Antidepressants Primer

Image: Circe Invidiosa by John William Waterhouse
Circe Invidiosa by John William Waterhouse

If you or someone you know is beginning treatment for depression, you probably have done some research. Of course, you’re being treated by a doctor who will advise you and do the prescribing, but like any smart patient, you want to be informed.

Chances are that one thing stands out: the choice of drugs for mood disorders like depression can be bewildering. Even for someone like me, who has been taking them for twenty years and writing about mental health almost as long, the landscape is confusing. Things have changed since I first started treatment for depression in 1990. There are several reasons for this.

  • There are a lot of drugs for mood disorders in general.
  • Many antidepressants been approved by the FDA for various ailments in addition to depression.
  • Some drugs that were initially developed for other ailments, like epilepsy, have been approved or used off-label to treat mood disorders (see the explanation of what “off-label” means below.

Antidepressant Families

Fortunately, antidepressants are not as confusing as they seem at first glance once you know that they can be broken down into several classes or “families”:

  • Monoamine oxidase inhibitor (MAOIs)
  • Tricyclics (TCAs)
  • Selective Serotonin Reuptake Inhibitor (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Noradrenergic and specific serotonergic antidepressants (NASSAs)
  • Norepinephrine (noradrenaline) reuptake inhibitors (NRIs)
  • Norepinephrine-dopamine reuptake inhibitors (NDRIs)

Off-Label

“Off-label” means that a drug is used for another ailment than the one it was initially developed for, but it has not been approved yet for that use by the FDA. It’s not illegal for physicians to prescribe medications off-label, but pharmaceutical companies can get into trouble for marketing a drug for an off-label use.

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