Common Medications Used to Treat Major Depressive Disorder

Sara Hoffman, PharmD
·7 min read

Medically reviewed by Lindsay Cook, PharmD

Major depressive disorder (MDD), also referred to as clinical depression or simply depression, is a mood disorder where a person has a consistently low or depressed mood and no longer finds interest in activities that used to bring them joy.

Several drug classes are commonly used to treat MDD, including antidepressants, antipsychotics, anti-anxiety medications, and other types of mood-stabilizing drugs.

This variety of classes can help individualize medication treatment to address a person's specific needs. For example, some antidepressants can also help with anxiety, and others may improve sleep. Wellbutrin (bupropion) is an antidepressant that can also help people quit smoking.

This article will discuss the types of medications used to treat MDD.

Getty Images / Bloomberg / Contributor
Getty Images / Bloomberg / Contributor

List of Major Depressive Disorder Medications

The medications used to treat MDD are grouped into the following classes:

Antidepressants and Increased Suicide Risk

Antidepressant medications are required to include a boxed warning in their prescribing information sheets about the risk of suicidal thoughts and behavior in children and adolescents.

The United States (U.S.) Food and Drug Administration (FDA) decided in 2004 to make this a requirement after analyzing studies and reports from the late 1990s and early 2000s where increased suicidal risk was observed in the first month or so after starting antidepressants in young people.

Since around 2010, more and more reports have questioned how valid or necessary this warning is due to statistics like a decrease in the use of antidepressant drugs and an increase in the rate of suicide among people with severe depression who go untreated.

If you are the caregiver of a child or adolescent struggling with depression, it’s normal to feel concerned about this warning. Discuss with your child’s healthcare provider the risks of suicidal thoughts or behaviors associated with starting antidepressants versus the risk of these events occurring from depression going untreated.



Help Is Available

If you or someone you know are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see the National Helpline Database.



What Is the Most Effective Medication for Major Depressive Disorder?

A study of over 500 trials, which included over 116,000 individuals, analyzed 21 different antidepressants used to treat depression in adults.

Within head-to-head studies, some of the most effective drugs were:

  • Amitriptyline

  • Lexapro (escitalopram)

  • Remeron (mirtazapine)

  • Paxil (paroxetine)

  • Effexor (venlafaxine)

  • Trintellix (vortioxetine)

Still, the analysis concluded that all antidepressants were more effective than placebo (a treatment with no active properties that's given to a control group in trials). This supports the practice of trying different medications for different individuals and the likely need to try more than one before finding the best option.

Another analysis of depression in children and adolescents included over 70 trials, more than 9500 participants, and primarily moderate to severe cases of depression.

This analysis looked at 16 antidepressant medications, seven psychotherapies, and five combinations of antidepressant and psychotherapy treatments. Prozac (fluoxetine), either alone or in combination with cognitive behavioral therapy (CBT), seemed to be the best choice for this population.

Finding the Right Medication For You

Finding the right medication to treat your MDD may take a couple of tries. Your healthcare provider may start with a certain drug based on other issues you may be struggling with (such as anxiety or trouble sleeping) or based on their own experience of successfully treating other individuals with depression.

It’s important to note that it sometimes takes up to eight to 12 weeks of consistently taking antidepressants as prescribed to see their full benefit. This may sound like a long wait time, but it is necessary to determine whether a medication is a good fit for you or whether another option may be better.

One option to consider that may help you find the best antidepressant medication and minimize side effects is pharmacogenetic testing. This is a somewhat new field where genetic information is collected that may help guide healthcare prescribers in choosing the ideal medication for you.

One study, including over 1500 people, found that prescribing medications based on the results of a 12-gene test significantly reduced side effects versus standard care guideline-based treatment.

Pharmacogenetic testing is not a sure bet, but it may lower your risk of medication-related side effects and lessen the time it takes to find the best medication option. Talk to your healthcare provider if you are curious about pharmacogenomic testing and whether it may optimize your treatment.

Options for Treatment-Resistant Depression

Sometimes, treatment with one medication isn’t enough to help with symptoms of depression.

You may experience a partial response to a medication, where your symptoms improve but not as much as they could, or maybe some symptoms still linger. If this happens, you and your healthcare provider may try a different medication or add another medication to your regimen.

The following are second-generation antipsychotics that are FDA-approved as add-on therapies to an antidepressant for treatment-resistant depression (TRD):

  • Abilify (aripiprazole)

  • Rexulti (brexpiprazole)

  • Seroquel (quetiapine)

  • Zyprexa (olanzapine)

Another newer treatment option for TRD is ketamine, a drug that has been used since the 1970s for anesthesia. It has been growing in popularity and investigation as a depression treatment in recent years. The drug is available as an intravenous infusion or an intranasal product called Spravato (esketamine).

Other Treatments for Major Depressive Disorder

Interventions beyond medication play a large role in treating depression. There are many different types and styles of therapy that can contribute to a successful depression treatment plan. Some of these types include:

  • Cognitive behavioral therapy (CBT), a form of talk therapy with a counselor that aims to correct unhealthy thoughts and behaviors that can contribute to depression

  • Psychodynamic psychotherapy, which analyzes internal conflicts and emotional patterns that contribute to depression

  • Interpersonal therapy, which is therapy focused on your relationships with others

  • Supportive therapy, which uses a combination of therapy types to treat depression

Some non-drug procedures that aim to treat depression include:

  • Electroconvulsive therapy (ECT), a procedure performed under anesthesia where electric currents are sent through a person’s brain, causing a small seizure, to try to alter the brain’s chemistry and reduce symptoms of depression.

  • Transcranial magnetic stimulation (TMS), a noninvasive 20-30 minute procedure involving using magnets to stimulate nerve cells in the brain, with a lower risk of side effects than ECT.

Summary

Many drug classes exist to treat major depressive disorder. These include SSRIs, SNRIs, TCAs, antipsychotics, and more. All of these groups of medications can improve symptoms of MDD and significantly impact quality of life.

These medications have been shown to work better than placebo in adults, with some of the most helpful options being SSRIs like Lexapro (escitalopram) and SNRIs like Effexor (venlafaxine).

It can take a few weeks or months for an antidepressant to reach its full treatment potential, so it’s important to give your medication plenty of time with consistent use as prescribed before deciding whether it is a good fit for you or not.

Medications can be helpful in treating the condition, but even better is combining drug treatment with non-drug interventions such as CBT.

Read the original article on Verywell Health.