Major depressive disorder — commonly referred to as depression — is characterized by symptoms, such as loss of interest, low energy, and feelings of guilt or hopelessness that have been present for more than 2 weeks. It is often treated with antidepressants, with or without psychotherapy.But with so many antidepressants available, which ones are the most effective? Here, we’ll discuss the various types of antidepressants available and how you and your prescriber can decide which one is the best choice for you.

What are the different types of antidepressants?

There are five common types of antidepressants:

1. Selective serotonin reuptake inhibitors (SSRIs)

2. Serotonin and norepinephrine reuptake inhibitors (SNRIs)

3. Atypical antidepressants

4. Tricyclic antidepressants (TCAs)

5. Monoamine oxidase inhibitors (MAOIs)

Below, we’ll discuss some well-known antidepressants and which classes they belong to.

1. SSRIs

Five well-known, SSRI medications that are FDA approved to treat depression include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

SSRIs are considered first-choice antidepressants. These medications are believed to work by raising the amount of serotonin — a hormone that helps regulate mood — in the brain. While effective for treating depression, it typically takes them about 2 weeks to start working and 4 to 8 weeks to experience their full benefits.

2. SNRIs

Three examples of well-known SNRIs that are FDA approved to treat depression include:

• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)
• Venlafaxine (Effexor)

SNRIs are another first-choice option. They’re thought to work by raising levels of serotonin and norepinephrine. Norepinephrine helps boost alertness and focus. Like SSRIs, these medications can also take 2 weeks to start working, and 4 to 8 weeks to fully work.

3. Atypical antidepressants

This group includes antidepressants that don’t fit into other medication classes. Five notable commonly prescribed atypical antidepressants are:

• Bupropion (Wellbutrin XL)
• Bupropion / dextromethorphan (Auvelity)
• Esketamine (Spravato)
• Mirtazapine (Remeron)
• Trazodone (Desyrel)

How some of these types of antidepressants work isn’t fully understood. Bupropion and mirtazapine are as effective as SSRIs and SNRIs. And both are considered first-choice options for treating depression. But trazodone can be helpful if a person has both depression and insomnia (trouble sleeping). Esketamine may be an option if you’ve tried at least two other antidepressants without success.

4. TCAs

There are several TCAs available, but four commonly prescribed examples are:

• Amitriptyline
• Desipramine (Norpramin)
• Doxepin
• Nortriptyline (Pamelor)

TCAs are thought to treat depression by raising levels of serotonin and norepinephrine in the brain. Some studies suggest that they may be more effective for certain people with severe depression. But they also have a greater risk of side effects. Because they aren’t as well-tolerated as previously listed antidepressants, they’re not first-choice antidepressants for most people.

Which type of antidepressant is the most commonly prescribed?

SSRIs are the most commonly prescribed type of antidepressant. This is because they’re effective and well-tolerated with mild side effects for many people. With many SSRIs available as generic products, they also tend to be more affordable. SNRIs and bupropion are also common choices for similar reasons.

Which antidepressant has the least side effects?

There isn’t a definitive answer for this question. All antidepressants can cause side effects. And everyone tolerates them a little differently. Generally speaking, SSRIs and SNRIs are well-tolerated by most people. They also have good evidence supporting their long-term safety. Older antidepressants, like TCAs and MAOIs, tend to cause more side effects.

Which antidepressant works the fastest?

Spravato is the antidepressant that works the fastest. It can start providing relief within a few hours. However, Spravato has a number of serious risks and you can only administer it if you’re at your prescriber’s office. It’s also only FDA approved for treatment-resistant depression. So it’s not an available option for most people.

Auvelity is another faster-acting antidepressant. It can start relieving depression symptoms in as little as 1 week. It can also be prescribed just like most other antidepressants. So there’s no restrictions for its use, unlike Spravato.

Other types of antidepressants usually take a few weeks to kick in. Generally speaking, you can expect to experience some effects between 4 and 6 weeks after starting your medication. If you don’t feel any change after 8 weeks, let your prescriber know that it doesn’t seem to be working.

How to Know Which Antidepressant Is Best for You

how do physicians know which antidepressants to try when prescribing them to patients?They often consider several factors, such as the symptoms experienced and whether any other health conditions are present. While there are some barriers to treatment, including negative side effects, solutions do exist—enabling healthcare providers to find the best antidepressant possible.

Antidepressant Selection Factors

Patient Symptoms

Co-Occurring Conditions

Potential Side Effects

Other Medications Being Taken

Family History

Pregnancy or Breastfeeding

Because of this, prescribers typically select an antidepressant medication based on its possible side effects or its ability to treat other health conditions you have. Depression treatments should be personalized based on your needs and your response to medication.

Be sure to let your healthcare provider know how you are feeling after starting an antidepressant. So, if necessary, they can make any changes and prescribe the best type of antidepressant for you.