The Complete Antidepressant List: Every Class, and Why No Single One Is Best

Maybe you’ve been handed a prescription and a pamphlet, or you’ve tried one medication that didn’t feel right and want to know what else exists. The names blur together fast. If you’re trying to make sense of your options, this list is built for you.

Your brain cells talk through chemical messengers such as serotonin, norepinephrine, and dopamine. After a message is sent, the sending cell pulls the leftover messenger back in, a step called reuptake. Many antidepressants adjust that recycling step with precision, and NIMH’s medication guide notes they usually take 4 to 8 weeks to work, with sleep, appetite, and energy often improving before mood lifts.

The standard approach to choosing one is well established. The 2023 ACP guideline from the American College of Physicians recommends cognitive behavioral therapy or a second-generation antidepressant, such as an SSRI, SNRI, or bupropion, as initial treatment for moderate to severe depression. A 2018 Lancet analysis pooling 522 trials and 116,477 adults found that all 21 antidepressants studied worked better than placebo, though the authors rated the certainty of evidence as moderate to very low. The results are real, and the science is well established.

But picking the medication is only the first decision, and at Siggy we don’t think anyone should start an antidepressant and then wait months for someone to ask how it’s going.

This guide lists every major antidepressant class, what each one is used for, the side effects that tend to decide the choice, and the newer options most lists leave out. The idea that the right antidepressant is the one that fits you, rather than one universal winner, comes straight from head-to-head trial evidence.

What This Page Covers

• What Are the Main Types of Antidepressants?
• Which SSRIs Are Available?
• What Are SNRIs Used For?
• What Are Atypical Antidepressants?
• Are Older Antidepressants Like TCAs and MAOIs Still Used?
• What Newer Antidepressants Have Been Approved?
• How Do Prescribers Choose the Right Antidepressant?
• What Should You Know Before Starting or Stopping?
• How Siggy Supports Antidepressant Treatment
• Find the Medication That Fits Your Life

What Are the Main Types of Antidepressants?

Antidepressants fall into a handful of classes based on which brain chemicals they affect. SSRIs are the most prescribed type and generally have fewer side effects than older drugs, according to NIH’s MedlinePlus Magazine. Here’s the big picture:

Class	Examples	Often Chosen For	Watch For
SSRIs	Sertraline, escitalopram, fluoxetine	Depression, anxiety	Upset stomach, sexual side effects
SNRIs	Venlafaxine, duloxetine, desvenlafaxine	Depression, anxiety, nerve pain	Blood pressure, sweating
Atypicals	Bupropion, mirtazapine, trazodone	Specific side effect needs	Varies by drug
TCAs	Amitriptyline, nortriptyline	When newer drugs haven’t helped	More side effects overall
MAOIs	Phenelzine, tranylcypromine	When other options fail	Strict diet, interactions
Newer agents	Esketamine, gepirone, dextromethorphan-bupropion	Varies by drug	Esketamine needs office monitoring

Which SSRIs Are Available?

Selective serotonin reuptake inhibitors (SSRIs) boost serotonin activity and are usually the first medication tried for depression and many anxiety disorders. Common SSRIs include:

• Sertraline (Zoloft)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Citalopram (Celexa)
• Paroxetine (Paxil)
• Fluvoxamine

Common side effects include upset stomach, headache, and sexual dysfunction, NIMH notes, and they’re usually mild and fade with time. Sexual side effects deserve an honest conversation. A 2009 sexual-function meta-analysis that asked patients directly found treatment-emergent sexual dysfunction in 25.8% to 80.3% of people across many common antidepressants, including several SSRIs.

Among SSRIs, escitalopram, sertraline, citalopram, and fluoxetine were among the better-tolerated antidepressants in the Lancet analysis. For a closer look at one of the most prescribed, see our guide on whether Lexapro is an antidepressant.

What Are SNRIs Used For?

Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase both serotonin and norepinephrine. The main options are venlafaxine (Effexor XR), desvenlafaxine (Pristiq), duloxetine (Cymbalta), and levomilnacipran (Fetzima).

SNRIs can be a good fit when pain and mood overlap. MedlinePlus drug information lists duloxetine for depression, generalized anxiety disorder, diabetic nerve pain, fibromyalgia, and ongoing bone or muscle pain. It also notes duloxetine can raise blood pressure, so checks before and during treatment matter. Our guides to Cymbalta for anxiety and depression and Pristiq for depression cover each in depth.

What Are Atypical Antidepressants?

Atypical antidepressants don’t fit neatly into the other classes, and each has its own profile. MedlinePlus Magazine describes three of the most common:

• Bupropion (Wellbutrin), which affects norepinephrine and dopamine, also treats seasonal affective disorder, and helps people quit smoking
• Mirtazapine (Remeron), sometimes chosen when depression comes with trouble sleeping or poor appetite
• Trazodone, approved for depression and also used, off-label, for insomnia and anxiety

Bupropion and mirtazapine stand out for one reason many patients care about: in the 2009 meta-analysis, neither caused more sexual dysfunction than placebo. Vortioxetine (Trintellix) and vilazodone (Viibryd) also act on serotonin, and vortioxetine was among both the more effective and better-tolerated drugs in head-to-head trials in the Lancet analysis. Read more in our guide to Trintellix for depression.

Are Older Antidepressants Like TCAs and MAOIs Still Used?

Yes, though less often. Tricyclic antidepressants (TCAs) include amitriptyline, nortriptyline (Pamelor), imipramine, desipramine (Norpramin), and doxepin. They tend to cause more side effects, so they’re generally prescribed after newer options haven’t worked, according to a Mayo Clinic guide.

Being older doesn’t make these drugs weaker: in the Lancet analysis, amitriptyline showed the largest effect against placebo of any drug studied, but it was also among those with the highest dropout rates.

Monoamine oxidase inhibitors (MAOIs) include phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and the selegiline skin patch (Emsam). Mayo Clinic notes they require a strict diet that avoids high-tyramine foods like certain cheeses and wines, and they can’t be combined with SSRIs.

What Newer Antidepressants Have Been Approved?

Several newer options work differently from traditional antidepressants:

• Esketamine (Spravato) is a nasal spray for treatment-resistant depression, given in a health care provider’s office or clinic, NIMH explains. In a 2025 esketamine trial of 378 adults, esketamine on its own improved symptoms more than placebo at 4 weeks, with nausea, dissociation, and dizziness as common side effects.
• Dextromethorphan-bupropion (Auvelity) was approved for major depressive disorder in 2022, according to its FDA prescribing label.
• Gepirone (Exxua) was approved for adults with major depressive disorder in 2023, per the FDA trial snapshot.
• Zuranolone (Zurzuvae) became the first pill for postpartum depression in 2023. Our guide to postpartum depression explains how it’s used.

NIMH also notes that some atypical antipsychotics are added when depression doesn’t respond to an antidepressant alone. For more on esketamine’s cousin, see our post on ketamine for depression.

How Do Prescribers Choose the Right Antidepressant?

Because all 21 drugs in the Lancet analysis beat placebo with modest differences between them, the decision usually comes down to fit. Prescribers typically weigh your main symptoms (sleep, appetite, energy, pain), which side effects matter most to you, how you or a close relative responded to a medication before, other health conditions, and every other medication or supplement you take.

That last point matters for safety. Combining antidepressants with other serotonin-boosting products, such as triptans for migraine or St. John’s wort, can cause serotonin syndrome, which is rare but life-threatening, NIMH warns. Our guide to first-line vs. second-line antidepressants walks through what happens when the first choice doesn’t work.

What Should You Know Before Starting or Stopping?

Give a medication time. Most need 4 to 8 weeks, and early changes in sleep or energy can be a sign it’s starting to help. Our guide to how long antidepressants take to work lays out the week-by-week picture.

Watch closely in the first few weeks. NIMH notes that children, teenagers, and young adults under 25 may have an increase in suicidal thoughts when starting an antidepressant or changing the dose. If that happens, contact your prescriber right away. If you’re in crisis, call or text 988, or call 911.

Don’t stop suddenly. A 2024 discontinuation meta-analysis of 79 studies found that about 1 in 6 to 7 people who stop an antidepressant have discontinuation symptoms beyond what placebo causes. Paroxetine, imipramine, and venlafaxine or desvenlafaxine were linked to more severe symptoms, so a gradual plan with your prescriber is safer.

How Siggy Supports Antidepressant Treatment

For most people, the hard part comes after the prescription: the side effect nobody warned them about, or the week-five doubt with no one to ask. It’s a feeling patients describe often: “No one checks in to see if it’s actually working.”

Siggy’s prescribers focus on treating anxiety and depression with options like SSRIs, and a licensed prescriber reviews every treatment plan before anything is prescribed. You start with an anonymous intake, with no name, email, or account, and describe your symptoms, past medications, and side effect concerns in your own words. Siggy doesn’t administer esketamine, which requires a certified in-person setting.

This article is for education only and isn’t a substitute for personal medical advice. It reflects sources available as of October 2026.

Find the Medication That Fits Your Life

The best antidepressant on paper isn’t always the best one for you. Start your anonymous intake and tell us what you’ve tried, what side effects worry you most, and what you want to feel again. It’s free, a real doctor reviews every clinical decision, and you’ll get a downloadable summary you can share with any clinician.