'Traditional' Medication

Anti-depressants Classifications
Anti-depressants A-Z
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Anti-depressant Classifications

Although you may have heard of the main 2 classifications, Tricyclic's and SSRI's, there are in fact 7 classifications altogether. These two main groups have many different anti-depressants in them but many of the newer drugs are so different that they call for their own classification. Lithium is not an anti-depressant but a mood stabiliser and will be cover in the 'alternative' section.

Here is a little information about each classification, including some of the anti-depressants in that group. It is not intended to get technical, if this interests you then you may wish to check out the online resources section for websites that do explain how the brain works, what chemicals are affected and how individual medications work to help correct any imbalance.

As jfo is a worldwide site and brand names vary, all medication will be referred to by its generic name.

Skip to: TCA SSRI MAOI RIMA NaSSA NARI SNRI

Tricyclic Antidepressants (TCA's)

TCA's are one of the oldest classes and still prescribed by some doctors as the first line of defence due to proven performance, although SSRI's are now also common as a first choice as they are seen to have fewer side effects.

They work by preventing a reabsorption of noradrenaline and serotonin, which prolongs a mood-lightening effect to help relieve the depression. This effect may be noticed within 2 weeks but the full effect may take between 4 and 6 weeks.

Some TCA's have more side effects than others including drowsiness, which may be an added benefit in targets who suffer with anxiety or are particularly agitated, such as Amitriptylene and Dothiepin. Those who are more lethargic may benefit from Imipramine or Lofepramine. Other side effects include constipation, dry mouth and weight gain.

Selective Serotonin Re-uptake Inhibitors (SSRIs)

SSRI's are prescribed for depression as well as other diagnoses including panic disorder, bulimia, social phobia and PTSD. They work by being specific to the neurotransmitter serotonin. Depression may be caused by a lack of serotonin, so the drug helps to stop a recycling of this chemical, hence the name Selective Serotonin Re-uptake Inhibitor.

SSRI's may take between 2 and 8 weeks to work. They are different from TCA's as they are less sedating and help those with lethargy and/or anxiety. Side effects of SSRI's are usually mild and often disappear after two weeks. These include diarrhoea or constipation, dry mouth, headaches, insomnia or drowsinesss and tremors.

While SSRI's are sometimes prescribed to help with anxiety, they can cause a worsening of it initially. This can be considered a good sign as usually, after a short time, the anxiety improves and both the depression and the anxiety respond well. Examples of SSRI's include Citalopram, Fluoxetine, Fluvoxamine, Paroxetine and Sertraline.

There have been some reports of suicides and suicidal ideations with those taking some SSRI's. Whether this is due to the drug itself or that the person already was suicidal is yet to be clarified. Mind have several pages about Paroxetine that visitors may be interested in. If you are interested in hearing updates about this issue and many other health issues, you may wish to subscribe to Bully News Now.

Monoamine oxidase inhibitors (MAOI's)

MAOI's are a very old class of anti-depressant that are rarely prescribed. This is due to the restricted diet that the patient needs to follow but in cases where other medications have been ineffective, MAOI's can be very successful in treating atypical depression. MAOI's may be prescribed for depression and/or phobias.

MAOI's work on the neurotransmitters serotonin and noradrenaline (they are known as monoamines). Depression may be caused by the lowering of these monoamines, which are broken down naturally by the chemical monoamine oxidase. MAOI's stop this chemical from breaking them down and hence the name Monoamine Oxidase Inhibitors.

Not only are there dietary restricted but MAOI's also interact with most other medications, including many common over the counter remedies. There should always be a gap of at least 14 days between taking MAOI's and other anti-depressants. Restricted food is anything that contains high levels of tyramine, the most commonly eaten include cheese, yeast extracts (some types of gravy) and most red wines. A full list would be given with any prescription. If you like a nice Chianti with cheese, let's just hope one of the other classifications work for you!

Interactions with other medication and restricted food can cause severe adverse reactions such as a hypertensive crisis (very high blood pressure), frequent headaches and nausea/vomiting. Extreme care must be taken if you get easily confused or are forgetful with such a long list of things you must avoid. Side effects without interactions can include difficulty in sleeping, weakness, dry mouth and weight gain. Some may also suffer with postural hypotension.

Some effect may be felt within 2 weeks although it may take between 4 and 6 weeks for the full effect. Whilst there are lots of choices within the TCA and SSRI classifications, there are only 3 generic drugs in the MAOI category and they all have similar side effects and all have the same dietary and medication restrictions. The two most commonly prescribed are Phenelzine and Tranylcypromine.

Reversible Inhibitors of Monoamine Oxidase type A (RIMA's)

While the effect of MAOI's is permanent, a new similar drug has been created that is reversible, working only on Type A monoamine oxidase (MAOI=A+B). RIMA's have fewer dietary and other medication interactions in comparison, with a higher tolerance possible of tyramine levels.

Some effect may be felt within 2 weeks although it may take between 4 and 6 weeks for the full effect. There is only one drug in this classification and it is used to treat major depression but is rarely given as a first line of defence.

Side effects (without interactions) include headache, disturbed sleep, restlessness, pins and needles, skin reactions (eg rash or itch). The only RIMA currently available is Moclobemide and it may also be prescribed for Social Phobia.

Noradrenergic and Specific Serotonergic Anti-depressants (NaSSA's)

NaSSA's are one of the newest types of antidepressant and claim to cause fewer side effects than TCA's or SSRI's while being as equally effective. They work on both noradrenaline and serotonin by blocking receptors to enhance the action in the brain and prolong the mood-lightening effect of any released noradrenaline and serotonin, which helps relieve depression.

NaSSA's may have a quicker onset of action and while some effect may be felt within 2 weeks it may take between 4 and 6 weeks for the full effect. Side effects are fewer but can still cause drowsiness, blurred vision and increased appetite (=weight gain!).

The only NaSSA currently available is Mirtazipine and it is only prescribed for depression.

Noradrenaline Re-uptake Inhibitors (NARI's)

NARI's are also one of the newer anti-depressant and comparative information is limited. Some say that it may be more effective but as everyone reacts differently, more research would be needed to confirm this.

NARI's work by preventing the re-absorption of noradrenaline, which increases the amount of noradrenaline in the brain. This acts to prolong the mood-lightening effect.

NARI's may have a quicker onset of action and while some effect may be felt within 2 weeks it may take between 4 and 6 weeks for the full effect. Side effects may include dry mouth, insomnia, postural hypotension, increases in heart rate and pins and needles.

The only NARI currently available is Reboxetine and it is only prescribed for depression.

Serotonin Noradrenaline Re-uptake Inhibitors (SNRI's)

SNRI's act in a similar way to TCA's by preventing the re-absorption of noradrenaline and serotonin, which prolongs the mood-lightening effect of any released noradrenaline and serotonin and so relieve the depression.

SNRI's may have a quicker onset of action and while some effect may be felt within 2 weeks it may take between 4 and 6 weeks for the full effect. Side effects are similar to SSRI's, the XL slow release version may help to reduce the level of nausea. SNRI's cause more disturbances in the gut and hand tremors are a particular problem.

The only SNRI currently available is Venlafaxine and it is prescribed for depression, depression associated with anxiety and Generalised Anxiety Disorder. Serious problems with withdrawal from Venlafaxine have been reported and you may wish to seek others experiences of this or talk to your doctor before agreeing to take Venlafaxine. See the 'Experiences' section for more details.

Anti-depressants A-Z

There are several online databases of anti-depressant medication. Try About or Netdoctor for two of the easiest to use. Both provide brand and generic names where possible.

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