ATC N06 — Psychoanaleptics

Amitriptyline is one of the oldest tricyclic antidepressants, in clinical use since 1961. Today it is more commonly used at low dose for neuropathic pain, chronic pain syndromes, migraine prevention and insomnia than for depression, where SSRIs and SNRIs have largely replaced it.

Fluoxetine is the first SSRI introduced into clinical practice, marketed as Prozac since 1987 and known for its very long half-life and active metabolite. It is used for depression, OCD, bulimia nervosa and premenstrual dysphoric disorder, and is on the WHO Essential Medicines List.

Citalopram is a widely prescribed SSRI for major depressive disorder and anxiety, marketed as Celexa and Cipramil. It is the racemic mixture from which escitalopram (the more active S-enantiomer) was developed; modern dosing is capped at 40mg daily because of dose-related QT prolongation.

Paroxetine is one of the older SSRI antidepressants, marketed as Paxil and Seroxat. It has a stronger anticholinergic profile and shorter half-life than other SSRIs, which makes its discontinuation syndrome notably more pronounced and warrants careful tapering.

Sertraline is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder, panic disorder, OCD, PTSD and social anxiety disorder in adults. Marketed as Zoloft and as authorised generics.

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) widely used for major depression and anxiety disorders. It is the active S-enantiomer of citalopram and is marketed as Lexapro and Cipralex.

Trazodone is an atypical antidepressant from the SARI class (serotonin antagonist and reuptake inhibitor). It is FDA-approved for major depression at higher doses but is far more commonly prescribed at low dose (25–100mg at bedtime) for chronic insomnia, where its sedating profile makes it useful.

Mirtazapine is an atypical antidepressant of the NaSSA class (noradrenergic and specific serotonergic antidepressant). It is sedating and appetite-stimulating at low doses, with notably fewer sexual side effects than SSRIs, and is widely used in depression with insomnia, weight loss or anxiety.

Bupropion is an atypical antidepressant that inhibits norepinephrine and dopamine reuptake. It is used for major depression and smoking cessation, and is generally considered to have a favourable sexual side-effect profile compared with SSRIs.

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) used for major depression, generalised anxiety disorder and panic disorder. Originally launched as Effexor, it now has authorised generics widely available in immediate-release and extended-release forms.

Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) approved for depression, generalised anxiety, diabetic peripheral neuropathic pain and chronic musculoskeletal pain. It is widely used as a first-line option when both mood and pain are concerns.