categories. Examples of these miscellaneous antidepressants include:
- Bupropion (Aplenzin®, Budeprion XL®, Budeprion SR®, Buproban®, Wellbutrin SR®, Wellbutrin XL®, Wellbutrin®, Zyban®): Works by affecting levels of the neurotransmitters norepinephrine and dopamine
- Mirtazapine (Remeron®): Works by affecting norepinephrine and serotonin
- Nefazodone (Serzone®): Works by affecting norepinephrine and serotonin