In terms of medication management, which classes are considered second-line treatments for depression?

Second-line treatments for depression often include SNRIs (serotonin-norepinephrine reuptake inhibitors), bupropion, and mirtazapine because they provide alternative mechanisms of action and can be effective for patients who do not achieve adequate response or experience intolerable side effects with first-line treatments like SSRIs.

SNRIs are effective due to their dual action of increasing the levels of both serotonin and norepinephrine in the brain, which can benefit patients suffering from major depressive disorder, particularly if there are also accompanying symptoms such as anxiety.

Bupropion, with its unique norepinephrine-dopamine reuptake inhibition, is particularly useful for patients who may also have attention issues or for those who are concerned about sexual side effects associated with SSRIs. Mirtazapine, although it has some serotonergic activity, primarily enhances norepinephrine and serotonin release and is particularly beneficial in patients who have insomnia or significant weight loss alongside their depression.

Together, these medications represent a robust second line of treatment by offering different mechanisms compared to first-line SSRIs while also addressing varying patient-specific symptoms and side effects.