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• Nefazodone (Dutonin, Nefadar, Serzone) – withdrawn/discontinued in most countries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)

• Atomoxetine (Strattera) - an NRI approved to treat ADHD
• Reboxetine (Edronax)
• Teniloxazine (Lucelan, Metatone) – also a 5-HT_2A receptor antagonist
• Viloxazine (Vivalan)

Although marketed as an antidepressant, a meta-analysis found that reboxetine was ineffective and potentially harmful.[1]

Norepinephrine–dopamine reuptake inhibitors (NDRIs)

• Bupropion (Wellbutrin) – weak NDRI, although its dopaminergic actions are controversial; may act as a norepinephrine–dopamine releasing agent (NDRA) alternatively or additionally; also a non-competitive antagonist of nicotinic acetylcholine receptors[2]

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)

Irreversible

Non-selective

• Isocarboxazid (Marplan)
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)

Selective for MAO-B

• Selegiline (Eldepryl, Zelapar, Emsam)

Reversible

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.

Mixed

Non-selective

• Bifemelane (Alnert, Celeport) – RIMA, irreversible inhibitor of MAO-B, and weak NRI

Others

Marketed

• Agomelatine (Valdoxan) – 5-HT_2C receptor antagonist and MT₁ and MT₂ receptor agonist
• Esketamine (Spravato) – non-competitive NMDA receptor antagonist[3]
• Ketamine (Ketalar) – non-competitive NMDA receptor antagonist – not specifically approved for depression (used off-label)[4]
• Tandospirone (Sediel) – 5-HT_1A receptor partial agonist
• 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-HT_2A and 5-HT_2C receptor antagonist
• Oxaflozane (Conflictan) – 5-HT_1A, 5-HT_2A, and 5-HT_2C 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[5]
• Tryptophan (Tryptan, Optimax, Aminomine) – precursor in serotonin biosynthesis
• Magnesium[6]
• Acetylcarnitine[7]
• Saffron[8]

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)[9]

Others

• Buspirone (Buspar) – 5-HT_1A 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 - 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[10][11][12]
• 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)
• Minocycline – Microglia inhibitor (Tetracycline antibiotics) – the overall antidepressant effect size of compared to placebo was -0.78 (95% CI: -0.4 to -1.33, P=0.005) in meta-analysis.[13] – not specifically approved for depression (used off-label).[14]

Combination products

• Amitriptyline/chlordiazepoxide - TCA and benzodiazepine (Limbitrol)
• 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

See also

• List of investigational antidepressants

References

1. 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.
2. 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.
3. "SPRAVATO™ (esketamine) nasal spray FDA label" (PDF). Food and Drug Administration. 5 March 2019. Retrieved 6 March 2019.
4. 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.
5. 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.
6. Tarleton EK, Littenberg B, MacLean CD, Kennedy AG, Daley C (2017). "Role of magnesium supplementation in the treatment of depression: A randomized clinical trial". PLOS One. 12 (6): e0180067. doi:10.1371/journal.pone.0180067. PMC 5487054. PMID 28654669.
7. Veronese N, Stubbs B, Solmi M, Ajnakina O, Carvalho AF, Maggi S (Feb–Mar 2018). "Acetyl-L-Carnitine Supplementation and the Treatment of Depressive Symptoms: A Systematic Review and Meta-Analysis". Psychosomatic Medicine. 80 (2): 154–159. doi:10.1097/PSY.0000000000000537. PMID 29076953.
8. Lopresti, Adrian L.; Drummond, Peter D. (November 2014). "Saffron (Crocus sativus) for depression: a systematic review of clinical studies and examination of underlying antidepressant mechanisms of action". Human Psychopharmacology. 29 (6): 517–527. doi:10.1002/hup.2434. ISSN 1099-1077. PMID 25384672.
9. 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.
10. Nasr, S (2004). "Modafinil as adjunctive therapy in depressed outpatients". Annals of Clinical Psychiatry. 16 (3): 133–8. doi:10.1080/10401230490486954. PMID 15517845.
11. Vaishnavi, Sandeep; Gadde, Kishore; Alamy, Sayed; Zhang, Wei; Connor, Kathryn; Davidson, Jonathan R. T. (August 2006). "Modafinil for atypical depression: effects of open-label and double-blind discontinuation treatment". Journal of Clinical Psychopharmacology. 26 (4): 373–378. doi:10.1097/01.jcp.0000227700.263.75.39. ISSN 0271-0749. PMID 16855454.
12. Ferraro, Luca; Fuxe, Kjell; Tanganelli, Sergio; Tomasini, Maria Cristina; Rambert, Francis A.; Antonelli, Tiziana (2002-04-01). "Differential enhancement of dialysate serotonin levels in distinct brain regions of the awake rat by modafinil: possible relevance for wakefulness and depression". Journal of Neuroscience Research. 68 (1): 107–112. doi:10.1002/jnr.10196. ISSN 0360-4012. PMID 11933055.
13. Rosenblat JD, McIntyre RS (2018). "Efficacy and tolerability of minocycline for depression: A systematic review and meta-analysis of clinical trials". Journal of Affective Disorders. 227: 219–225. doi:10.1016/j.jad.2017.10.042. PMID 29102836.
14. Dean, Olivia M.; Kanchanatawan, Buranee; Ashton, Melanie; Mohebbi, Mohammadreza; Ng, Chee Hong; Maes, Michael; Berk, Lesley; Sughondhabirom, Atapol; Tangwongchai, Sookjaroen (August 2017). "Adjunctive minocycline treatment for major depressive disorder: A proof of concept trial". The Australian and New Zealand Journal of Psychiatry. 51 (8): 829–840. doi:10.1177/0004867417709357. ISSN 1440-1614. PMID 28578592.