This post was written by Dr. Andrea Patterson, Parkview Behavioral Health Institute.
Antidepressants are a common part of care plans designed to combat changes in mood, including anxiety, depression and ongoing sadness. In this post, we break down some of these medications, specifically, neurotransmitters, and how they work in the body.
Neurotransmitters
Neuro means related to the nervous system, which includes your brain, brain stem, spinal cord and nerves. A transmitter is something that sends a signal.
Neurotransmitters are simply molecules that the cells in your nervous system use to send signals. Most psychiatric medications work by impacting these signals. There are many neurotransmitters, but we are going to focus on three of the most important targets for depression: serotonin, norepinephrine and dopamine.
Serotonin
Serotonin is a neurotransmitter that impacts mood, motivation, memory, sleep and even digestion. It is the target of the most common antidepressant medications.
Selective serotonin reuptake inhibitors (SSRIs) prevent serotonin from being removed after it is released, so that serotonin slowly builds up over time. That means if you do not feel a difference the first time you take it, give it time! Most antidepressants take weeks to months to work fully.
Examples of SSRIs include:
- Fluoxetine (Prozac®)
- Sertraline (Zoloft®)
- Citalopram (Celexa®)
- Escitalopram (Lexapro®)
- Paroxetine (Paxil®)
These medications are common and well-studied, so your doctor or provider is likely to choose an SSRI first for depression. This is especially true if you also have conditions that SSRIs also treat like anxiety, post-traumatic stress disorder or obsessive-compulsive disorder.
Norepinephrine
Norepinephrine is a neurotransmitter that impacts energy and alertness. Medications that work on norepinephrine alone are used to help concentration in attention deficit hyperactivity disorder (ADHD). Medications that impact both serotonin and norepinephrine are called serotonin/norepinephrine reuptake inhibitors (SNRIs).
Examples of SNRIs include:
- Duloxetine (Cymbalta®)
- Venlafaxine (Effexor®)
- Desvenlafaxine (Pristiq®)
Although SSRIs are usually tried for depression first, SNRIs are likely to be the next medication class tried. Your doctor or provider might also pick an SNRI if you have a blood relative who does well on an SNRI, you have issues with attention or you suffer from certain kinds of chronic pain (which some SNRIs have been shown to treat).
Dopamine
Dopamine is a neurotransmitter involved in movement and pleasure. Too little dopamine can cause issues like the tremor and sadness found in Parkinson’s disease. Too much dopamine can cause over-excitement, impulsivity and even hallucinations. Too much dopamine can happen with recreational drug use, manic episodes in bipolar disorder and schizophrenia.
Bupropion (Wellbutrin®) is an antidepressant medication believed to work by impacting both dopamine and norepinephrine. Your doctor or provider may choose bupropion if you do not respond well to SSRIs/SNRIs, if you have a blood relative who does well on it, if you have issues with attention or if you want help quitting smoking (since it has also been found to help nicotine cravings).
In summary
- There are multiple neurotransmitters that medications can target.
- Most medications take weeks to months to fully work, so try not to get discouraged if you do not feel a difference right away.
- If one type of antidepressant causes side-effects or does not work for you, there are lots of other options to choose from. This article only lists some of the most common types.
- Know your family history: if an antidepressant works for a family member, it may be a good option for you to try.
- Some antidepressants can also be used to treat other conditions like anxiety, pain, insomnia, or even nicotine cravings. Talk to your doctor or provider about the best options for you!
