What are antidepressants?

Antidepressants (ADs) are drugs that make you feel less miserable. They are supposed to cure depression, apathy, abulia, anxiety (where they overlap with anxiolytics), OCD and other mental woes. Sometimes they do, but they also come with various side effects.

SSRIs - selective serotonin reuptake inhibitors. There are six main SSRIs (fluoxetine, sertraline, citalopram and escitalopram, fluvoxamine, paroxetine). The most famous and prescribed drugs. Many people benefit from them and they are probably the best ones to start with. A common side effect of all serotonin ADs is the loss of libido, or in plain words, the inability to get it on.

(S)NRIs - more powerful ADs that regulate not only serotonin but also norepinephrine. Examples are venlafaxine, duloxetine, milnacipran. They work effectively, but their side effects/withdrawal are somewhat worse.

Tricyclics - one of the first antidepressants. Their chemical structure has three cycles with a tail, hence the name. They act as powerful SNRIs, but with additional effects on histamine, cholinergic and other receptors. Very effective, but have a lot of side effects and are very dangerous in overdose. In most countries are represented by amitriptyline, as well as clomipramine and imipramine. There are also doxepin, trimipramine etc.

SNDIs - act on norepinephrine and dopamine. Apart from bupropion there are not many of them.

MAOIs (monoamine oxidase inhibitors). Inhibit the enzyme that breaks down serotonin, norepinephrine and dopamine. There are two classes, reversible and irreversible (as well as affecting MAO-A and MAO-B)

• Irreversible MAOIs. Examples are phenelzine, tranylcypromine, isoniazid, isocarboxazid, selegiline. Some of the most powerful antidepressants, but also serious side effects. Absolutely not to be taken with SSRIs and other serotonin drugs because of the terrible serotonin syndrome, as well as cheese because of the tyramine syndrome (severe blood pressure rise).
• Reversible MAOIs - widely represented by moclobemide. Not the strongest ones, but their side effects are mild. With SSRIs, however, it is better not to mix.

Various antidepressants (mirtazapine, trazodone, vortioxetine, agomelatine, etc.). Act on different mechanisms and differently.