In fact, there are even flow charts, called algorithms, which outline a logical progression that doctors might follow in determining what the best antidepressant is for you. These algorithms are based on the current knowledge in the medical field about which type of antidepressant works best for which patient. Still, there is no telling what you may or may not respond to. In fact, many people don’t respond to their first antidepressant, or they experience undesirable side effects, so they have to try a second, third, or fourth option before finding what works best for them.
Factors to Consider
There many factors that are considered when a physician chooses an antidepressant for you—beyond the type of depression you are living with.
Your Symptoms
Some antidepressants can do double duty. For instance, if you have been losing weight because you’re not eating, your doctor might decide to put you on an antidepressant that is known to cause weight gain. If you’re having trouble sleeping, your doctor might choose one that you can take before bed that makes you sleepy. Other examples of antidepressants that may have double-duty functions include:
Smoking cessation: Wellbutrin (bupropion) is actually the same drug as the popular stop-smoking medication sold under the brand name Zyban. For a smoker, Wellbutrin may be the logical choice for lifting depression and aiding in smoking cessation. Neuropathy: Both tricyclic antidepressants and the serotonin-norepinephrine reuptake inhibitors (SNRIs) Cymbalta (duloxetine) and Effexor (venlafaxine) have been found to be helpful. Bedwetting: Though tricyclic antidepressants tend to be used less often than some of the newer formulations, for those who are struggling with bedwetting, Tofranil (imipramine) may help with both problems. Learning disabilities: It’s thought that some antidepressants may have a secondary benefit of helping with some learning disabilities. If this is you, talk to your physician about whether or not one of these medications may work for you.
Potential Side Effects
If you’ve been on an antidepressant before, your doctor will want to know what side effects were particularly bothersome for you. If you are on a medication that has side effects you find intolerable, you’re less likely to stay on it, so choosing one that gives you the least side effects is the goal. This can take some trial and error.
Other Medications You’re Taking
Some medications, including antibiotics and steroids, can interact with antidepressants, so your doctor needs to know what other medication (including over-the-counter, prescription, vitamins, and supplements) you’re taking to make the best decision.
Other Health Conditions You Have
Again, some antidepressants can do double duty with both physical and mental illnesses. So, for example, if you have attention-deficit/hyperactivity disorder (ADHD) and depression, taking a medication like Wellbutrin (bupropion) can help both. On the physical side, if you have fibromyalgia or chronic pain, your doctor might prescribe Cymbalta (duloxetine) because it can help with both pain and depression. Sometimes this may mean choosing an antidepressant that is more likely to cause weight gain even in someone who is overweight or choosing an antidepressant that doesn’t treat another condition the person has, even if that option appears to be available.
Your Family History
Especially for parents or siblings, how a medication worked for them is a good indicator of how it might work, or not, for you.
Whether You’re Pregnant or Breastfeeding
Since antidepressants can have an effect on the baby, your doctor will want to steer clear of antidepressants that have been shown to be harmful. You and your doctor will have to figure out the best plan to manage your depression while you are pregnant or thinking of becoming pregnant or breastfeeding.
Health Insurance and Cost
Some newer antidepressants don’t have a generic form available yet and maybe costly, which may influence your doctor’s choice.
On and Off-Label Uses
It’s also important to make a distinction between on-label and off-label uses of medications. On-label use means that the medication has received FDA-approval for that indication. Off-label use does not mean that a medication is not useful, but rather that it does not yet have FDA-approval for that indication. It’s also important for people to know that some physicians are more willing than others to consider prescribing off-label medications.
Barriers to Finding the Right Treatment
Side effects, as mentioned above, can present major barriers to finding the right medication for you. This is the point when the physician and the patient must work together to find a solution that the patient can live with. Options might include the following: There was an error. Please try again.
Accepting the side effect as a trade-off for depression reliefAugmenting with other medications (using more than one medication together to control depression and/or relieve side effects)Trying a new medication
Your doctor should always try to find the drug that gives the best depression relief with the fewest side effects for you—but keep in mind that, unfortunately, no drug is going to be perfect. There are two side effects that people seem to find the most troubling: sexual dysfunction and weight gain.
Sexual Side Effects
One of the classic symptoms of depression is a loss of sex drive. Rather ironically, many of the medications used to treat depression can also potentially cause sexual side effects. If these problems affect you and you cannot tolerate them, Serzone (nefazodone), Trintellix (vortioxetine), Wellbutrin (bupropion), and Remeron (mirtazapine) are medications that have fewer sexual side effects. Of course, these medications may have other side effects.
Weight Gain
Weight gain on antidepressants is another commonly complained about side-effect. In this department, Paxil (paroxetine) and Remeron (mirtazapine) are two of the worst offenders. Effexor (venlafaxine), Wellbutrin (bupropion), and Prozac (fluoxetine) are antidepressants that are not as likely to cause weight gain, and many people even lose a few pounds. But again, everyone is different. Some people gain weight on medications unlikely to cause weight gain and lose weight on those that often cause weight gain.
Side Effects Aren’t Always Bad
Believe it or not, side effects are not necessarily a bad thing. A drug like Prozac that suppresses appetite may not be desirable for someone who has an eating disorder or is too thin but may be helpful for someone who has diabetes or is overweight. Along those same lines, a drug that increases appetite, such as Paxil (paroxetine) or Remeron (mirtazapine), could benefit someone who is underweight while potentially causing issues for someone who is overweight. The same applies to antidepressants that are stimulating and those that are sedating. An antidepressant that tends to be stimulating such as Wellbutrin (bupropion) may be helpful for someone with a vegetative depression or someone who seems to have no energy—but could be the wrong choice for someone living with an anxiety disorder in addition to depression. By the same token, a sedating antidepressant such as mirtazapine could work well for someone who is anxious but might be the wrong choice for someone who is already feeling a total lack of energy with their depression. Again, it is important to remember that every person is different. Follow Now: Apple Podcasts / Spotify / Google Podcasts
A Word From Verywell
Finding the best antidepressant for you may take some trial and error. When you start a new medication, monitor your symptoms for a couple of weeks and report back to your prescribing physician. Be prepared to have an open and honest conversation about your experience—what’s working for you and what’s not. Together, you can determine the right treatment plan for you.
