Major Depressive Disorder is a primary type and the most dominant type of depression. If you suffer from MDD, your management will be a two-pronged approach: (1) intake of medications or drugs (2) psychotherapy. In some occasions, depending on your response to the first two modes of treatment, you could be subjected to electroconvulsive therapy (ECT).

Medications and Treatment for Major Depressive Disorder:

Selective serotonin reuptake inhibitors (SSRIs)
In the preceding discussion, it was mentioned that the low level of serotonin in your brain causes the manifestation of MDD symptoms. For this reason, a group of anti-depressants was developed and was called the selective serotonin reuptake inhibitors (SSRIs) because they inhibit the recycling of serotonin. Thus maintaining its high level in your neurons and preventing the appearance of MDD symptoms. Examples of SSRIs are the following:
· Citalopram (Celexa)
· Escitalopram (Lexapro)
· Fluoxetine (Prozac)
· Paroxetine (Paxil, Pexeva)
· Sertraline (Zoloft)
· Vilazodone (Viibryd)

It has been determined that 30-50% of MDD patients do not respond to this class of drugs.

Serotonin/norepinephrine reuptake inhibitors (SNRIs)
Sometimes, you do not fully respond to the SSRIs. If this happens, it is possible that you manifest more of the positive effect. Thus, you need to take a norepinephrine reuptake inhibitor. But since you at the same time have symptoms which are responsive to the SSRI, then the most logical treatment is to give you a combination of both the SSRI and selective norepinephrine reuptake inhibitor. Thus, the so-called serotonin/norepinephrine reuptake inhibitors (SNRIs) were developed. True enough, it was observed that SNRIs were more effective than SSRIs for treating MDD. Examples of SNRIs are the following:
· Desvenlafaxine (Pristiq)
· Duloxetine (Cymbalta)
· Venlafaxine (Effexor)
· Venlafaxine XR (Effexor XR)
· Milnacipran (Savella)
· Levomilnacipran (Fetzima)
The most common side effects of SNRIs are nausea, dizziness, and sweating.

Atypical antidepressants
These antidepressants are different from each other and do not fit into any of the conventional classifications. They do not have a common mechanism of alleviating the symptoms of MDD, although each one of them acts on the dopamine, and/or serotonin, and/or norepinephrine. They are usually resorted to when the first line drugs, belonging to the SSRIs, fail to improve your symptoms. Examples of atypical antidepressants are:
· Bupropion (Wellbutrin, Forfivo XL, Aplenzin)
· Mirtazapine (Remeron)
· Nefazodone (Serzone)
· Trazodone (Desyrel, Oleptro)
· Vortioxetine (Brintellix)

Tricyclic antidepressants (TCAs)
The tricyclic antidepressants (TCAs) were one of the first groups of drugs that were used to treat MDD. They were effective as antidepressants but had a number of side effects which are not observed and found in the newer drugs. They act on serotonin and norepinephrine; however, they also block your muscarinic (M1), histamine (H1), and alpha-adrenergic receptors. Because of this wide-ranging influence, inevitably they could exact a number of unwanted and side effects on other systems of your body. This led to the reduction in the number of medical doctors who prescribe these drugs.

Examples of TCAs are the following:
· Amitriptyline (Elavil)
· Desipramine (Norpramin)
· Doxepine (Sinequan)
· Imipramine (Tofranil)
· Nortriptyline (Pamelor)
· Clomipramine (Anafranil)
· Maprotiline (Ludiomil)
· Trimipramine (Surmontil)
· Protriptyline (Vivactil)

The most common side effects of TCAs are the following: dry mouth, constipation, blurred vision, urinary retention, dizziness, tachycardia (increased heart rate), memory impairment, and disturbance of consciousness.

Monoamine oxidase inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) are drugs that block the activity of an enzyme monoamine oxidase which breaks down norepinephrine, serotonin, and dopamine in your brain and other parts of your body. The drawback of MAOIs is that they have a number of interactions with other drugs and foods, causing more side effects compared to the newer drugs. Examples of MAOIs are:
· Phenelzine (Nardil)
· Selegiline (Emsam)
· Tranylcypromine (Parnate)
Common side effects are postural hypotension, weight gain, and sexual disturbances.

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is a form of treatment where electric current is applied so that your body will experience some form of generalized seizure. It is expected that by having a seizure, the concentration levels of some of the neurotransmitters that you lack will increase and you will be treated with your disease. With the advent of new drugs, ECT is now rarely used; however, there are indications when to use it as enumerated below:
· Need for a rapid response to antidepressants
· Failure of drug therapies
· History of good response to ECT
· Patient’s preference
· High risk of suicide
· High risk of medical morbidity and mortality