Which Antidepressant Is Best for Me?

Which antidepressant is best for me? It’s a good question if you struggle with an anxiety disorder or depression and are thinking of talking to a healthcare provider about your treatment options.

The journey to finding the perfect match for your mental health needs involves patience and potentially a bit of experimentation. The right treatment for you can depend on your symptoms, illness severity, existing health conditions, and perhaps most importantly of all, your genetics. 

So, if you’re looking to answer “Which depression medication is best for me?”, we don’t have a definitive answer. But we also understand that knowledge is power. Below, we outline the different antidepressant options available and what to expect from their effects.

Healthcare professionals prescribe antidepressants medications to treat several conditions, including:

• Major depression

• Generalized anxiety disorder (GAD)

• Obsessive-compulsive disorder (OCD)

• Post-traumatic stress disorder (PTSD)

• Chronic pain

Some antidepressants can also help with panic disorder and social phobia.

Additionally, because antidepressants can sometimes worsen bipolar disorder symptoms, they’re not a first-line treatment. 

From 2015 to 2018, the Centers for Disease Control and Prevention (CDC) reported that over 13 percent of U.S. adults used antidepressants in the past month.

Many of these medications work by modifying or balancing certain brain chemicals known as neurotransmitters.

Research suggests that antidepressants may be more effective for moderate to severe depression and might be less helpful for mild cases.

The main types of antidepressants are:

• Selective serotonin reuptake inhibitors (SSRIs)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Tricyclic antidepressants (TCAs)

• Monoamine oxidase inhibitors (MAOIs)

• Atypical antidepressants

Learn more about these drugs and their potential side effects in our full list of antidepressants.

Keep reading to find out how these medications could work for you.

Antidepressants each have their unique ways of working and come with their own set of side effects, which can vary from person to person.  

Selective Serotonin Reuptake Inhibitors (SSRIs)

Experts believe selective serotonin reuptake inhibitors (SSRIs) work by preventing serotonin-producing brain cells from reabsorbing the neurotransmitter after it’s released.

Serotonin is a chemical responsible for regulating certain body functions, like sleep and mood.

Some examples of SSRIs include: 

• Citalopram (Celexa^®)

• Escitalopram (Lexapro^®)

• Fluvoxamine (Luvox^®)

• Fluoxetine (Prozac^®)

• Paroxetine (Paxil^®)

• Sertraline (Zoloft^®)

Doctors primarily prescribe SSRIs to treat major depressive disorder, but may sometimes prescribe them for the treatment of: 

• Anxiety

• OCD

• Panic disorders

• Social anxiety disorder

• PTSD

• Eating disorders

These antidepressant drugs are a first-line choice for treating depression and other mental health conditions because they’re effective and come with fewer side effects compared to older antidepressants such as tricyclic antidepressants.

Which SSRI is right for me? 

A meta-analysis of 522 randomized controlled trials revealed that escitalopram, paroxetine, and sertraline are among the most effective and well-tolerated SSRIs.

But like any medication, side effects are possible.

Some common side effects of SSRIs include:

• Weight gain

• Sexual side effects

• Nausea

• Trouble sleeping (insomnia)

• Drowsiness

One study found that compared to sertraline, escitalopram and paroxetine may increase the risk of gaining at least 5 percent of your baseline weight.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Similar to SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) also work by preventing the brain from reabsorbing the chemical serotonin, plus norepinephrine.

Norepinephrine increases alertness and attention, affects your mood and sleep cycle and is part of your body’s emergency response system to danger (AKA your fight-or-flight response).

In addition to depression, SNRIs can help with:

• Anxiety disorders

• Panic disorder

• Fibromyalgia

• Chronic musculoskeletal pain resulting from conditions like arthritis

• Diabetic peripheral neuropathic pain (nerve pain and damage from diabetes)

SNRIs might also help you if you haven’t responded well to SSRIs. 

Some common SNRIs include: 

• Venlafaxine (Effexor^®)

• Levomilnacipran (Fetzima^®)

• Duloxetine (Cymbalta^®)

• Desvenlafaxine (Pristiq^®)

The possible side effects of SNRIs are similar to those of SSRIs and can include:

• Insomnia

• Headaches

• Nausea

• Dry mouth

• Sexual dysfunction

Research shows that SNRIs can be just as effective as SSRIs for treating depression, with a slightly higher chance of remission, but also a higher risk of difficult to tolerate side effects.

Which SNRI is right for me?

A meta-analysis found that venlafaxine, a commonly-prescribed SNRI, was well tolerated and more effective at treating symptoms of GAD than a placebo. Venlafaxine, along with other antidepressants approved for GAD, might be a fit for you if you live with depression and anxiety symptoms. 

Many psychiatrists choose duloxetine when they believe a patient will benefit from an SNRI because, compared to the others, its effects on serotonin and norepinephrine are more balanced.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants are an older class of medications. Healthcare professionals may prescribe them to treat:

• Major depression

• Anxiety disorders

• Chronic pain

Like other antidepressants, TCAs work to increase serotonin and norepinephrine levels in the brain, affecting mood and alertness.

TCAs are just as effective as SSRIs in treating depression but they carry a higher risk of side effects. 

Common side effects of TCAs include:

• Blurred vision

• Dry mouth

• Constipation

• Low blood pressure

• Rapid heartbeat

• Weight gain

A review of studies suggests that compared to SSRIs and SNRIs, TCAs have lower tolerability, higher heart-related risks, and higher discontinuation rates — meaning people tend to stop taking the medication early on.

TCAs can also have harmful side effects if you take them with certain medications or if you have certain health conditions, like glaucoma or heart vessel damage.

Your healthcare provider may prescribe a tricyclic antidepressant if you don’t respond well to SSRIs or SNRIs.

Many tricyclic antidepressants are only available as generic brands. Some examples of TCAs for anxiety and depression include desipramine (Norpramin^®), doxepin, imipramine (Tofranil^®), nortriptyline (Pamelor^®), and amitriptyline.

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) are another older class of antidepressants. Again, doctors don’t typically prescribe them as a first-line treatment for mental health disorders anymore. 

MAOIs block the enzyme monoamine oxidase, which breaks down neurotransmitters like serotonin, norepinephrine, dopamine, and tyramine.

Although effective, these antidepressants can cause dangerous interactions with medications, supplements, and foods containing tyramine. 

Like TCAs, a healthcare professional may prescribe MAOIs when other antidepressant medications don’t work.

Examples of MAOIs include:

• phenelzine (Nardil^®)

• selegiline (Emsam^®)

• tranylcypromine (Parnate^®)

Atypical Antidepressants

Atypical antidepressants don’t fit into the other categories of antidepressants.

Take bupropion (Wellbutrin XL^®), for instance. It’s a common treatment for depression and seasonal affective disorder (SAD).

Each atypical antidepressant works differently. 

Bupropion, unlike SSRIs and SNRIs, prevents the reuptake of dopamine and norepinephrine. Dopamine helps you feel pleasure and gives you motivation to work for the things you want. It also helps with focus and concentration.

Another atypical antidepressant, mirtazapine, blocks alpha-2 adrenergic receptors, allowing for the release of norepinephrine.

Atypical antidepressants like bupropion and mirtazapine are just as effective as other antidepressants in treating depression, but bupropion doesn’t work well for anxiety.

The short answer: it depends.

The best antidepressant for you is the one that effectively addresses your symptoms, fits the severity of your condition, and aligns with your health status and current medications. 

Your healthcare provider can help you consider the following factors when deciding on an antidepressant for you:

• Side effects

• Cost

• Whether you’ve responded well to other medications 

• Your preferences

The most important factor, however, may be your genetics. It would be nice if we had a genetic test that would tell us which antidepressant is best, but there are so many different genes involved, it’s too complicated for the current state of our technology. If a close relative responds well to an antidepressant, there’s a good chance it will work for you, too, but in most cases, it’s trial and error. If one antidepressant isn’t right, try another. Patience and persistence pay off.

Before starting a new medication, discuss any current health conditions and medications with your provider. It’s also important to keep them in the loop about any new or persisting side effects and how you’re feeling throughout your treatment. 

The main goal of antidepressants is to relieve your symptoms and help you get back to living your life. 

Finding the best antidepressant takes time, especially since it can take a few weeks to start seeing noticeable changes in mood or behavior.

Finding the best antidepressant for major depression or anxiety disorders can take some trial and error.

Research has shown that combining psychotherapy and antidepressant medications might be beneficial. 

A review of 52 studies involving over 3,600 patients found that a combination of antidepressant medications and psychotherapy for those with an anxiety or depressive disorder was slightly more effective than antidepressant medications alone.

The best depression medication for you is the one that offers the most benefits with the fewest side effects. Ultimately, everyone’s journey to finding the right antidepressant and depression treatment is unique.

Let’s recap what we know about antidepressants:

• You have quite a few options. Even if you don’t respond to the first antidepressant you try, there are plenty of other medications available that can target depression symptoms.

• You might experience side effects. Deciding on the right antidepressant for you involves weighing the pros and cons of each one — including the side effects. 

• You can always try a different option, but talk to your provider first. Don’t stop taking an antidepressant without first consulting a healthcare professional. 

Not sure where to start with mental health treatment? Take our short online mental health assessment to get started on a tailored treatment plan just for you!