What do psychiatrists prescribe for depression? A comprehensive guide to medication

October 6, 2025 •

4 min read

According to the American Psychiatric Association, a clinical depression diagnosis requires symptoms to last at least two weeks and represent a change in one's previous level of functioning. To treat this condition, psychiatrists utilize various pharmacological tools, and a common query for many patients is, "What do psychiatrists prescribe for depression?".

Quick Summary

This article explores the different classes of medications psychiatrists use to treat depression, including first-line options like SSRIs and SNRIs, and alternative treatments such as TCAs, MAOIs, and atypical antidepressants. It also explains augmentation strategies and the importance of collaborative treatment planning to find the right therapeutic approach.

Key Points

Antidepressants are central to treatment: Psychiatrists primarily prescribe antidepressants, such as SSRIs and SNRIs, for moderate to severe depression to help regulate mood and other symptoms.
First-line options are SSRIs and SNRIs: Due to their favorable side-effect profile, SSRIs (e.g., Prozac, Zoloft) are often the first choice, followed by SNRIs (e.g., Cymbalta, Effexor) if needed.
Diverse options for non-responders: For treatment-resistant depression, psychiatrists may use atypical antidepressants (e.g., Wellbutrin), older TCAs, or even MAOIs when other options fail.
Adjunctive therapy is common: In some cases, mood stabilizers or atypical antipsychotics may be added to an antidepressant to enhance its effect and manage severe or persistent symptoms.
Medication is part of a larger plan: Pharmacological treatment is most effective when combined with psychotherapy, allowing individuals to address underlying causes and develop coping mechanisms.
Collaboration and patience are key: Finding the right medication and dosage requires close collaboration with a psychiatrist and can take time, with gradual adjustments to minimize side effects.
Never stop abruptly: Discontinuing medication suddenly can cause unpleasant withdrawal symptoms and increase the risk of relapse, emphasizing the need for professional guidance when stopping or tapering dosage.

The Role of Medication in Depression Treatment

For many individuals with moderate to severe depression, medication is a crucial component of a comprehensive treatment plan. Psychiatrists, who are medical doctors specializing in mental health, are uniquely qualified to evaluate a patient's condition and determine the most suitable medication. While antidepressants do not "cure" depression, they can be highly effective in managing symptoms, alleviating distress, and improving daily functioning. They work by altering the levels and activity of key neurotransmitters, or chemical messengers, in the brain, which in turn helps to regulate mood. Often, medication is most effective when used in combination with psychotherapy, also known as talk therapy. The process of finding the right medication often involves a collaborative discussion between the patient and the psychiatrist, considering factors such as specific symptoms, potential side effects, and previous treatment history.

First-Line Treatments: SSRIs and SNRIs

Psychiatrists most often begin treatment with modern antidepressants that are generally safer and have fewer side effects than older alternatives. The first choices are typically selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs).

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are the most commonly prescribed class of antidepressants. They work by increasing the concentration of the neurotransmitter serotonin in the brain, which is associated with feelings of well-being and happiness. Their popularity is due to their overall efficacy, relative safety, and tolerability.

Common SSRIs include:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

For patients whose depression doesn't respond fully to an SSRI, an SNRI may be the next step. SNRIs work by increasing the levels of both serotonin and norepinephrine in the brain, which can help with mood, alertness, and energy. Some people may find SNRIs more effective, particularly if they experience symptoms like fatigue.

Common SNRIs include:
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor XR)
- Desvenlafaxine (Pristiq)

Alternative and Augmentation Therapies

If first-line medications are not effective or cause bothersome side effects, psychiatrists have a range of other options to consider, including older classes of antidepressants and augmentation strategies using other types of medications.

Atypical Antidepressants

This group of medications works in different ways than SSRIs or SNRIs and is often used when a patient has specific symptoms or has not responded to other treatments.

Examples of atypical antidepressants:
- Bupropion (Wellbutrin): Works on norepinephrine and dopamine and may help with concentration and energy.
- Mirtazapine (Remeron): Can be helpful for insomnia and low appetite.
- Vortioxetine (Trintellix): Recommended for adults whose depression has not responded to two other antidepressants.

Tricyclic Antidepressants (TCAs)

TCAs are an older but effective class of antidepressants. They are often reserved for cases where newer medications have not provided relief, primarily due to their more significant side effect profile. They work by blocking the reuptake of serotonin and norepinephrine, but also affect other receptors in the body.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs are another older class of medication typically used as a last resort for treatment-resistant depression. They require strict dietary restrictions to avoid dangerous interactions with certain foods and medications, so they are not commonly prescribed.

Augmentation Medications

In some cases, a psychiatrist may add a second medication to an antidepressant to enhance its effects. This can include:

Atypical Antipsychotics: Medications like aripiprazole (Abilify) and quetiapine (Seroquel) can be used alongside antidepressants to augment their effects.
Lithium: This mood stabilizer can be added to an existing antidepressant regimen for treatment-resistant depression.

Comparison of Antidepressant Classes


Feature	SSRIs	SNRIs	TCAs	MAOIs
Mechanism of Action	Blocks serotonin reuptake	Blocks serotonin and norepinephrine reuptake	Blocks serotonin and norepinephrine reuptake (and others)	Blocks the enzyme monoamine oxidase, preventing breakdown of neurotransmitters
Typical Use	First-line treatment for moderate to severe depression	Often used when SSRIs are ineffective or for certain symptoms	Reserved for treatment-resistant cases due to side effects	Rarely used; for treatment-resistant depression only
Side Effects	Mild, often resolve over time (e.g., nausea, headache)	Mild to moderate (e.g., nausea, dry mouth, can affect blood pressure)	More severe (e.g., dry mouth, constipation, dizziness, blurred vision)	Serious (e.g., dietary restrictions required, drug interactions)
Safety Profile	Generally high, considered safest	Generally high, but monitor blood pressure	Lower due to risk of serious side effects and overdose	Lower due to dietary and drug interactions

The Patient-Psychiatrist Partnership

Selecting the right medication is not a one-size-fits-all approach. Psychiatrists work closely with patients to tailor treatment based on individual needs, response, and tolerability. The process requires patience, as it can take several weeks for an antidepressant to show its full effect. Initial doses are typically low and adjusted over time. It's also vital to monitor for side effects and report any concerns to the psychiatrist. Abruptly stopping medication can lead to withdrawal symptoms and is not recommended.

Conclusion

Psychiatrists prescribe a variety of medications to help individuals with depression, with SSRIs and SNRIs being the most common starting points. For those who do not respond to these initial treatments, other options like atypical antidepressants, TCAs, MAOIs, or augmentation with other medications are available. It is crucial to remember that medication is a tool to manage symptoms, and a holistic approach often combines it with psychotherapy. Finding the right combination can be a journey, but with open communication and persistence, most people with depression can find an effective path toward recovery and improved quality of life. For further resources, the National Institute of Mental Health (NIMH) provides comprehensive information on mental health medications and treatments.

Frequently Asked Questions

The most common medications prescribed are Selective Serotonin Reuptake Inhibitors (SSRIs). Examples include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro).

Antidepressants work by balancing neurotransmitters in the brain, such as serotonin and norepinephrine. This process helps to regulate mood, improve sleep patterns, and stabilize emotions.

If a patient does not respond to the first medication, a psychiatrist may switch to a different class of antidepressant, such as an SNRI or atypical antidepressant, or augment the current treatment with another medication.

Yes. In some cases, a psychiatrist might prescribe mood stabilizers (like lithium), atypical antipsychotics, or newer treatments like esketamine, often in combination with an antidepressant, especially for treatment-resistant depression.

It can take several weeks for antidepressants to become fully effective. Most people start to notice improvements in symptoms after four to eight weeks, with the full therapeutic effect seen later.

No. Medication is often most effective when combined with psychotherapy (talk therapy). For mild depression, therapy alone may be recommended.

Antidepressants are not considered addictive in the same way as narcotics, but abruptly stopping them can cause withdrawal symptoms. For this reason, a dose should always be reduced gradually under a doctor's supervision.

A psychiatrist considers various factors, including the patient's specific symptoms, potential side effects, other medical conditions, and any other medications the patient is taking. It is a highly individualized process.