The Science
Medication Categories & Mechanisms
Understanding how different medications affect neurotransmitter levels
Medication Categories
Selective Serotonin Reuptake Inhibitors (SSRIs)
Increase serotonin by blocking the serotonin transporter (SERT).
Citalopram, Escitalopram, Paroxetine, Fluvoxamine: Pure serotonergic
Fluoxetine: Affects 5-HT2C receptor, enhancing energy
Sertraline: Has dopamine transporter affinity
Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
Elevate both serotonin and norepinephrine by blocking SERT and NET transporters.
Venlafaxine: SSRI at low doses; noradrenergic at higher doses
Desvenlafaxine: Does not rely on cytochrome P450 metabolism
Duloxetine: Robust serotonin and strong norepinephrine effects
Levomilnacipran: Highest norepinephrine boost among SNRIs
Serotonin Partial Agonist Reuptake Inhibitors (SPARIs)
Block SERT and partially activate serotonin autoreceptor.
Vortioxetine: Acts on 5-HT3 and 5-HT7 receptors; aids cognition
Vilazodone: Reduces drug interaction risks
Buspiron: Pure autoreceptor agonist; pairs with SSRIs
Norepinephrine/Dopamine Reuptake Inhibitors (NDRIs)
Increase norepinephrine and dopamine by blocking NET and DAT.
Bupropion: Boosts motivation and concentration; does not affect serotonin
MAO-A Inhibitors
Increase serotonin, norepinephrine, and dopamine by blocking monoamine oxidase A.
Moclobemide: Reversible inhibitor with lower dietary restrictions
Tricyclic Antidepressants (TCAs)
Older class with side effects; still used in specific cases.
Nortriptyline: Primarily increases norepinephrine; effective for chronic pain
Norepinephrine Reuptake Inhibitors (NRIs)
Increase norepinephrine by blocking NET.
Atomoxetine: Enhances focus and alertness; used for ADHD
Serotonin 2A Receptor Antagonists (5-HT2A)
Block the 5-HT2A receptor to reduce anxiety and sleep issues.
Mirtazapine: Tetracyclic; sedative properties
Trazodone: Often prescribed for insomnia
Low-dose antipsychotics: Aripiprazole, brexpiprazole, quetiapine
Stimulants
Enhance dopamine and norepinephrine through multiple mechanisms.
Amphetamines (Adderall, Dexedrine): Strong dopamine/norepinephrine boost
Methylphenidate (Ritalin, Concerta): Milder effects; primarily ADHD treatment
Adrenergic Receptor Agonists
Reduce norepinephrine and dopamine by stimulating alpha-2 receptors.
Clonidine: Originally antihypertensive; used off-label for ADHD and anxiety
Guanfacine: Similar to clonidine; prescribed for ADHD
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