How to Know Which Antidepressant Is Best for You

How to Know Which Antidepressant Is Best for You Depression Treatment Medication Print How to Know Which Antidepressant Is Best for You By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. Learn about our editorial policy Nancy Schimelpfening Medically reviewed by Medically reviewed by Daniel B. Block, MD on January 29, 2020 twitter linkedin Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Daniel B. Block, MD Updated on February 04, 2020 Depression Overview Types Symptoms Causes & Risk Factors Diagnosis Treatment Coping ADA & Your Rights Depression in Kids Towfiqu Photography / Moment / Getty Images The quest to find the right  antidepressant medication  can feel very hit or miss. While it might seem a bit random how doctors choose which  antidepressant  to prescribe for you, there really is some logic to it. 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 dont 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.?? Up to 80% of people do eventually respond to depression treatment, so there is every reason to have hope that you will land on the right one for you. Factors to Consider When Choosing an Antidepressant There many  factors that are considered when a physician chooses an antidepressant  for youâ€"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 youre not eating, your doctor might decide to put you on an antidepressant that is known to cause weight gain. If youre 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 with the brand name Zyban.  For a smoker, Wellbutrin may be the logical choice by 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: Its 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 youve 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, youre 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 Youre 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) youre 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.   When prescribing an antidepressant, the first goal should be treating 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 doesnt 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 Youre 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. Taking Antidepressants During Pregnancy Health Insurance and Cost Some newer antidepressants dont have a generic form available yet and maybe costly, which may influence your doctors choice. On and Off-Label Uses Its 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. Its also important for people to know that some physicians are more willing than others to consider prescribing off-label medications. The best thing you can do is to work together with your doctor as a team to find the right antidepressant. Nobody knows your body better than you do or understands your preferences as well as you. 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. Depression Discussion Guide Get our printable guide to help you ask the right questions at your next doctors appointment. Download PDF Options might include the following:?? 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 youâ€"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), Wellbutrin (bupropion), and Remeron (mirtazapine) are medications that have fewer sexual side effects.?? Of course, these medications may have other side effects. Sexual Side Effects From Antidepressants 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, and some people gain weight on medications unlikely to cause weight gain and lose weight on those that often cause weight gain. How Antidepressants Can Affect Weight Side Effects Arent 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 energyâ€"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.?? 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 experienceâ€"whats working for you and whats not. Together, you can determine the right treatment plan for you. What to Do If Your Antidepressant Stops Working