In the world of antidepressants, there are many drugs to choose from. Your doctor will likely guide you through this process, but it helps to have a bit of information beforehand. This article will discuss first line antidepressants. These are the most commonly-prescribed antidepressants.
What Is a First Line Antidepressant?
The term first line antidepressant is somewhat self-explanatory. These drugs are considered the first line of defense against depression. If you go to your doctor to seek help for depression, they’ll probably offer you a first line antidepressant.
These drugs are considered first line because they strike a safe balance between usefulness, tolerability, and side effects. If you don’t respond well to a first line antidepressant you will likely be given something else.
Examples of First Line Antidepressants
The most common first line antidepressants are SSRIs and SNRIs. Below we offer an explanation and examples of both types of drug.
SSRIs are selective serotonin reuptake inhibitors. They affect serotonin in the brain. Serotonin is responsible for regulating mood among other things. SSRIs make serotonin more effective.
These are some examples of common first line SSRIs.
- Celexa (citalopram). General doses range from 10-40mg.
- Cipralex (escitalopram). General doses range from 10-20mg, not exceeding 10mg in elderly patients.
- Prozac (fluoxetine). The most common antidepressant. Doses range from 10-80 mg.
- Paxil (paroxetine). Doses range from 50-200 mg, never exceeding 300mg.
- Zoloft (sertraline). Doses range from 50-150mg.
SSRIs are usually well-tolerated. However, they are not free from side effects. Common side effects include sleep problems, high blood pressure, digestive problems, and sexual changes.
The other, most common first line antidepressants are SNRIs. SNRI stands for serotonin and norepinephrine reuptake inhibitors. These drugs work on serotonin as well as norepinephrine (adrenaline). Since they work on adrenaline they are generally more stimulating than SSRIs. Professionals refer to stimulating antidepressants as activating.
These are some examples of common first line SNRIs.
- Cymbalta (duloxetine). General doses range from 30-60 mg, never exceeding 120mg.
- Pristiq (desvenlafaxine). Doses range from 50-100mg.
- Effexor (venlafaxine). Doses range from 37.5-375 mg.
SNRIs are usually well tolerated. However, side effects may also occur with these drugs. Side effects are often similar to SSRIs. These include changes in sexual behavior, sleep problems, sweating, and nausea.
Other First Line Antidepressants
There are a few other first line antidepressants. These include:
- Wellbutrin (bupropion). Wellbutrin is a NDRI. It affects norepinephrine and dopamine. It may cause changes in sleeping habits, reduced appetite, and headaches.
- Remeron (mirtazapine). Remeron is a NaSSAs that affects noradrenaline and serotonin. Doses range from 15-30mg and, in extreme cases, up to 60 mg.
- Manerix (moclobemide) is a RIMA that affects monoamine oxidase. Doses range from 300-600 mg. Manerix may cause insomnia, dry mouth, and high blood pressure.
There are many antidepressants out there. First-line antidepressants are prescribed to people who have not had experience with other antidepressants. If these drugs don’t work for you, your doctor will likely prescribe something else.
When starting a new antidepressant program it’s important to be aware of side effects. Talk to your doctor to ensure that you find a drug that works for you. If you experience difficulty with apathy or other side effects, let them know.