The Most Common Antidepressants
The National Health Service of England publishes yearly data on the amount of prescriptions healthcare providers have made for each available medication. WhatMedicine.Org has assembled the data for the 20 most common antidepressants below, as well as briefly expanding on each listed drug.
Additionally, a compiled table of the 15 most prescribed antidepressants in the United States has been added to the article for comparison. To learn more about each antidepressant, view the key antidepressant data at the end of the article.
Additionally, a compiled table of the 15 most prescribed antidepressants in the United States has been added to the article for comparison. To learn more about each antidepressant, view the key antidepressant data at the end of the article.
Table of Contents
What are Antidepressants?
Antidepressants, as their name suggests, are medications used to treat depression. In the past, older drugs like monoamine oxidase inhibitors (MAOI) and tricyclic antidepressants (TCA) were commonly prescribed. Nowadays, more modern antidepressants, including selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), and atypical antidepressants, are the primary choice.
The United States Food and Drug Administration (FDA) has approved over 25 different antidepressants, and there are even more unapproved options available in other countries. These days, antidepressants are often used for conditions beyond depression treatment.
Therefore, this list focuses on the number of annual prescriptions for each antidepressant rather than specifically for treating depression. Moreover, antidepressants are diverse both in their side effects, but also in what disorders they may be used, outside of treating major depressive disorder.
Therefore, this list focuses on the number of annual prescriptions for each antidepressant rather than specifically for treating depression. Moreover, antidepressants are diverse both in their side effects, but also in what disorders they may be used, outside of treating major depressive disorder.
Important Considerations
Antipsychotic medications, such as Aripiprazole, were intentionally excluded from the list of the most commonly prescribed antidepressants. While these drugs are occasionally employed as adjuncts in depression treatment, they are not typically prescribed as standalone treatments for unipolar depression. As a result of this decision, Flupentixol was removed from the list, despite its classification as an antidepressant in the NHS dataset.
Furthermore, Bupropion has been included in this roster, despite its lack of approval for depression treatment in the United Kingdom, where it is only sanctioned as a smoking cessation aid under the brand name Zyban. Nonetheless, Bupropion finds widespread use in depression treatment in various regions around the world, notably in the United States.
The 20 Most Common Antidepressants in the UK (2021)
| Antidepressant | Brand Name | Drug Type |
Prescriptions |
|---|---|---|---|
| Sertraline | Zoloft | SSRI | 20,297,395 |
| Amitriptyline | Elavil | TCA | 14,930,177 |
| Citalopram | Celexa | SSRI | 14,224,798 |
| Mirtazapine | Remeron | NaSSa | 11,249,963 |
| Fluoxetine | Prozac | SSRI | 7,235,716 |
| Venlafaxine | Effexor | SNRI | 5,225,892 |
| Duloxetine | Cymbalta | SNRI | 3,199,924 |
| Escitalopram | Lexapro | SSRI | 1,519,588 |
| Paroxetine | Paxil | SSRI | 1,286,811 |
| Trazodone | Desyrel | SARI | 1,226,973 |
| Nortriptyline | Pamelor | TCA | 747,576 |
| Dosulepin | Prothiaden | TCA | 436,174 |
| Vortioxetine | Trintellix | SSRI | 248,533 |
| Clomipramine | Anafranil | TCA | 227,924 |
| Lofepramine | Lomont | TCA | 151,565 |
| Imipramine | Tofranil | TCA | 123,450 |
| Bupropion | Zyban | NDRI | 36,784 |
| Agomelatine | Valdoxan | Other | 26,440 |
| Fluvoxamine | Luvox | SSRI | 24,237 |
| Reboxetine | Edronax | NRI | 23,081 |
Source: NHSBSA | Table by WhatMedicine.Org
The Most Common Antidepressants in the US (2020)
Publicly accessible data regarding the prescription volumes of the most common antidepressants in the United States is partially limited. However, ClinCalc, a website providing evidence-based clinical decision support tools and calculators for medical professionals, has compiled statistics based on MEPS data for the top 300 prescribed drugs in the US. This data serves as a valuable complement to the NHS statistics, as it provides a comparison between the US and UK prescribing trends for antidepressants.
| Antidepressant | Brand Name | Drug Type | Prescriptions |
|---|---|---|---|
| Sertraline | Zoloft | SSRI | 38,219,814 |
| Escitalopram | Lexapro | SSRI | 30,605,646 |
| Bupropion | Wellbutrin | SNRI | 28,889,368 |
| Trazodone | Desyrel | SARI | 26,210,731 |
| Fluoxetine | Prozac | SSRI | 23,403,050 |
| Duloxetine | Cymbalta | SNRI | 22,546,920 |
| Citalopram | Celexa | SSRI | 18,549,176 |
| Venlafaxine | Effexor | SNRI | 15,022,423 |
| Amitriptyline | Elavil |
TCA | 9,083,401 |
| Paroxetine | Paxil | SSRI | 9,029,667 |
| Mirtazapine | Remeron | NaSSa | 6,601,131 |
| Nortriptyline | Pamelor | TCA | 3,815,024 |
| Desvenlafaxine | Pristiq | SNRI | 3,267,575 |
| Vortioxetine | Trintellix | SSRI | 1,826,351 |
| Doxepin | Silenor | TCA | 1,721,843 |
Source: ClinCalc | Table by WhatMedicine.Org
Interesting Observations
Some things may stand out when examining the statistical data of the most common antidepressants in both the United Kingdom and the United States. Here are a few potentially interesting observations.
Citalopram vs Escitalopram
An initial point of interest lies in the much higher prescription rate in the UK of Citalopram compared to Escitalopram, despite research suggesting that Escitalopram may offer better tolerability and efficacy. Notably, Escitalopram carries a less pronounced risk related to QTc prolongation.
This may be due to the decision by the Medicines and Healthcare Products Regulatory Agency in the United Kingdom to issue safety warnings of QTc prolongation for both Citalopram and Escitalopram, as opposed to the U.S. Food & Drug Agency, which has only issued a warning for Citalopram.
This may be due to the decision by the Medicines and Healthcare Products Regulatory Agency in the United Kingdom to issue safety warnings of QTc prolongation for both Citalopram and Escitalopram, as opposed to the U.S. Food & Drug Agency, which has only issued a warning for Citalopram.
Sertraline's Predominance
Sertraline is the most prescribed antidepressant in both the US and the UK, and possibly other parts of the world as well. This is likely due to its proven effectiveness, tolerability, and versatility in treating various psychiatric disorders. It has also been extensively studied and has a lower risk of drug interactions.Low Use of Bupropion
The relatively low use of Bupropion can be surprising from a non-UK perspective, especially when compared to the share of prescriptions in the US, where it was the third most prescribed antidepressant in 2020.
The absence of approval for depression in the UK raises the question as to why Bupropion is not officially available for the treatment of depression in the UK. Especially when considering how Bupropion may be equally tolerable to SSRIs while lacking sexual side effects and weight gain.
The absence of approval for depression in the UK raises the question as to why Bupropion is not officially available for the treatment of depression in the UK. Especially when considering how Bupropion may be equally tolerable to SSRIs while lacking sexual side effects and weight gain.
Off-Label Prescriptions
Numerous older antidepressant agents are placed relatively highly on the list, even though they are typically relegated to secondary treatment options for depression and often reserved for cases of treatment resistance, e.g. TCAs such as Amitriptyline and Imipramine.
While we lack the data for confidently drawing conclusions, we suspect that the off-label use for some of these medications may make up a large part of their number of prescriptions. For the very same reason, we can suspect that Mirtazapine and Trazodone may have their prescription amount highly impacted by off-label use for insomnia.
While we lack the data for confidently drawing conclusions, we suspect that the off-label use for some of these medications may make up a large part of their number of prescriptions. For the very same reason, we can suspect that Mirtazapine and Trazodone may have their prescription amount highly impacted by off-label use for insomnia.
Finding The Right Antidepressant
As indicated by the above tables, a large variety of different antidepressants are available for treating depression. The effectiveness and tolerability, even of the most common antidepressants, are highly individual. Therefore, finding a suitable antidepressant can take both time and effort.
Taking the antidepressant quiz can provide general guidance about how to find an appropriate antidepressant for you. It consists of 20 questions and only takes a few minutes to complete. The quiz may help you find a potentially suitable option, which you can then further discuss with your psychiatrist.
Taking the antidepressant quiz can provide general guidance about how to find an appropriate antidepressant for you. It consists of 20 questions and only takes a few minutes to complete. The quiz may help you find a potentially suitable option, which you can then further discuss with your psychiatrist.
It should be emphasized that clear communication between the prescribing healthcare provider and patient is the foundation of quality care. Discussing the benefits and drawbacks of different antidepressants can increase treatment adherence. This is essential, as up to a third of all patients choose to discontinue their prescribed antidepressants as a result of intolerable side effects.
Key Antidepressant Data
= SSRIs = SNRIs = TCAs = Other Antidepressants
1. Sertraline
Launched: In 1991 with the brand name Zoloft.
Mechanism of Action: It is a selective serotonin reuptake inhibitor (SSRI) that primarily increases the levels of serotonin in the brain.
FDA Approvals: Approved for major depressive disorder (MDD), obsessive-compulsive disorder (OCD) in both adults and children over 6, panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD).
Off-Label Uses: Generalized anxiety disorder, premenstrual dysphoric disorder, binge eating disorder, bulimia nervosa, body dysmorphic disorder, premature ejaculation.
Note: Sertraline has widespread use across the globe due to its relatively high efficiency, wide range of indications, and favorable side effect profile.
2. Amitriptyline
Launched: In 1961 with the brand name Elavil.
Mechanism of Action: It is a tricyclic antidepressant that affects the balance of certain neurotransmitters in the brain.
FDA Approvals: FDA-approved for the relief of symptoms in depression.
Off-Label Uses: Often used for migraine prevention and as an analgesic for chronic pain conditions.
Note: Amitriptyline was historically prescribed as the primary treatment for depression, however, nowadays it is reserved only for treatment-resistant depression. It's more commonly prescribed for migraine prophylaxis (at lower doses), which may help to explain why it's one of the most prescribed antidepressants.
3. Citalopram
Launched: In 1998 with the brand name Celexa.
Mechanism of Action: An SSRI that selectively increases serotonin levels in the brain.
FDA Approvals: Approved for major depressive disorder (MDD).
Off-Label Uses: Non-FDA-approved uses include alcohol use disorder, coronary arteriosclerosis, obsessive-compulsive disorder, panic disorder, postmenopausal flushing, and premenstrual dysphoric disorder.
Note: The enantiomer of Citalopram, Escitalopram, has been shown to have a higher efficiency in treating depression. Nonetheless, its use is more widespread than Escitalopram.
4. Mirtazapine
Launched: In 1996 with the brand name Remeron.
Mechanism of Action: It's an atypical antidepressant with noradrenergic and specific serotonergic properties (NaSSA).
FDA Approvals: Approved for major depressive disorder (MDD).
Off-Label Uses: Mirtazapine is often prescribed at low doses for insomnia due to its sedative effects. It is also used in appetite stimulation.
Note: Common off-label use for insomnia may explain the large number of prescriptions for Mirtazapine.
5. Fluoxetine
Launched: In 1987 with the brand name Prozac.
Mechanism of Action: Fluoxetine was the first FDA-approved SSRI for depression. It primarily works by increasing the amount of available serotonin in the brain's nerve synapses.
FDA Approvals: Approved for major depressive disorder (MDD) in both adults and children over 7 years old, obsessive-compulsive disorder (OCD) in both adults and children over 7 years old, panic disorder, bulimia nervosa, and premenstrual dysphoric disorder.
Off-Label Uses: Social anxiety disorder (social phobia), post-traumatic stress disorder in adults, borderline personality disorder, Raynaud phenomenon, and selective mutism.
Note: Fluoxetine is one of the most commonly used and well-researched antidepressants for children and adolescents.
6. Venlafaxine
Launched: In 1993 with the brand name Effexor.
Mechanism of Action: Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that, as the name implies, increases the levels of serotonin and norepinephrine in the brain.
FDA Approvals: Approved for major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and panic disorder.
Off-Label Uses: Can be used for neuropathic pain and atypical pain syndromes, such as fibromyalgia, diabetic neuropathy, complex pain syndromes, hot flashes, and migraine prevention. It may also be used in post-traumatic stress disorder, obsessive-compulsive disorder, and premenstrual dysphoric disorder.
Note: The most commonly prescribed SNRI type of antidepressant.
7. Duloxetine
Launched: In 2004 with the brand name Cymbalta.
Mechanism of Action: Just like the aforementioned Venlafaxine, Duloxetine is an SNRI that increases serotonin and norepinephrine in the nerve synapses.
FDA Approvals: Approved for major depressive disorder (MDD), generalized anxiety disorder, diabetic neuropathy, fibromyalgia, and chronic musculoskeletal pain.
Off-Label Uses: Non-FDA-approved uses include other atypical or chronic pain syndromes, as well as stress urinary incontinence.
Note: The drug may be particularly helpful in managing pain-related symptoms in addition to depression, which may explain its extensive use.
8. Escitalopram
Launched: In 2002 with the brand name Lexapro.
Mechanism of Action: An SSRI that primarily increases serotonin levels in the brain.
FDA Approvals: Approved for major depressive disorder (MDD) and generalized anxiety disorder.
Off-Label Uses: Social anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, and vasomotor symptoms of menopause.
Note: Escitalopram has gained popularity in recent years due to its improved side-effect profile and efficiency compared to its less-recently discovered enantiomer, Citalopram.
9. Paroxetine
Launched: In 1992 with the brand name Paxil.
Mechanism of Action: An SSRI that primarily increases serotonin levels in the brain.
FDA Approvals: Approved for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and premenstrual dysphoric disorder.
Off-Label Uses: Obsessive-compulsive disorder, social anxiety disorder, separation anxiety, dysthymia, body dysmorphic disorder, postpartum depression, premature ejaculation, malignancy-related pruritus unresponsive to standard treatment
Note: Known for its effectiveness in treating a range of anxiety and depressive disorders.
10. Trazodone
Launched: In 1981 with the brand name Desyrel.
Mechanism of Action: Another atypical antidepressant, which mainly works as a serotonin antagonist and reuptake inhibitor (SARI) with sedative effects.
FDA Approvals: Trazodone is FDA-approved for major depressive disorder.
Off-Label Uses: While FDA-approved for depression, the drug is mainly prescribed off-label at low doses for insomnia, due to its sedative properties. It's also used off-label for anxiety, substance abuse, bulimia, and fibromyalgia.
Note: Trazodone's use in insomnia may explain why it's among the most prescribed antidepressants.
11. Nortriptyline
Launched: Nortriptyline has been on the market as a treatment for depression since 1963.
Mechanism of Action: A tricyclic antidepressant similar to amitriptyline, affecting a wide variety of neurotransmitters in the brain, but mainly serotonin and norepinephrine.
FDA Approvals: Depression.
Off-Label Uses: Like amitriptyline, it is often used for chronic pain conditions - posthepatic neuralgia, and persistent myofascial pain, amongst others. It has also been used in migraine prophylaxis.
Note: Nortriptyline shares similarities with amitriptyline and is typically used for similar purposes. Like many other TCAs, it can commonly cause unwanted side effects and the toxicity of nortriptyline can be very harmful to the body.
12. Dosulepin
Launched: Dosulepin was introduced to the UK market in 2023.
Mechanism of Action: Similar to amitryptiline, it's a tricyclic antidepressant that affects various neurotransmitters.
FDA Approvals: Dosulepin is not available on the US market.
Off-Label Uses: Depression, psychogenic fascial pain.
Note: Dosulepin was once the most frequently prescribed antidepressant in the United Kingdom, however, it presents no therapeutic advantages over TCAs and has a high toxicity when overdosed.
13. Vortioxetine
Launched: In 2013 with the brand name Trintellix.
Mechanism of Action: Often classified as an SSRI, even though it has a unique pharmacological profile and multimodal mechanism of action.
FDA Approvals: Approved for use in major depressive disorder (MDD).
Off-Label Uses: No information about off-label use.
Note: Vortioxetine is the most recent addition to the list of antidepressants.
14. Clomipramine
Launched: In the 1960s with the brand name Anafranil.
Mechanism of Action: A tricyclic antidepressant similar to amitriptyline.
FDA Approvals: Approved for obsessive-compulsive disorder (OCD) in age 10 and older.
Off-Label Uses: Anxiety, treatment-resistant depression, cataplexy syndrome, insomnia, neuropathic pain, chronic pain.
Note: Known for its effectiveness in treating obsessive-compulsive disorder.
15. Lofepramine
Launched: Lofepramine was introduced as a treatment for depression in the early 1980's.
Mechanism of Action: A tricyclic antidepressant that is thought to treat depression by acting on the neurotransmitters serotonin and norepinephrine.
FDA Approvals: Not available on the US market.
Off-Label Uses: No information about off-label use.
Note: It is usually considered a third-generation TCA, as unlike the first- and second-generation TCAs it is relatively safe in overdose and has milder and less frequent side effects compared to its older counterparts.
16. Imipramine
Launched: In both the US and Europe during the late 1950s under the brand name Tofranil.
Mechanism of Action: A tricyclic antidepressant.
FDA Approvals: While FDA-approved for depression, it's a second-line choice and primarily indicated in severe depression due to side effects and overdose toxicity concerns.
Off-Label Uses: Panic disorder. Chronic neuropathic pain. It's also used as adjunctive therapy in nocturnal enuresis in children above six years of age.
Note: Between 1998 and 2017, along with amitriptyline, imipramine was the most commonly prescribed first antidepressant for children aged 5-11 years in England.
17. Bupropion
Launched: The drug was originally first patented in 1974 and FDA approved in 1985 under the brand name Wellbutrin. Before 2000, Bupropion was referred to as Amfebutamone.
Mechanism of Action: It is a norepinephrine-dopamine reuptake inhibitor (NDRI) with a unique pharmacological mechanism. As such, it's classified as an atypical antidepressant.
FDA Approvals: Approved for major depressive disorder, smoking cessation, as well as seasonal affective disorder (SAD).
Off-Label Uses: Non-FDA-approved uses include sexual dysfunction, obesity, bipolar depression, and ADHD.
Note: While only licensed for smoking cessation in the UK, it is one of the most commonly prescribed antidepressants for depression in many countries worldwide.
18. Agomelatine
Launched: In 2009 with the brand name Valdoxan.
Mechanism of Action: A melatonergic agonist and selective serotonin antagonist. Due to its unique mechanism of action, it's classified as an atypical antidepressant.
FDA Approvals: Not FDA approved in the US due to the risk of liver toxicity.
Off-Label Uses: Limited use in countries where it is available.
Note: Agomelatine generally lacks the common side effects of many other antidepressants, however, liver values must be routinely monitored in those taking the drug.
19. Fluvoxamine
Launched: In 1994 with the brand name Luvox.
Mechanism of Action: Fluvoxamine is one of the earliest selective serotonin reuptake inhibitors.
FDA Approvals: Approved for obsessive-compulsive disorder (OCD) in adults and children over 8 years. In 2008 it was approved for social anxiety disorder.
Off-Label Uses: Major depressive disorder, posttraumatic stress disorder, panic disorder.
Note: It was the first SSRI to be approved by the U.S. FDA specifically for the treatment of OCD.
20. Reboxetine
Launched: In the 1980s with the brand name Edronax.
Mechanism of Action: A norepinephrine reuptake inhibitor (NRI), much like Atomoxetine, is a drug used in the treatment of ADHD.
FDA Approvals: The drug is not approved for use in the US, but it is available in several other countries for the treatment of depression.
Off-Label Uses: Panic disorder, ADHD.
Note: Reboxetines' efficiency in treating depression has been widely debated. A systematic review from 2018 concluded that reboxetine was more effective than placebo, but significantly less efficacious than other antidepressants tested.
Source of Drug Information: StatsPearls, NCBI.
Author: J. Martin, M.D.
Last update: February 29, 2024
Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness, seek immediate medical attention.
Last update: February 29, 2024
Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness, seek immediate medical attention.