Currently three neurotransmitters—serotonin, norepinephrine and dopamine—have been implicated as the most important neurotransmitters in depression. Depletion of these neurotransmitters cause specific symptoms that can help the physician choose which antidepressant would be the first choice for each patient.
Symptoms of Neurotransmittor Depletion
| SEROTONIN LOSS | NOREPINEPHRINE LOSS | DOPAMINE LOSS |
| Anxious depression | Lethargic depression | Joyless depression |
| Waking during night | Restless sleep | Sleeping too much |
| Panic symptoms | Worry | Apathetic |
| Obsessions and compulsions | Feeling tired all the time | No motivation |
| Anger, irritability | Lethargic | No pleasure |
| Traumatic dreams | Run down feeling | Decreased sexual drive and function |
| Flashbacks | Chronic pain symptoms | Poor concentration & attention |
Specific Medications that primary work on the “Big” three neurotransmitters
| SEROTONIN | NOREPINEPHRINE | DOPAMINE |
| Prozac | Effexor XR (“pure” serotonin med at doses below 150 mg daily; in doses higher than 150 mg increases both norepinephrine and serotonin)P | Wellbutrin XL |
| Paxil-CR | Cymbalta (Boosts serotonin & norepinephrine in equal amounts) | Vivactil |
| Zoloft | Norpramin | |
| Celexa | Pamelor | |
| Lexapro | Vivactil | |
| Remeron | | |
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