Your Guide to 5 Common Types of Antidepressants

Major depressive disorder — commonly referred to as depression — is characterized by symptoms, such as loss of interest, low energy, and feelings of guilt or hopelessness that have been present for more than 2 weeks. It is often treated with antidepressants, with or without psychotherapy.

But with so many antidepressants available, which ones are the most effective? Here, we’ll discuss the various types of antidepressants available and how you and your prescriber can decide which one is the best choice for you.

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What are the different types of antidepressants?

There are five common types of antidepressants:

1. Selective serotonin reuptake inhibitors (SSRIs)

2. Serotonin and norepinephrine reuptake inhibitors (SNRIs)

3. Atypical antidepressants

4. Tricyclic antidepressants (TCAs)

5. Monoamine oxidase inhibitors (MAOIs)

Below, we’ll discuss some well-known antidepressants and which classes they belong to.

Keep in mind: We will not be discussing the risks, warnings, and drug interactions for each type of antidepressant in this article. Please talk with your mental healthcare team for more information on your specific medication.

1. SSRIs

Five well-known, SSRI medications that are FDA approved to treat depression include:

• Citalopram (Celexa)

• Escitalopram (Lexapro)

• Fluoxetine (Prozac)

• Paroxetine (Paxil)

• Sertraline (Zoloft)

SSRIs are considered first-choice antidepressants. These medications are believed to work by raising the amount of serotonin — a hormone that helps regulate mood — in the brain. While effective for treating depression, it typically takes them about 2 weeks to start working and 4 to 8 weeks to experience their full benefits.

2. SNRIs

Three examples of well-known SNRIs that are FDA approved to treat depression include:

• Desvenlafaxine (Pristiq)

• Duloxetine (Cymbalta)

• Venlafaxine (Effexor)

SNRIs are another first-choice option. They’re thought to work by raising levels of serotonin and norepinephrine. Norepinephrine helps boost alertness and focus. Like SSRIs, these medications can also take 2 weeks to start working, and 4 to 8 weeks to fully work.

3. Atypical antidepressants

This group includes antidepressants that don’t fit into other medication classes. Five notable commonly prescribed atypical antidepressants are:

• Bupropion (Wellbutrin XL)

• Bupropion / dextromethorphan (Auvelity)

• Esketamine (Spravato)

• Mirtazapine (Remeron)

• Trazodone (Desyrel)

How some of these types of antidepressants work isn’t fully understood. Bupropion and mirtazapine are as effective as SSRIs and SNRIs. And both are considered first-choice options for treating depression. But trazodone can be helpful if a person has both depression and insomnia (trouble sleeping). Esketamine may be an option if you’ve tried at least two other antidepressants without success.

4. TCAs

There are several TCAs available, but four commonly prescribed examples are:

• Amitriptyline

• Desipramine (Norpramin)

• Doxepin

• Nortriptyline (Pamelor)

TCAs are thought to treat depression by raising levels of serotonin and norepinephrine in the brain. Some studies suggest that they may be more effective for certain people with severe depression. But they also have a greater risk of side effects. Because they aren’t as well-tolerated as previously listed antidepressants, they’re not first-choice antidepressants for most people.

5. MAOIs

The MAOIs that are FDA approved for depression include:

• Isocarboxazid (Marplan)

• Phenelzine (Nardil)

• Selegiline patches (Emsam)

• Tranylcypromine (Parnate)

MAOIs work by blocking a protein called monoamine oxidase (MAO). MAO’s job is to break down serotonin, norepinephrine, and dopamine. By blocking this protein, MAOIs help raise levels of these chemical messengers in the brain.

MAOIs are not typically recommended for most people with depression due to their risks of serious side effects, necessary dietary restrictions, and many medication interactions. However, studies have shown they can be effective for treatment-resistant depression — depression that doesn’t improve with other antidepressants.

Is there a best antidepressant?

Over the years, studies have compared various types of antidepressants. After reviewing the available research, the American Psychiatric Association found that no one antidepressant was more effective at treating depression than others. Instead, antidepressants are typically recommended based on factors like their side effects and whether you’ve responded favorably to a particular medication in the past.

Most people will start taking either an SSRI or SNRI. These medications are generally better tolerated than other antidepressants. And they can also treat other conditions that people sometimes have along with depression, like anxiety.

But in the end, the best antidepressant is the one that gives you the most benefits with the fewest side effects. Everyone’s journey to finding the right depression treatment is unique.

Quiz: Is your antidepressant working?

Which type of antidepressant is the most commonly prescribed?

SSRIs are the most commonly prescribed type of antidepressant. This is because they’re effective and well-tolerated with mild side effects for many people. With many SSRIs available as generic products, they also tend to be more affordable. SNRIs and bupropion are also common choices for similar reasons.

Which antidepressant has the least side effects?

There isn’t a definitive answer for this question. All antidepressants can cause side effects. And everyone tolerates them a little differently. Generally speaking, SSRIs and SNRIs are well-tolerated by most people. They also have good evidence supporting their long-term safety. Older antidepressants, like TCAs and MAOIs, tend to cause more side effects.

Which antidepressant works the fastest?

Spravato is the antidepressant that works the fastest. It can start providing relief within a few hours. However, Spravato has a number of serious risks and you can only administer it if you’re at your prescriber’s office. It’s also only FDA approved for treatment-resistant depression. So it’s not an available option for most people.

Auvelity is another faster-acting antidepressant. It can start relieving depression symptoms in as little as 1 week. It can also be prescribed just like most other antidepressants. So there’s no restrictions for its use, unlike Spravato.

Other types of antidepressants usually take a few weeks to kick in. Generally speaking, you can expect to experience some effects between 4 and 6 weeks after starting your medication. If you don’t feel any change after 8 weeks, let your prescriber know that it doesn’t seem to be working.

How does a prescriber decide which antidepressant is best for you?

There are several factors that help a prescriber decide which type of antidepressant may be best for you. These include things like success with an antidepressant in the past, other health conditions you may have, and side effects you’re concerned about.

If you’ve successfully taken an antidepressant in the past, this is always a good place to start. You’re more likely to experience benefits from a medication that has worked before. But if you’ve never taken medication for depression before, prescribers often look at the likelihood of side effects when choosing a medication.

Newer antidepressants, such as SSRIs and SNRIs, tend to be better tolerated than older ones. You might prefer SNRIs over SSRIs if you also have certain chronic pain conditions, such as fibromyalgia. This is because some SNRIs are also approved for these conditions.

Sexual problems, like erectile dysfunction, tend to be more common with SSRIs and SNRIs than with other antidepressants. If sexual side effects happen, bupropion may be a better choice. These side effects are very uncommon with this medication. Bupropion can also be added to your medication regimen to help with sexual side effects if your current antidepressant is working well for your depression.

As mentioned earlier, trazodone is a possible choice if you have both depression and insomnia. This medication tends to cause a lot of drowsiness as a side effect, so your prescriber may suggest it as a way of helping you sleep better.

Which antidepressant is the hardest to come off of?

One downside of SSRIs and SNRIs is that they can be difficult to stop taking. This is because these medications can cause withdrawal symptoms if your dose is lowered too quickly. Be sure to follow your prescriber’s instructions about how you should lower your dose.

Withdrawal symptoms from these antidepressants may include:

• Flu-like symptoms

• Insomnia

• Nausea

• Headaches

• “Pins-and-needles” sensations

• “Electric shock-like” sensations

If you experience these symptoms when trying to stop taking your antidepressant, let your prescriber know. But keep in mind that these symptoms are temporary and should resolve within 1 to 2 weeks.

Good to know: Not all SSRIs and SNRIs have the same risk of causing withdrawal symptoms after stopping them. SSRIs or SNRIs that last longer in the body have a lower risk. For instance, venlafaxine doesn’t stay in the body as long as fluoxetine. So, you may have a greater risk of withdrawal symptoms if you’re stopping venlafaxine compared to fluoxetine.

Why trust our experts?

Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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We created this article for Therapy for Black Girls, an online space dedicated to encouraging the mental wellness of Black women and girls.