The U.S. Food and Drug Administration (FDA) is responsible for determining the safety of a drug for its labeled usage based on data from clinical trials. Numerous drugs across several classes have been approved for the treatment of depression. The generic (chemical) names of these FDA-approved medications along with their common brand names are provided below.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are the first-line approach to treating depression. They are effective at improving symptoms and--relative to alternative drug treatments--produce fewer side effects. They are also generally safe for long-term use. Although specific side effects may vary by drug, common side effects of SSRIs include headache, nausea, dry mouth, fatigue, irritability, sleep disturbances, weight gain and sexual side effects. The SSRIs that are FDA approved for the treatment of depression include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Paxil CR, Pexeva) and sertraline (Zoloft).
An olanzapine and fluoxetine combination (Symbyax) received FDA approval in 2009 for treatment of bipolar depression only. It is classed as both an SSRI and atypical antipsychotic.
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) prevent the reuptake of both serotonin and norepinephrine in the brain, thus boosting mood. Like SSRIs, SNRIs have few serious side effects and are considered as a first approach to pharmacotherapy. Venlafaxine (Effexor) and duloxetine (Cymbalta) are two FDA-approved SNRIs.
Tricyclic Antidepressants (TCAs) and Heterocyclics
Tricyclic Antidepressants (TCAs) and Heterocyclics work by inhibiting the reuptake of serotonin and norepinephrine in the brain. However, they also block other cell receptors, which accounts for the extensive list of side effects that they may cause. It is because of these side effects that tricyclics and heterocyclics are not usually the first choice in pharmacotherapy for depression, although they can be effective in helping people with depression 52% to 56% of the time.
Serious side effects include confusion, seizures, difficulty breathing, hypotension, shaking (pseudoparkinsonism), arrhythmias and hallucinations. Tricyclics and heterocyclics should also not be taken by patients with certain heart medications or anticonvulsants.
Tricyclic antidepressants approved for depression treatment include amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil, Tofranil-PM), nortriptyline (Pamelor), protriptyline (Vivactil) and trimipramine (Surmontil). Amoxapine (Asendin, Asendis, Defanyl, Demolox or Moxadil), trazodone hydrochloride (Desyrel) and maprotiline hydrochloride (Ludiomil) are FDA-approved heterocyclics for depression.
Monoamineoxidase Inhibitors (MAOIs)
Monoamineoxidase Inhibitors (MAOIs) are believed to prevent the enzyme monoamine oxidase from metabolizing serotonin and norepinephrine, thus alleviating mood. MAOIs approved by the FDA for depression include Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan) and selegiline (Emsam). Serious side effects and safety concerns prevent physicians from prescribing MAOIs as a first course; however, they may be used to treat individuals who are resistant to treatments with SSRIs. Selegiline (Emsam) is the first transdermal skin patch for depression.
Bupropion
Bupropion (Wellbutrin SR, Zyban) does not belong to any of the other classes of approved depression drugs but is FDA approved for depression treatment. It balances the levels of the neurotransmitters dopamine and norepinephrine in the brain.
Antipsychotics
Atypical antipsychotics may be prescribed for bipolar depression and cases of treatment-resistant unipolar depression. Mentioned above, Symbyax is part antipsychotic and is FDA approved for bipolar depression only.
Research has demonstrated that augmenting pharmaceutical and behavioral treatment with atypical antipsychotics such as risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel) and ziprasidone (Geodon) may be efficacious in treatment-resistant and bipolar depression. However, these medications are not currently FDA approved for the purpose of treating depression.
