Which antidepressant is right for me?

Coping with depression is no easy feat. Much more than just sadness, severe depression can feel completely crushing, making it difficult to function and nearly impossible to enjoy the things you used to. Luckily, with treatment, symptoms of depression can be lifted.  

Antidepressants are a common, effective treatment for major depressive disorder. They’re quite common, with over 10% of people in the US taking them. Antidepressants have various FDA-approved indications and are also used for other mental health conditions, too, such as anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).  

If you’re considering antidepressants to treat your depression, here’s what you need to know about depression treatment options.  

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs work by acting on serotonin, a neurotransmitter (chemical messenger) in the brain. Serotonin is thought to be linked to depression. SSRIs increase the availability of serotonin in the brain, which in turn reduces depression symptoms.  

These antidepressants are considered the first-line medication treatment for depression due to their proven efficacy and lower risk of intolerable or serious side effects compared to older medications like monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants (TCAs). Common side effects of SSRIs include nausea, dry mouth, and dizziness, but they’ll typically subside within a few days to weeks.  

Examples of SSRIs are:

• Celexa (Citalopram)

• Lexapro (Escitalopram)

• Prozac (Fluoxetine)

• Luvox (Fluvoxamine)

• Paxil (Paroxetine)

• Zoloft (Sertraline)

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs work similarly to SSRIs, but instead of just acting on serotonin, they affect two neurotransmitters in the brain: serotonin and norepinephrine. Ultimately, SNRIs increase the availability of both of these neurotransmitters, reducing symptoms of depression. Like SSRIs, they also have a low risk of intense adverse effects. SNRIs are very common, but not as commonly prescribed as SSRIs.

Examples of SNRIs are:

• Cymbalta (Duloxetine)

• Effexor (Venlafaxine)

• Fetzima (Levomilnacipran)

• Pristiq (Desvenlafaxine)

Tricyclic antidepressants (TCAs)

TCAs work by increasing the availability of serotonin and norepinephrine in the brain. Some TCAs have a greater effect on serotonin, while others have a stronger effect on norepinephrine.  

These are an older class of antidepressants, and although they are similarly as effective as SSRIs, they are less commonly prescribed due to a higher risk of side effects due to their anticholinergic effects, such as lightheadedness upon standing, trouble urinating, or blurred vision. Still, TCAs may work for some people, and yourA psychiatrist might prescribe a TCA if your symptoms haven’t responded to SSRIs or SNRIs.    

Examples of TCAs are:

• Elavil (amitriptyline)

• Asendin (amoxapine)

• Silenor (doxepin)

• Norpramin (desipramine)

• Tofranil (imipramine)

• Aventyl (nortriptyline)

• Vivactil (protriptyline)

• Surmontil (rrimipramine)

Monoamine oxidase inhibitors (MAOIs)  

MAOIs, the first type of antidepressant introduced, act on an enzyme called MAO (monoamine oxidase). This enzyme breaks down important neurotransmitters in the brain, including dopamine, serotonin, and norepinephrine. MAOIs block the effects of MAO, making more of these neurotransmitters available, which can alleviate depression symptoms.  

Since they are an older class of antidepressants, they are not commonly prescribed due to strict guidelines while taking the medication and a risky side effect profile (such as dangerously high blood pressure). However, an MAOI certainly doesn’t guarantee severe side effects. More mild or moderate side effects (like dry mouth, dizziness, weight gain, and sexual problems) are more common.  

These meds are typically saved for last-resort situations where other medications have not worked, such as in the case of severe depression that is treatment-resistant.  

Examples of MAOIs are:

• Nardil (phenelzine)

• Ensam (selegiline)

• Parnate (tranylcypromine)

• Marplan (isocarboxazid)

Atypical antidepressants

Atypical antidepressants work differently than all the above classes of antidepressants. Each one has a unique mechanism of action. However, they all impact neurotransmitters (like serotonin, dopamine, or norepinephrine) and overall brain chemistry to relieve symptoms of depression.  

Side effects will vary depending on the specific atypical antidepressant. However, some general overarching common side effects are dizziness, dry mouth, appetite changes, or stomach upset. New or worsening suicidal thoughts are also a concern with any type of antidepressant, especially in teens and young adults.  

Examples of atypical antidepressants are:

• Wellbutrin (bupropion)

• Remeron (mirtazapine)

• Trintellix (vortioxetine)

• Viibryd (vilazodone)

How do I choose an antidepressant medication?

Ultimately, a psychiatrist will make the call on which antidepressant medication is best for you, depending on your symptoms, medical history, and co-occurring mental health conditions. They can determine which class of antidepressant is best for you, weighing the pros and cons of each.  

Keep in mind that it can take several weeks to feel the full effects of an antidepressant. Additionally, it’s important to remember that on top of medications, talk therapy is a crucial part of depression recovery. Through talk therapy, a therapist can help you learn coping skills to manage your depression symptoms. For many people with depression, a combination of therapy and medication is the most effective way to treat depression.

If you’re looking for a psychiatrist to aid in depression treatment, consider Talkiatry.  

We’re a national psychiatry practice that treats a wide variety of mental health conditions, including mood disorders like depression. We provide virtual, in-network services so you can get the care you need from the comfort of your home. To get started, complete our free online assessment to get matched with a psychiatrist.  

FAQs

Which antidepressants have the least side effects?  

The general consensus is that SSRIs are the antidepressants that have the least side effects and are best tolerated. However, every individual is different and responds to medications differently. Taking an SSRI doesn’t guarantee that you’ll have minimal side effects, but the odds are in your favor.  

Which antidepressants make you gain weight?

Many antidepressants have a possible side effect of weight gain –– but that doesn’t mean that you’ll definitely gain weight when you take them. However, research has found that certain medications across the classes of antidepressants—like Remeron (mirtazapine), TCAs, and MAOIs— are more likely to cause weight gain than others. If you’re worried about this side effect, let your doctor know.

What is the most effective antidepressant?

There is no single “best” or “most effective” antidepressant. Everyone is different and responds to medications differently. For example, while an SSRI might bring one person the most symptom relief, a TCA might be more effective for another person. Sometimes, it takes some trial and error to figure out what the most effective antidepressant is for you. Combining an antidepressant with talk therapy can also result in significant benefits.  

Related article: What is the best antidepressant for teens?

Talkiatry is a mental health practice, and our clinicians review everything we write. However, articles are never a substitute for professional medical advice, diagnosis, or treatment. If you think you may need mental health help, talk to a psychiatrist. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.