Columbia University Health Services

Drugs called antidepressants are used to treat depression. Antidepressants belong to several different categories. They affect the function of certain neurotransmitters in the brain, although the process is not well understood.

The most widely used medications for both major depression and dysthymia are called SSRIs (selective serotonin reuptake inhibitors) or SNRIs (seratonin/norepinephrine reuptake inhibitors). These drugs affect neurotransmitters in the brain known as serotonin and norepenephrine, which are believed to play a role in causing depression.

There are currently six SSRIs (drugs that affect serotonin) available in the United States :

• Prozac (fluoxetine)
• Paxil (paroxetine) 
• Zoloft (sertraline)
• Luvox (fluoxamine)
• Celexa (citalopram)
• Lexapro (escitalopram oxalate)

Three SNRIs (drugs that affect both serotonin and norepenephrine) are currently available. They are

• Effexor (venlaxafine)
• Remeron (mirtazapine) 
• Cymbalta (duloxetine)

Another widely used drug for treating both major depression and dysthymia is Wellbutrin (bupropion). Wellbutrin directly affects chemicals in the brain other than serotonin, mainly noradreneline and dopamine.

Some people respond well to one drug and do not respond well to other drugs in the same class. Side effects for each drug also vary from person to person. Therefore, if a particular drug does not help you feel better or gives you unacceptable side effects, you may respond well to a different antidepressant. Occasionally people respond best to a combination of medications.

The antidepressants listed here are generally the first choice for treating both dysthymia and major depression. They are as effective as older drugs used to treat depression and have fewer, less serious potential side effects.

How safe are these drugs medically?
Generally these drugs are very safe. The antidepressants listed here have not been used long enough to study very long-term side effects. However over 10 years of study and use, no long-term side effects have been found. In addition, the newer drugs are safer for people with suicidal impulses; it is very hard to kill yourself with an overdose of these antidepressants alone.

Go Ask Alice! is the health question and answer Internet service produced by the Alice! Health Promotion Program. If it's on your mind, it's probably on Go Ask Alice!

Questions