List of antidepressants
This is a complete list of clinically approved prescription antidepressants throughout the world, as well as clinically approved prescription drugs used to augment antidepressants, by pharmacological and/or structural classification. Chemical/generic names are listed first, with brand names in parentheses. All drugs listed are approved specifically for major depressive disorder unless noted otherwise.
Selective serotonin reuptake inhibitors (SSRIs)
- Citalopram (Celexa, Cipramil)
- Escitalopram (Lexapro, Cipralex)
- Fluoxetine (Prozac, Sarafem)
- Fluvoxamine (Luvox, Faverin)
- Paroxetine (Paxil, Seroxat)
- Sertraline (Zoloft, Lustral)
Serotonin–norepinephrine reuptake inhibitors (SNRIs)
- Desvenlafaxine (Pristiq)
- Duloxetine (Cymbalta)
- Levomilnacipran (Fetzima)
- Milnacipran (Ixel, Savella)
- Venlafaxine (Effexor)
Serotonin modulator and stimulators (SMSs)
- Vilazodone (Viibryd)
- Vortioxetine (Trintellix)
Serotonin antagonist and reuptake inhibitors (SARIs)
- Nefazodone (Dutonin, Nefadar, Serzone) – withdrawn/discontinued in most countries
- Trazodone (Desyrel)
Norepinephrine reuptake inhibitors (NRIs)
- Reboxetine (Edronax)
- Teniloxazine (Lucelan, Metatone) – also a 5-HT2A receptor antagonist
- Viloxazine (Vivalan) – also a 5-HT2B receptor antagonist and 5-HT2C receptor agonist
Although marketed as an antidepressant, a meta-analysis found that reboxetine was ineffective and potentially harmful.[1]
Atomoxetine (Strattera) is an NRI approved to treat ADHD which may be used off-label for depression although evidence of efficacy is poor.[2][3][4][5]
Norepinephrine–dopamine reuptake inhibitors (NDRIs)
- Bupropion (Wellbutrin) – also a non-competitive antagonist of nicotinic acetylcholine receptors[6]
Tricyclic antidepressants (TCAs)
- Amitriptyline (Elavil, Endep)
- Amitriptylinoxide (Amioxid, Ambivalon, Equilibrin)
- Clomipramine (Anafranil)
- Desipramine (Norpramin, Pertofrane)
- Dibenzepin (Noveril, Victoril)
- Dimetacrine (Istonil)
- Dosulepin (Prothiaden)
- Doxepin (Adapin, Sinequan)
- Imipramine (Tofranil)
- Lofepramine (Lomont, Gamanil)
- Melitracen (Dixeran, Melixeran, Trausabun)
- Nitroxazepine (Sintamil)
- Nortriptyline (Pamelor, Aventyl)
- Noxiptiline (Agedal, Elronon, Nogedal)
- Opipramol (Insidon)
- Pipofezine (Azafen/Azaphen)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
Tetracyclic antidepressants (TeCAs)
- Amoxapine (Asendin)
- Maprotiline (Ludiomil)
- Mianserin (Tolvon)
- Mirtazapine (Remeron)
- Setiptiline (Tecipul)
Mianserin, mirtazapine, and setiptiline are also sometimes described as noradrenergic and specific serotonergic antidepressants (NaSSAs).
Monoamine oxidase inhibitors (MAOIs)
Non-selective
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
Selective for MAO-B
- Selegiline (Eldepryl, Zelapar, Emsam)
Non-selective
Caroxazone (Surodil, Timostenil) was formerly used as an antidepressant, but has been discontinued.
Selective for MAO-A
- Metralindole (Inkazan)
- Moclobemide (Aurorix, Manerix)
- Pirlindole (Pirazidol)
- Toloxatone (Humoryl)
These drugs are sometimes described as reversible inhibitors of MAO-A (RIMAs).
Eprobemide (Befol) and minaprine (Brantur, Cantor) were also formerly used as antidepressants, but have been discontinued.
Non-selective
- Bifemelane (Alnert, Celeport) – RIMA, irreversible inhibitor of MAO-B, and weak NRI
Others
Marketed
- Agomelatine (Valdoxan) – 5-HT2C receptor antagonist and MT1 and MT2 receptor agonist
- Esketamine (Spravato) – non-competitive NMDA receptor antagonist[7]
- Ketamine (Ketalar) – non-competitive NMDA receptor antagonist – not specifically approved for depression (used off-label)[8]
- Tianeptine (Stablon, Coaxil) – weak and atypical μ-opioid receptor agonist
Discontinued/withdrawn
- α-Methyltryptamine [αMT] (Indopan) – non-selective serotonin receptor agonist, serotonin–norepinephrine–dopamine releasing agent (SNDRA), and weak RIMA
- Etryptamine [α-Ethyltryptamine (αET)] (Monase) – non-selective serotonin receptor agonist, SNDRA, and weak RIMA
- Indeloxazine (Elen, Noin) – serotonin releasing agent (SRA), NRI, and NMDA receptor antagonist
- Medifoxamine (Clédial, Gerdaxyl) – weak serotonin–dopamine reuptake inhibitor (SDRI) and 5-HT2A and 5-HT2C receptor antagonist
- Oxaflozane (Conflictan) – 5-HT1A, 5-HT2A, and 5-HT2C receptor agonist
- Pivagabine (Tonerg) – unknown/unclear mechanism of action
Over-the-counter
The following antidepressants are available both with a prescription and over-the-counter:
- Ademetionine [S-Adenosyl-L-methionine (SAMe)] (Heptral, Transmetil, Samyl) – cofactor in monoamine neurotransmitter biosynthesis
- Hypericum perforatum [St. John's Wort (SJW)] (Jarsin, Kira, Movina) – TRPC6 activator, and various other actions
- Oxitriptan [5-Hydroxytryptophan (5-HTP)] (Cincofarm, Levothym, Triptum) – precursor in serotonin biosynthesis
- Rubidium chloride [RbCl] (Rubinorm) – unknown/unclear mechanism of action[9]
- Tryptophan (Tryptan, Optimax, Aminomine) – precursor in serotonin biosynthesis
Adjunctive treatments
Atypical antipsychotics
- Amisulpride (Solian) – specifically approved, in low doses, as a monotherapy for dysthymia
- Aripiprazole (Abilify) – specifically approved as an adjunct for major depressive disorder
- Brexpiprazole (Rexulti) – specifically approved as an adjunct for major depressive disorder
- Lurasidone (Latuda) – specifically approved for depressive episodes in bipolar disorder
- Olanzapine (Zyprexa) – specifically approved as an adjunct for major depressive disorder
- Quetiapine (Seroquel) – approved as an adjunct for both major depressive disorder and depressive episodes in bipolar disorder
- Risperidone (Risperdal) – not specifically approved as an adjunct for major depressive disorder (used off-label)
Typical antipsychotics
- Trifluoperazine (Stelazine) – not specifically approved as an adjunct for major depressive disorder (used off-label)[10]
Others
- Buspirone (Buspar) – 5-HT1A receptor partial agonist – not specifically approved for depression (used off-label)
- Lithium (Eskalith, Lithobid) – mood stabilizer (mechanism of action unknown/unclear) – not specifically approved for depression (used off-label)
- Modafinil (Provigil) – marketed as an eugeroic or wakefulness-promoting drug, a weak dopamine reuptake inhibitor with other pharmacodynamic effects of relevance in improving depressive symptoms, used off-label[11][12][13][14]
- Thyroxine (T4) – thyroid hormone (thyroid hormone receptor agonist) – not specifically approved for depression (used off-label)
- Triiodothyronine (T3) – thyroid hormone (thyroid hormone receptor agonist) – not specifically approved for depression (used off-label)
Combination products
- Amitriptyline/chlordiazepoxide (Limbitrol) – TCA and benzodiazepine combination
- Amitriptyline/perphenazine (Etafron) – TCA and typical antipsychotic combination
- Flupentixol/melitracen (Deanxit) – TCA and typical antipsychotic combination
- Olanzapine/fluoxetine (Symbyax) – SSRI and atypical antipsychotic combination – specifically approved as a monotherapy for depressive episodes in bipolar disorder and treatment-resistant depression
- Tranylcypromine/trifluoperazine (Parstelin, Parmodalin, Jatrosom N, Stelapar) – MAOI and typical antipsychotic combination
References
- Eyding D, Lelgemann M, Grouven U, Härter M, Kromp M, Kaiser T, Kerekes MF, Gerken M, Wieseler B (2010). "Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials". BMJ. 341: c4737. doi:10.1136/bmj.c4737. PMC 2954275. PMID 20940209.
- Fedder D, Patel H, Saadabadi A. "Atomoxetine". PMID 29630286. Cite journal requires
|journal=(help) - Dell'Osso B, Palazzo MC, Oldani L, Altamura AC (December 2011). "The noradrenergic action in antidepressant treatments: pharmacological and clinical aspects". CNS Neurosci Ther. 17 (6): 723–32. doi:10.1111/j.1755-5949.2010.00217.x. PMC 6493872. PMID 21155988.
- Fleurence R, Williamson R, Jing Y, Kim E, Tran QV, Pikalov AS, Thase ME (2009). "A systematic review of augmentation strategies for patients with major depressive disorder". Psychopharmacol Bull. 42 (3): 57–90. PMID 19752841.
- Corp SA, Gitlin MJ, Altshuler LL (September 2014). "A review of the use of stimulants and stimulant alternatives in treating bipolar depression and major depressive disorder". J Clin Psychiatry. 75 (9): 1010–8. doi:10.4088/JCP.13r08851. PMID 25295426.
- Arias HR, Santamaría A, Ali SF (2009). "Pharmacological and neurotoxicological actions mediated by bupropion and diethylpropion". Int. Rev. Neurobiol. International Review of Neurobiology. 88: 223–55. doi:10.1016/S0074-7742(09)88009-4. ISBN 9780123745040. PMID 19897080.
- "SPRAVATO™ (esketamine) nasal spray FDA label" (PDF). Food and Drug Administration. 5 March 2019. Retrieved 6 March 2019.
- Zhang MW, Harris KM, Ho RC (2016). "Is off-label repeat prescription of ketamine as a rapid antidepressant safe? Controversies, ethical concerns, and legal implications". BMC Med Ethics. 17: 4. doi:10.1186/s12910-016-0087-3. PMC 4714497. PMID 26768892.
- Gian F. Placidi; Liliana Dell'Osso; Giuseppe Nistico; Hagop S. Akiskal (6 December 2012). Recurrent Mood Disorders: New Perspectives in Therapy. Springer Science & Business Media. pp. 293–. ISBN 978-3-642-76646-6.
- Thase ME (2016). "Adverse Effects of Second-Generation Antipsychotics as Adjuncts to Antidepressants: Are the Risks Worth the Benefits?". Psychiatr. Clin. North Am. 39 (3): 477–86. doi:10.1016/j.psc.2016.04.008. PMID 27514300.
- Urban AE, Cubała WJ (February 2020). "The role of eugeroics in the treatment of affective disorders". Psychiatr Pol. 54 (1): 21–33. doi:10.12740/PP/OnlineFirst/90687. PMID 32447354.
- Kleeblatt J, Betzler F, Kilarski LL, Bschor T, Köhler S (May 2017). "Efficacy of off-label augmentation in unipolar depression: A systematic review of the evidence". Eur Neuropsychopharmacol. 27 (5): 423–441. doi:10.1016/j.euroneuro.2017.03.003. PMID 28318897.
- Nunez NA, Singh B, Romo-Nava F, Joseph B, Veldic M, Cuellar-Barboza A, Cabello Arreola A, Vande Voort JL, Croarkin P, Moore KM, Biernacka J, McElroy SL, Frye MA (March 2020). "Efficacy and tolerability of adjunctive modafinil/armodafinil in bipolar depression: A meta-analysis of randomized controlled trials". Bipolar Disord. 22 (2): 109–120. doi:10.1111/bdi.12859. PMID 31643130.
- Szmulewicz AG, Angriman F, Samamé C, Ferraris A, Vigo D, Strejilevich SA (June 2017). "Dopaminergic agents in the treatment of bipolar depression: a systematic review and meta-analysis". Acta Psychiatr Scand. 135 (6): 527–538. doi:10.1111/acps.12712. PMID 28256707.
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