Most common antidepressants

What are the most common antidepressant medications?

Understanding the leading antidepressants provides insights into current prescribing behaviors and treatment preferences. For example, sertraline hydrochloride represents a significant portion of antidepressant prescriptions. This drug, sold under the brand name Zoloft among others, accounted for 16.7% of total antidepressants prescribed and dispensed in the U.S. in 2023, according to data from Definitive Healthcare. Developed by Pfizer, sertraline hydrochloride was first approved for use in the U.S. in 1991. The introduction of generic versions following the expiration of Pfizer's patent in 2006 led to increased competition in the antidepressant market, offering more affordable options for patients.

In second place is trazodone hydrochloride with 15.4% of total prescriptions. Initially developed by Pfizer, trazodone was first approved by the U.S. Food and Drug Administration (FDA) in 1981. Trazodone is classified as a serotonin antagonist and reuptake inhibitor (SARI), and is thought to work by blocking certain serotonin receptors and inhibiting the reuptake of serotonin in the brain to help improve mood and alleviate symptoms of depression. In addition to its antidepressant effects, trazodone is commonly prescribed off-label for insomnia due to its sedative properties.

Fluoxetine comes in third, accounting for 12.6% of antidepressant prescriptions. Commonly known by the brand name Prozac, fluoxetine was first approved for use in the U.S. in 1987. It was developed and marketed by Eli Lilly. Fluoxetine belongs to the selective serotonin reuptake inhibitor class. It’s widely used to treat several mental health conditions by increasing serotonin levels in the brain, and helping improve mood, sleep, and energy levels. It’s also used off-label for conditions like generalized anxiety disorder (GAD) and post-traumatic stress disorder (PTSD).

How trends in antidepressant prescription are changing healthcare

With the landscape of mental health care evolving, trends in antidepressant prescription point to several strategic opportunities for biopharma and behavioral health organizations looking to compete or bring new treatments into the market.

Below are a few of the emerging trends we’re watching:

Patent expirations and generic competition

As patents for branded antidepressants continue to expire, generic versions are increasingly dominating the market. This trend has already been observed with widely prescribed antidepressants like sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil), where the introduction of generics has led to lower prices and broader accessibility.

While generic competition increases patient access, it also places significant pressure on pharmaceutical companies. As the exclusivity of branded medications diminishes, companies must adopt innovative strategies to preserve their market share in this crowded space.

One common strategy is the introduction of new product formulations, such as extended-release versions, to extend market exclusivity in the face of impending generic entry. Other approaches may include targeting unmet needs, such as developing fast-onset therapies or drugs with novel mechanisms of action, to deliver added value and differentiate offerings. Additionally, obtaining FDA approval to market drugs for additional indications can help broaden their utility. Brand-only drugs will continue to largely compete for use in treatment-refractory patients.

Rising demand for nontraditional therapeutics

Interest in psychedelic-assisted therapy and NMDA receptor modulation (e.g., ketamine-based treatments) is increasing. Companies considering entry into these innovative areas may benefit from early R&D investment and strategic partnerships with mental health practitioners open to novel therapies. We touch upon the implications of psilocybin and other medications for treating major depressive disorders in our trends blog on the rise of non-opioid pain management.

Digital therapeutics are changing how mental health care is seen and treated

Digital therapeutics are evidence-based therapeutic interventions that are driven by software. They aim to prevent, treat, or manage medical diseases or disorders using mobile devices, sensors, apps, virtual reality, and other tools.

While the most common digital therapeutics are mobile health apps that help people exercise or eat healthier, there is an emerging subset of software designed specifically for patients with mental or behavioral health conditions.

The applications and potential benefits of these apps are among the most talked about in healthcare today. Digital therapeutics are helping overworked physicians focus on the patients most in need of care while still supporting less critical patients through remote education, monitoring, and improved care coordination. For biopharma and behavioral health organizations looking for a competitive edge, researching and investing in digital therapeutics may be the solution.

Mental healthcare is finding a new home in urgent care centers

The shift of mental health patients seeking care at urgent care centers (UCCs) reflects a broader transformation in healthcare delivery, driven by factors like limited mental health provider availability, lengthy wait times for psychiatric services, and growing demand for convenient, immediate access to care.

The demand for mental health treatment at UCCs is altering the typical prescribing landscape and presents a unique opportunity for biopharma companies.

One example is the kind of medications UCCs most commonly prescribe. These facilities tend to prescribe drugs that are easy to initiate and monitor, such as SSRIs, because some treatments have lower monitoring requirements and a favorable safety profile. Biopharma companies can adjust their product positioning to strategically highlight the efficacy and ease of use of their medications to more effectively sell to UCCs and increase market share. What are the different types of antidepressants?

Antidepressant medications can fall into a number of different categories based on how the drug affects the body’s chemistry. The main types of antidepressants include:

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs generally have fewer side effects than other types of antidepressants, which contributes to the number of people who take SSRIs. The top two medications on the list above - sertraline and escitalopram – are examples of SSRI antidepressant medications.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs work similarly to SSRIs but affect both serotonin and norepinephrine in the brain. The medication in sixth place on the list above, duloxetine, is an example of an SNRI medication.

Atypical antidepressants

Atypical antidepressants are a diverse group of medications that don't fit neatly into the other categories. The drugs trazodone and bupropion on the list above are examples of atypical antidepressant medications. Trazodone is often classified as a SARI but can be included under the “atypical” umbrella due to its distinct mechanism. Bupropion (Wellbutrin) is another atypical antidepressant with a unique mechanism of action, as it primarily affects dopamine and norepinephrine.

Tricyclic antidepressants

Tricyclic antidepressants are some of the earliest types of antidepressant medications. They have some increased risks of side effects so they are less frequently prescribed today and are often reserved for patients with more treatment-resistant conditions.

Monoamine oxidase inhibitors (MAOIs)

MAOIs are the first type of antidepressant medications developed and have mostly been replaced with the more popular antidepressant medication types, such as SSRIs and SNRIs, due to their fewer side effects.

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