Common Medications Used in Psychiatry

Upon assessment and evaluation of your symptoms of mental health, your provider may recommend medication based on your discussion. You should always know the symptoms that your provider is targeting and how the medication prescribed will work to improve those symptoms.

There are some common medications for depression that your provider may recommend based on clinical studies, history of efficacy in the general population, and side effect profile. There are three major neurotransmitters that are currently implicated in depression and anxiety: Norepinephrine (energy/alertness), Dopamine (reward/motivation), Serotonin (mood/well-being).

SSRI (Selective Serotonin Reuptake Inhibitors) (e.g. Prozac, Zoloft, Paxil, Lexapro, Luvox, Celexa) These medications came about in the 1980s and replaced the older versions of antidepressants called Tricyclic Antidepressants (TCAs). The SSRI medications have less side effects and work for a broader range of patients making them much more effective than the older TCAs. SSRIs work by keeping serotonin in the brain for a longer period so it can be used more effectively before reabsorption. Serotonin plays a key role in regulating mood, helping you feel more balanced, calm, and emotionally stable.

SNRI (Serotonin-Norepinephrine Reuptake Inhibitor) (e.g. Cymbalta, Pristiq, Effexor, Fetzima): SNRIs work with the neurotransmitters serotonin and norepinephrine; norepinephrine is related to adrenaline and can help increase energy, attention, and motivation. These medications are often used when patients have not responded well to SSRIs. 

Cymbalta (duloxetine) – may help relieve depression and can also reduce certain types of nerve (neuropathic) pain

Effexor (venlafaxine) – may affect dopamine at higher doses and can help with depression, anxiety, and symptoms such as hot flashes during menopause

Pristiq (desvenlafaxine) – similar to Effexor and effective for treating depression

NDRI (Norepinephrine-Dopamine Reuptake Inhibitor) (e.g. Bupropion IR, SR and XL) Also marketed as Wellbutrin, this is the only formulation of an NDRI antidepressant. It’s unique in that it doesn’t allow for serotonin reuptake inhibition, so this medication can be used as an adjunct for patients diagnosed with bipolar disorder who have achieved mood stabilization but may continue to struggle with depressive symptoms.

Novel antidepressants (e.g., Trintellix and Viibryd) are newer medications with unique mechanisms of action that affect brain chemicals differently than traditional classes like SSRIs or SNRIs. 

Trintellix (vortioxetine) - Its actions include inhibiting the serotonin transporter (similar to SSRIs), stimulating certain serotonin receptors and blocking others.  Because of these combined effects, Trintellix influences multiple brain circuits involved in mood regulation, emotional processing, learning and memory and cognitive flexibility. Providers may consider it when patients have persistent depressive symptoms, cognitive slowing (brain fog) related to depression, sexual side effects from other antidepressants or an incomplete response to previous medications.

Viibryd (Vilazodone) - This is a prescription antidepressant used to treat major depressive disorder (MDD) in adults. It works by affecting serotonin, a brain chemical involved in mood. Viibryd acts as a selective serotonin reuptake inhibitor (SSRI), which increases serotonin levels, and also partially stimulates a serotonin receptor (5-HT1A) that plays a role in mood and anxiety regulation. This dual action may help improve both depression and anxiety symptoms. Viibryd may help reduce symptoms such as persistent sadness, loss of interest in activities, fatigue, poor concentration, sleep problems, and feelings of hopelessness. Some also notice improvement in anxiety, irritability, and emotional stress. 

Noradrenergic and Specific Serotonergic Antidepressant (NaSSA) : NaSSAs work by increasing norepinephrine and serotonin in the brain and blocking certain receptors that affect mood, sleep, and appetite.

Remeron (Mirtazipine) - Remeron is a NaSSA and works by increasing the release of both norepinephrine and serotonin in the brain. It also blocks certain receptors that affect sleep, appetite, and anxiety, which contributes to its calming effects. Remeron may help improve symptoms such as low mood, loss of interest in activities, anxiety, poor sleep, and decreased appetite. Many patients notice that it can be especially helpful for insomnia, as it tends to have a sedating effect—particularly at lower doses. Healthcare providers may consider starting Remeron for people with depression who also struggle with sleep problems, poor appetite, or weight loss. It may also be chosen when other antidepressants cause nausea or sexual side effects.

We are here to answer questions that arise! Do not hesitate to reach out to your provider if you are unsure about the way certain medications work, have questions about side effects, or if a medication may be right for you. Our team is here to help develop a treatment plan that follows evidence-based practice and is realistic in incorporating it into your daily routine.

Written by Amanda Puckett, PMHNP-BC

~ Serene Wellness Psychiatry ~