Most commonly used types of antidepressants: ssris, duals, tricyclics, and atypicals

Pharmacological treatment of depression has evolved significantly, offering a variety of options that allow for a more personalized therapeutic approach.

Among the most commonly used are selective serotonin reuptake inhibitors (SSRIs), dual antidepressants, tricyclics, and atypical antidepressants. Each group has specific characteristics in terms of its mechanism of action, side effect profile, and clinical applicability.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are considered first-line treatment for moderate to severe depression due to their safety and tolerability profile. They work by increasing the availability of serotonin in the synaptic space, improving serotonergic transmission, which is associated with improved mood and other depressive symptoms.

The most common SSRIs include fluoxetine, sertraline, paroxetine, citalopram, and escitalopram. These drugs are widely used not only because of their efficacy, but also because they have fewer anticholinergic and cardiotoxic effects compared to older antidepressants. However, they can cause side effects such as sexual dysfunction, insomnia, initial anxiety, nausea, and, in some cases, weight gain.

Dual antidepressants (SSRI-SNRI)

Serotonin and norepinephrine reuptake inhibitors (SNRIs), also known as dual antidepressants, act on both neurotransmitters, which may offer a therapeutic advantage in some patients.

Venlafaxine and duloxetine are classic examples of this group. They are particularly indicated in cases with prominent physical symptoms, such as chronic pain, in addition to depression. Although their effectiveness is comparable to that of SSRIs, they can cause high blood pressure at high doses and other adverse effects such as nausea, sweating, and anxiety.

Tricyclic antidepressants (TCAs)

Tricyclics were long the cornerstone of antidepressant treatment. They work by blocking the reuptake of norepinephrine and serotonin, but they also affect other neurochemical systems, which increases the risk of side effects. Among the most commonly used are amitriptyline, imipramine, and nortriptyline.

Although effective, their use is now more restricted due to their adverse profile: they can cause sedation, weight gain, orthostatic hypotension, cardiac conduction disturbances, and toxicity in case of overdose. However, they remain useful in severe, melancholic, or treatment-resistant depression.

Atypical antidepressants and other mechanisms

This group includes drugs that do not fit entirely into the above categories due to their specific mechanisms of action. Mirtazapine, for example, has a significant sedative effect and may be useful in patients w