Selective serotonin reuptake inhibitors are the most commonly used class of antidepressants, making up about 58% of antidepressant prescriptions, according to a Dec. 9, 2024 Definitive Healthcare article.
SSRIs block the reuptake of serotonin neurotransmitters at the synapses of neurons. This process results in more overall serotonin, theorized to help with symptoms of depression and anxiety, according to a May 1, 2023 National Library of Medicine article.
Sertraline, fluoxetine and escitalopram — name brands Zoloft, Prozac and Lexapro — are the most commonly used types, according to the Definitive Healthcare article.
Serotonin and norepinephrine reuptake inhibitors are the second-most prescribed, making up about 19% of prescriptions. They prevent the reuptake of both serotonin and norepinephrine, which is associated with increased attentiveness, improved sleep cycles, mood and memory, according to Cleveland Clinic.
Still, the positive effects of SSRIs and SNRIs may not warrant the frequency with which they are prescribed.
One of my close friends, Lilli Taylor, a junior in high school, stated that her experience on the SSRI Sertraline decreased her trust in the psychiatric process.
“It sort of made me feel like they were just throwing out random options, and I guess hoping something stuck,” she said.
She explained that Sertraline didn’t improve her mental health, and the experience discouraged her from trying psychopharmacology again in the future.
“It made me feel like, why would I go back on medication if medication didn’t do anything for me the first time, even if it were a different medication?” she said.
The idea that all antidepressants function similarly, and that if you’ve tried SSRIs, the so-called “greatest” medication, you’ve tried them all, is something I’ve noticed in conversations on the topic.
A result of the glorification of SSRIs for treating patients with major depressive disorder or generalized anxiety disorder is the reinforcement of these beliefs.
More than two-thirds of people with MDD do not achieve symptom improvement with their first antidepressant, which is likely to be an SSRI, according to a July 11, 2017 Jama Network study.
Additionally, trying several other antidepressants can often yield similar results, considering about a third of MDD patients have what is considered “treatment-resistant depression,” according to the Cleveland Clinic.
When those struggling with mental illness do not respond to medications advertised as the most effective, they are often left feeling disheartened just as Lilli did.
Undeniably, SSRIs have helped countless people manage their symptoms, but they aren’t the only option. Studies indicate that they may not even be the most effective antidepressants, especially when prescribing for treatment-resistant depression.
Atypical antidepressants are those that aren’t classified under one of the main categories of antidepressants, according to a Mental Health America article.
The use of atypical antidepressants among patients with treatment-resistant depression resulted in greater reductions of symptoms than SSRIs, and fewer side effects were observed, according to a Dec. 24, 2024 National Library of Medicine study.
Norepinephrine dopamine reuptake inhibitors, or NDRIs, another class of atypical antidepressants, have also shown promising results in recent years. The increase in dopamine and norepinephrine neurotransmitters helps to regulate mood, and their stimulating properties have been used to treat attention-deficit/hyperactivity disorder as well, according to a May 29, 2024 Very Well Mind article.
Tricyclic and tetracyclic antidepressants, which only differ in their chemical structures, block the reuptake of serotonin and norepinephrine, but do so differently than SNRIs. They greatly reduce MDD symptoms, but also have a higher risk of side effects, especially if an overdose occurs, according to a Feb. 22, 2024 WebMD article.
Among 21 medications used in a study, a tricyclic antidepressant and a tetracyclic antidepressant showed the highest efficacy. The efficacy of symptom reduction from SSRIs, SNRIs and other atypical antidepressants appeared to be fairly evenly distributed, according to an April 7, 2018 Lancet article.
There are so many antidepressants with each working uniquely in the brain. Whether a person responds to a medication is dependent on their individual brain chemistry. What is a life-changer for one person might do nothing for someone else.
If you’ve recently been prescribed SSRIs and are considering starting them, don’t be afraid to.
Still, keep in mind that finding the right medication can be a long process of trial and error — adjusting dosages, finding a balance between different medications, tolerating side effects and often many of them not working. Don’t feel disheartened if the first medication you try doesn’t work for you.
SSRIs can be life changing for some, but they are not the only option. There are countless medications available, and one you never heard of could be your saving grace.
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