The most effective antidepressant compared to placebo was the tricyclic antidepressant amitriptyline, which increased the chances of treatment response more than two-fold (odds ratio [OR] 2.13, 95% credible interval [CrI] 1.89 to 2.41).
Selective Serotonin Reuptake Inhibitors (SSRIs)
This class includes sertraline, citalopram, escitalopram, paroxetine, fluoxetine and fluvoxamine. SSRIs are: the most commonly prescribed antidepressants in Australia. often a doctor's first choice for most types of depression.
In general, because of the side effect and safety profile, selective serotonin reuptake inhibitors (SSRIs) are considered to be the first line antidepressants. Other preferred options include tricyclic antidepressants, mirtazapine, bupropion, and venlafaxine.
Choosing an antidepressant — For the initial treatment of severe depression, we use serotonin-norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs).
Exposure therapy (ET), which follows the Pavlovian extinction model, is regarded as the gold-standard treatment for social anxiety disorder (SAD).
Zoloft (sertraline)
Zoloft is another SSRI antidepressant that can also treat depression and certain types of anxiety. It causes side effects similar to those of Prozac. Some of these side effects go away after a month of taking these medications, but others can last longer.
Fluoxetine is probably the best known SSRI (sold under the brand name Prozac). Other SSRIs include citalopram (Cipramil), escitalopram (Cipralex), paroxetine (Seroxat) and sertraline (Lustral).
SSRIs are usually the first choice medicine for depression because they generally have fewer side effects than most other types of antidepressant.
SSRIs are among the most frequently sold drugs in Australia. Sertraline (sold under the brand name Zoloft) and escitalopram (Cipralex and Lexapro) are both among Australia's 10 most commonly prescribed medications.
Four new antidepressants have been recently marketed in Australia. They are the selective reversible monoamine oxidase A inhibitor, moclobemide, and the selective serotonin reuptake inhibitors (SSRIs), fluoxetine, paroxetine and sertraline.
SSRIs and SNRIs are often the first-line treatment for anxiety. Common SSRI brands are Celexa, Lexapro, Luvox, Paxil, and Zoloft. Common SNRI brands are Pristiq, Cymbalta, and Effexor XR. Pros: They are effective for a lot of people and they have a solid safety profile.
Ketamine. Ketamine is a medication originally used for anesthesia and pain relief, but medical professionals also use it to help people with treatment-resistant depression. Unlike other antidepressants, ketamine can improve depression symptoms in just a few hours.
Doctors often start by prescribing an SSRI. These drugs are considered safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and vilazodone (Viibryd).
Prozac (fluoxetine) and Wellbutrin (bupropion) are examples of “energizing” antidepressants; whereas Paxil (paroxetine) and Celexa (citalopram) tend to be more sedating. Initial choices therefore, should be predicated on how the depression presents—as outlined in #2 above.
SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). Serotonin and norepinephrine reuptake inhibitors (SNRIs).
Takeaway. The FDA has recently approved brexanolone (Zulresso) and esketamine (Spravato) to treat depression. These new approaches for treating depression appear to offer some worthwhile advantages compared to SSRIs and SNRIs, including acting in hours as opposed to days or weeks.
Buspirone (BuSpar) works much more slowly than benzodiazepines and may not treat all types of anxiety disorder, but it causes fewer side effects and has a lower risk of dependency.
A second therapeutic candidate, LYT-310 (oral cannabidiol), is expected to enter the clinic in Q4 of 2023.
Bupropion, citalopram, escitalopram, and sertraline were better tolerated than the other antidepressants. Escitalopram and sertraline were found to have the best combination of efficacy and acceptability.
Dextromethorphan/bupropion (Auvelity), was recently approved by the United States (US) Food and Drug Administration (FDA) for the treatment of depression.
Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders. Generally a short-term treatment, CBT focuses on teaching you specific skills to improve your symptoms and gradually return to the activities you've avoided because of anxiety.
Benzodiazepines (also known as tranquilizers) are the most widely prescribed type of medication for anxiety. Drugs such as Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam) work quickly, typically bringing relief within 30 minutes to an hour.
Benzodiazepines most commonly used to treat anxiety disorders are clonazepam (Rivotril)*, alprazolam (Xanax) and lorazepam (Ativan). Also used are bromazepam (Lectopam), oxazepam (Serax), chlordiazepoxide (once marketed as Librium), clorazepate (Tranxene) and diazepam (Valium).