Antidepressants: Selecting one that's right for you
Confused by the choice in antidepressants? With persistence, you and your doctor should find one that works so that you can enjoy life more fully again.By Mayo Clinic Staff
Antidepressants are a popular treatment choice for those with depression. Although antidepressants may not cure depression, they can reduce your symptoms. The first antidepressant you try may work fine. But if it doesn't relieve your symptoms, or it causes side effects that bother you, you may need to try another.
But don't give up. A number of antidepressants are available, and chances are you'll be able to find one that works well for you.
Finding the right antidepressant
There are a number of antidepressants available that work in slightly different ways and have different side effects. Most work equally well to relieve depression, so choosing the right one generally involves subtle differences. When prescribing an antidepressant that's likely to work well for you, your doctor may consider:
- Your particular symptoms. Symptoms of depression can vary, and one antidepressant may relieve certain symptoms better than another. For example, if you have trouble sleeping, an antidepressant that's slightly sedating may be a good option.
- Possible side effects. Side effects of antidepressants vary from one medication to another and from person to person. Bothersome side effects, such as dry mouth, weight gain or sexual side effects, can make it difficult to stick with treatment.
- Whether it worked for a close relative. How a medication worked for a first-degree relative, such as a parent or sibling, can indicate how well it might work for you.
- Interaction with other medications. Some antidepressants can cause dangerous reactions when taken with other medications.
- Whether you're pregnant or breast-feeding. Many antidepressants may not be safe for your baby when taken during pregnancy or later when you're breast-feeding. Work with your doctor to find the best way to manage your depression when you're expecting or planning on becoming pregnant.
- Other health conditions. Some antidepressants may cause problems if you have certain mental or physical health conditions. On the other hand, certain antidepressants may help treat other physical or mental health conditions along with depression. For example, bupropion (Wellbutrin) may help relieve symptoms of both attention-deficit/hyperactivity disorder (ADHD) and depression. Other examples include using duloxetine (Cymbalta) to help with pain symptoms or fibromyalgia, or using amitriptyline to prevent migraine headaches.
- Cost and health insurance coverage. Some antidepressants can be expensive, especially if there's no generic version available.
Types of antidepressants
Certain brain chemicals called neurotransmitters are associated with depression — particularly serotonin (ser-o-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-meen). Most antidepressants relieve depression by affecting these neurotransmitters. Each type (class) of antidepressant affects these neurotransmitters in slightly different ways.
Many types of antidepressant medications are available to treat depression, including those below. Discuss possible major side effects with your doctor or pharmacist.
- Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include fluoxetine (Prozac, Selfemra), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). Examples of SNRI medications include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran (Fetzima).
- Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin, Aplenzin, Forfivo XL) falls into this category. It's one of the few antidepressants not frequently associated with sexual side effects.
- Atypical antidepressants. These medications don't fit neatly into any of the other antidepressant categories. They include trazodone (Oleptro), mirtazapine (Remeron) and vortioxetine (Brintellix). Both are sedating and usually taken in the evening. A newer medication called vilazodone (Viibryd) is thought to have a low risk of sexual side effects.
- Tricyclic antidepressants. Tricyclic antidepressants — such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin) and protriptyline (Vivactil) — tend to cause more side effects than newer antidepressants. So tricyclic antidepressants generally aren't prescribed unless you've tried an SSRI first without improvement.
- Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, often when other medications haven't worked, because they can have serious side effects. Using an MAOI requires a strict diet because of dangerous (or even deadly) interactions with foods ― such as certain cheeses, pickles and wines ― and some medications, including birth control pills, decongestants and certain herbal supplements. Selegiline (Emsam), a newer MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs. These medications can't be combined with SSRIs.
- Other medications. Other medications may be added to an antidepressant to enhance antidepressant effects. Your doctor may recommend combining two antidepressants or medications such as mood stabilizers or antipsychotics. Anti-anxiety and stimulant medications might also be added for short-term use.
- Depression. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/depression/index.shtml. Accessed Oct. 10, 2014.
- Katon W, et al. Unipolar depression in adults: Choosing initial treatment. http://www.uptodate.com/home. Accessed Oct. 10, 2014.
- Hirsch M, et al. Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects. http://www.uptodate.com/home. Accessed Oct. 10, 2014.
- Hirsch M, et al. Serotonin-norepinephrine reuptake inhibitors (SNRIs): Pharmacology, administration, and side effects. http://www.uptodate.com/home. Accessed Oct. 10, 2014.
- Hirsch M, et al. Tricyclic and tetracyclic drugs: Pharmacology, administration, and side effects. http://www.uptodate.com/home. Accessed Oct. 10, 2014.
- Hirsch M, et al. Monoamine oxidase inhibitors (MAOIs) for treating depressed adults. http://www.uptodate.com/home. Accessed Oct. 10, 2014.
- Block SG, et al. Emerging antidepressants to treat major depressive disorders. Asian Journal of Psychiatry. In press. Accessed Oct. 10, 2014.
- Papadakis MA, ed., et al. Current Medical Diagnosis & Treatment 2014. 53rd ed. New York, N.Y.: The McGraw-Hill Companies; 2014. http://accessmedicine.mhmedical.com/book.aspx?bookId=330. Accessed Oct. 10, 2014.
- Understanding major depression and recovery. National Alliance on Mental Illness. http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23039. Accessed Oct. 10, 2014.
- Viibryd (prescribing information). St. Louis, Mo.: Forest Pharmaceuticals Inc.; 2014. http://www.viibryd.com/. Accessed Oct. 10, 2014.
- Hirsch M, et al. Atypical antidepressants: Pharmacology, administration, and side effects. http://www.uptodate.com/home. Accessed Oct. 10, 2014.
- Kung S (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 12, 2014.
- Krieger CA (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 21, 2014.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 24, 2014.