Decoding antidepressants

Our writer takes sertraline, part of the SSRI family of drugs, but there are other types of antidepressant too – and many more acronyms

SSRI

Selective serotonin reuptake inhibitors are one of the most common types of antidepressant. They are believed to work by increasing the level of serotonin (a mood stabiliser) in the brain. Serotonin is usually ‘reabsorbed’ by nerve cells after carrying a message between them – these block that reuptake. Often prescribed as a first choice as they tend to have fewer side effects than other antidepressants. Examples: citalopram, fluoxetine (brand name Prozac), sertraline.

SNRI

Serotonin and noradrenaline reuptake inhibitors are similar to SSRIS, but rather than only affecting serotonin levels, they impact levels of norepinephrine, also known as noradrenaline, too. (This hormone and neurotransmitter plays an important role in the fight-or-flight response.) There are varying reports about whether this is more effective than using SSRIS – it seems to come down to the individual’s response to it. Examples: duloxetine, venlafaxine.

NASSA

Noradrenaline and specific serotonergic antidepressants are said to be effective for some people who are unable to take SSRIS. The side effects are generally alike, but NASSAS cause fewer sexual problems in some patients (one of the possible side effects of SSRIS), though according to the NHS they may cause more drowsiness at first. They are another option that ups how much noradrenaline and serotonin is available in the brain.

Examples: mirtazapine.

TCA

Tricyclic antidepressants are used infrequently as they can be more dangerous in the event of an overdose. They are an older type of antidepressant, mostly used in serious cases if a patient has failed to respond to other options, but difficult side effects can be more likely with tricyclics. Again, in common with SNRIS, they impact reuptake of noradrenaline and serotonin.

Examples: amitriptyline, clomipramine, lofepramine, nortriptyline.