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Most Common Antidepressants

If you have major depression, chances are good that you could name a few common antidepressants off the top of your head. When most people think of antidepressants, they think of the current most popular classes of medications: the SSRIs (Selective-Serotonin Reuptake Inhibitors) and the SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors). In particular, the SSRI “Prozac” seems to have become a reference term for all antidepressants, similar to “Coke” being used as a reference for all sodas.

It is relatively difficult to document the “most common” antidepressants because what is common today may not be common in 20 years; the pharmaceutical industry is constantly evolving.  New drugs are being created and backed by heavy marketing, while old ones are getting prescribed less. A common antidepressant treatment in the 1970s may have been a TCA or MAOI like Amitriptyline, while the most common antidepressant in the early 2000s was an SSRI.

These days in 2014, the most common antidepressant treatment option is actually an SNRI named “Cymbalta.”  There’s no telling how various classes of antidepressants will continue to change and what will be considered “common” years from now. To help keep things in perspective, I’ve created a list of the most common antidepressant medications based on classification (mechanisms of action).  Although the SNRIs have become more popular in recent years, the most common treatments for depression are still the SSRIs.

Most Common Antidepressants

Below is a list of most common antidepressants based on specific class. For newer classes like the SSRIs and SNRIs, expect newer drugs that are less common to become more common in forthcoming years. Understand that not all antidepressants are listed below. If you would like to find other medications, you can look at the complete antidepressants list.  Additionally if you are interested in common non-pharmaceutical treatments, read about natural antidepressants.

Most common SSRIs

SSRIs: Selective Serotonin Reuptake Inhibitors were initially approved in the late 1980s with the introduction of Prozac. Nearly all SSRIs with the exception of Luvox have become extremely popular throughout the United States and the rest of the world. They function by inhibiting reuptake of the neurotransmitter serotonin. They are largely considered a first-line treatment for major depression and anxiety disorders and have become the most common antidepressants.

  • Prozac (Fluoxetine): This is arguably the most popular antidepressant of all time in regards to branding and media attention. It is regarded by many as an embodiment of the entire SSRI class of drugs. It was the first SSRI introduced to the market in the 1980s and is still very commonly used.
  • Zoloft (Sertraline): This SSRI was approved in 1991, just a couple years after Prozac. It was marketed well and is still one of the most commonly prescribed SSRI medications. It is used for both depression and various types of anxiety.
  • Lexapro (Escitalopram): This is an SSRI that was approved in the early 2000s to treat depression and generalized anxiety. It is touted as being an improved version of the drug Celexa, and many agree with these claims. It is one of the most common SSRIs of the past decade.
  • Celexa (Citalopram): This drug was found effective for major depression and approved in 1998. A few years after it had been on the market, a modified (arguably improved) version of the drug was created named “Lexapro.” Despite widespread conversion of patients from Celexa to Lexapro, it still remains a commonly used antidepressant.
  • Paxil (Paroxetine): This is an SSRI that was developed primarily for anxiety disorders and depression. In recent years it has become associated with some of the worst withdrawal symptoms, side effects, and has been linked to birth defects. This drug is less frequently prescribed than when it was initially introduced, but it is still a commonly used SSRI for individuals with anxiety.

Most common SNRIs

SNRIs: Serotonin-Norepinephrine Reuptake Inhibitors were introduced to the United States in 1994 when the company Wyeth began marketing Effexor. This drug worked slightly different than SSRIs because it also affected the neurotransmitter norepinephrine. There is some evidence that low norepinephrine causes depression (in addition to serotonin), so companies created drugs that acted on both neurotransmitters. These days Effexor is still common, but Cymbalta has overtaken it in regards to popularity due to its approval to treat a variety of conditions in addition to depression.

  • Cymbalta (Duloxetine): This has become the most prescribed (2013-2014), top selling (2013-2014), and most popular antidepressant in 2014. In part this is due to the fact that it’s approved to treat an array of conditions other than depression such as: fibromyalgia, neuropathic pain, and chronic pain. It will remain the most common SNRI as it continues to dominate the market.
  • Pristiq (Desvenlafaxine): This medication is essentially an improved version of Effexor by manufacturers. In recent years it has become significantly more common than Effexor due to heavy marketing and attempts by the manufacturers to convince doctors that this drug is superior to Effexor. Expect this drug to become commonly used in upcoming years.
  • Effexor (Venlafaxine): Of all time, this is the most common SNRI medication. It is the oldest and has been around since the mid 1990s. It is medically approved for the treatment of depression and anxiety disorders. It was prescribed heavily until recent years in which a questionably “improved” version of the drug was created (Pristiq).
  • Fetzima (Levomilnacipran): This is the newest SNRI that works differently than other SNRIs on the market because it affects norepinephrine to a greater extent than serotonin.  Although it is not yet a common antidepressant, it is projected to be a household name in the next few years.  It is closely related to the older drug Milnacipran, which never got approval in the United States.

Most common atypical antidepressants

Atypical: This class of antidepressants is unique in that none of the drugs have similar mechanisms of action to other classes of drugs. All drugs in the “atypical” class have unique properties and are usually considered when a more common SSRI or SNRI is ineffective. The most common atypical antidepressant options include: Viibryd, Wellbutrin, Trazodone, and Remeron. Brintellix is a newer antidepressant that many suspect will become commonly used in the future.

  • Wellbutrin (Bupropion): This is perhaps the most common atypical antidepressant prescribed throughout history. Although Viibryd may currently be more popular, this one is more common. It works significantly different than all other antidepressants in that it affects norepinephrine and dopamine without affecting serotonin. In addition to being a common antidepressant, it is also a common smoking cessation aid.
  • Viibryd (Vilazodone): This drug is similar to SSRIs, except it also affects the 5-HT1A receptor as a partial agonist. Although it is a newer drug, it is quickly becoming a common name in the antidepressant industry.
  • Remeron (Mirtazapine): This is an atypical antidepressant that is commonly used when a person doesn’t respond to other medications. It is considered among the most potent antidepressants on the market, and functions as an NaSSA (Noradrenergic and Specific Serotonin Antidepressant).
  • Trazodone (Oleptro): This drug was formerly sold under the brand “Desyrel” and is a common atypical antidepressant. It is significantly less common than Viibryd and Wellbutrin, but has unique properties as a SARI (Serotonin Antagonist and Reuptake Inhibitor). It is now sold as an extended-release drug in the form of Oleptro.
  • Brintellix (Vortioxetine): This is a very new atypical antidepressant that was approved by the FDA for treating major depression in 2013. It works as an SMS (Serotonin Modulator and Stimulator), making it relatively unique. Despite being newer, it will become more commonly prescribed in upcoming years.

Most common tricyclic antidepressants

Tricyclic (TCA): This class of antidepressants is considered one of the oldest. These drugs are noted for their three ring atomic structure. Many of the tricyclics are less common these days simply because SSRIs are considered safer with better tolerability. This class of drugs acts on serotonin and norepinephrine to elicit an antidepressant response.

  • Amitriptyline (Elavil): This is a very commonly used tricyclic antidepressant and one of the most utilized throughout history. It was introduced to markets in 1961 and was heavily prescribed until the introduction of newer SSRIs.
  • Nortriptyline (Pamelor): This is another common TCA drug that is closely related to the more commonly prescribed Amitriptyline. It is used for major depression as well as some types of pain, and to prevent childhood bedwetting.
  • Doxepin (Sinequan): This is a common TCA drug that comes in both pill form and as a skin cream. It is used to treat depression as well as various skin conditions such as hives. Although it is less common than SSRIs, it is a common tricyclic antidepressant option.
  • Desipramine (Norpramin): At one point this was another very common TCA medication. These days people have discovered the fact that it could have genotoxic effects and is associated with increased risk of breast cancer.

Most common MAOIs

MAOI: Monoamine Oxidase Inhibitors are the oldest class of antidepressants. They function by increasing levels of various neurotransmitters in the brain. Most older hydrazine-based MAOIs have been withdrawn from the market. This entire class of drugs is often deemed outdated and is seldom used. In the event that a person has tried SSRIs, SNRIs, atypicals, tricyclics, and various antidepressant augmentation strategies, MAOIs may be tested. Below are the most commonly used MAOI drugs on the market.

  • Nardil (Phenelzine): This is an MAOI with that is still commonly used when an individual fails to respond to first and second-line treatment options for depression. Due to the fact that MAOIs can interact with food containing tyramine, they are less common. However, of drugs in the MAOI class, this is one of the more common medications prescribed.
  • Parnate (Tranylcypromine): This is an MAOI that is effective for treating major depression and anxiety disorders. It is non-selective and irreversible, therefore is likely to have an interaction with food containing tyramine. It is one of the only MAOIs still utilized today.
  • Emsam patch (Selegiline): This is an older MAOI antidepressant that was redeveloped as a transdermal (skin) patch. In patch-form, it is called “Emsam” and is used for major depression and Parkinson’s disease.
  • Moclobemide (Aurorix / Manerix): This is an MAOI with reversible properties and is commonly used in countries outside of the United States including: Australia and the United Kingdom. It has been found effective in treating both depression and social anxiety. It is a commonly used antidepressant in developing countries due to the fact that it has minimal side effects.

Predicting the Most “Common” Antidepressants of the Future

It is difficult to predict what the most common types of antidepressants will be in the future. In a few years, development of drugs like ALKS 5461 could be considered major breakthroughs in treatment for major depression. The reason antidepressants are developed at such a slow rate is because the entire process takes significant time. First a company must think of a reasonable idea for a drug, then they must put it through extensive testing, the tests must show efficacy and safety, and finally the FDA must approve it.

Additionally since it isn’t really well-known what specifically causes depression, companies are essentially making guesses as to what treatments will work. They base guesses off of existing drugs as well as current medications on the market. When one company creates a specific type of medication, the trend from other companies is to usually follow suit and develop something similar. Then the goal is to maximize drug profits by milking the patent for as long as possible.

When the patent expires, many companies develop a “prodrug” or better version of their current drug to continue making more money. This encourages a lack of creativity on the part of drug companies and the extremely long FDA approval process also discourages companies from trying an outside-the-box treatment. The way I see it is that similar medications to what already exists will dominate the antidepressant market in the near future.  One spin off of current drugs that I expect to become fairly common are the Triple Reuptake Inhibitors (SNDRIs) because they target dopamine in addition to serotonin and norepinephrine.

In the more distant future, I expect alternative classes of medications with less side effects to be developed. Additionally I expect more experimental therapies such as low-field magnetic stimulation to become common (assuming they are found effective). In the far future, I expect scientists to come up with individualized gene therapies based on an individual’s genetic code; unfortunately this is unlikely to happen in my lifetime.

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