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If you struggle with an anxiety disorder or depression, looking for the best antidepressant can be a step in the right direction. But you may be asking yourself, “Which antidepressant is best for me?”
Finding the best antidepressant can take time as well as trial and error.
With a variety of antidepressants available to treat anxiety symptoms, depressive symptoms and other mental health conditions, the choices can be overwhelming.
You’re looking for the best antidepressant, which can depend on your symptoms, severity of illness, health conditions and more.
We’ve explained the different antidepressants available and how they work for different people.
Antidepressants are a medication used to treat several conditions, such as major depression, generalized anxiety disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and chronic (long-term) pain.
They can also be used for the treatment of other anxiety disorders like panic disorder and social phobia.
Between 2015 and 2018, over 13 percent of U.S. adults used antidepressants daily.
Different antidepressants work in moderately different ways, but it is believed that many work to modify or balance certain neurotransmitters — also referred to as brain chemicals.
Research suggests that antidepressants can be helpful for people with chronic, moderate or severe depression and may not have as much of an effect on symptoms of mild depression.
The major types of antidepressants are:
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
You can learn more from our full list of antidepressants about all the types of antidepressants, their side effects and more.
Keep reading to learn about the different types of antidepressants and how they work for various people.
Antidepressants all work in slightly different ways and have different side effects, especially in different people.
Selective serotonin reuptake inhibitors are believed to work by preventing the brain from reabsorbing the neurotransmitter serotonin.
Serotonin is a chemical responsible for regulating certain body functions, such as sleep, mood and happiness.
Some examples of SSRIs include:
SSRIs are primarily used to treat major depression but can also be prescribed or used off-label for the treatment of anxiety, obsessive-compulsive disorder (OCD), panic disorders, social anxiety disorder, post-traumatic stress disorder (PTSD) and eating disorders.
Selective serotonin reuptake inhibitors are the most commonly prescribed antidepressants.
These antidepressant drugs are often used as a first choice because of their effectiveness and fewer side effects, especially compared to older antidepressants such as tricyclic antidepressants.
A meta-analysis of 117 randomized controlled trials found that sertraline and escitalopram were the most effective and better tolerated over eight weeks of treatment.
However, as with any medication, side effects are possible. Some common side effects of SSRIs include:
Sexual side effects
These side effects can be related to the specific medication as well as the dosage.
In one double-blind trial comparing paroxetine, fluoxetine and sertraline, those taking paroxetine experienced the greatest weight gain over 32 weeks.
Similar to SSRIs, serotonin-norepinephrine reuptake inhibitors also work by preventing the brain from reabsorbing the chemical serotonin as well as norepinephrine.
Norepinephrine increases alertness and attention, affects mood and sleep cycle and is part of the body’s emergency response system to danger — also known as “fight-or-flight”.
In addition to depression, SNRIs can also be used to treat anxiety disorders, panic disorder, fibromyalgia, chronic musculoskeletal pain and diabetic peripheral neuropathic pain (nerve pain and damage from diabetes).
Serotonin-norepinephrine reuptake inhibitors may be prescribed to those who had unsuccessful treatment for depression using selective serotonin reuptake inhibitors (SSRIs).
Some common SNRIs include:
Side effects of SNRIs are similar to those of SSRIs and can include insomnia, headaches, nausea, dry mouth and possible sexual dysfunction.
Also similar to SSRIs, the effect SNRIs have on serotonin and norepinephrine (and therefore, your mood) can vary depending on the dosage.
Venlafaxine, a popular SNRI sold under the brand name Effexor®, when taken at a higher dosage of 225mg a day (the maximum amount in the extended-release tablet form) compared to the initial dosage of 75mg per day, has significant effects on both norepinephrine and serotonin reuptake.
Generally, research has shown that SNRIs are just about as effective as SSRIs for treating depression, although with slightly higher rates of remission.
Some studies have also shown that venlafaxine was more effective at treating symptoms of anxiety compared to buspirone (an anti-anxiety medication) or a placebo.
An older class of antidepressant medications, tricyclic antidepressants are used to treat major depression, anxiety disorders and chronic pain. Many of these uses are off-label (the use of a drug for conditions other than the ones it has been approved for).
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 are not a first-line treatment as they have more significant side effects.
Common side effects of TCAs include blurred vision, dry mouth, constipation, low blood pressure, rapid heartbeat and weight gain.
A review of studies comparing SSRIs and SNRIs to tricyclic antidepressants also found TCAs to have lower tolerability, higher cardiac side effects and more people stop taking the medication earlier (higher drop-out rate).
TCAs can also have harmful side effects when taken with certain medications or if you have certain health conditions, like glaucoma or damage to the heart vessels.
However, 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 TCAs used to treat anxiety, depression and other conditions are desipramine (Norpramin®), doxepin, imipramine (Tofranil®) and nortriptyline (Pamelor®).
Monoamine oxidase inhibitors are another older class of antidepressants also not typically prescribed as first-line treatments for depression due to their risk of side effects and drug interactions.
MAOIs work to block the enzyme monoamine oxidase, which breaks down neurotransmitters such as serotonin, norepinephrine, dopamine and tyramine.
Although effective, these antidepressants also have a considerable risk of interacting with certain foods that contain tyramine, potentially causing a sudden, life-threatening increase in blood pressure.
Like TCAs, a healthcare professional may prescribe monoamine oxidase inhibitors when other antidepressant medications don’t work.
Atypical antidepressants are simply antidepressant drugs that don’t fit in any of the other classes.
Various atypical antidepressants have different ways of working.
Bupropion works similarly to SSRIs and SNRIs, only to stop the reuptake of dopamine and norepinephrine.
Another atypical antidepressant, mirtazapine, blocks alpha-2 adrenergic receptors, which allows norepinephrine to be released.
Certain atypical antidepressants, such as bupropion, are as effective for depression as other common antidepressants.
In a review of six randomized controlled trials comparing bupropion to SSRIs (fluoxetine, sertraline and paroxetine), all were found to be effective at managing symptoms of depression, although bupropion had less severe side effects of nausea and sexual dysfunction.
The answer to which antidepressant is best for me?
The short answer is it depends.
The longer answer is whichever antidepressant you and your symptoms respond best to, is the right fit for the severity of your condition, any current health issues you’re experiencing and any other medications you’re currently taking among other factors.
A healthcare provider or mental health professional will typically prescribe an antidepressant based on factors like side effects, cost, whether you’ve responded well to a particular medication in the past and patient preference.
Be sure to discuss any medications you’re currently taking as well as any health conditions you have with your healthcare provider before starting a new antidepressant.
Also, let them know about any new or persisting side effects after you’ve started any antidepressant and how your symptoms are progressing.
The main goal of antidepressants is to relieve your symptoms (whether from severe depression, generalized anxiety disorder or another condition) and make you feel emotionally stable and able to get through your day.
But finding the best antidepressant takes time, especially since it can take a few weeks to start seeing any changes in mood or behavior.
Fortunately, there are other treatment options for anxiety and depression, sometimes used in addition to antidepressant medications.
Finding the best antidepressant for major depression or anxiety disorders can sometimes take trial and error.
However, there are other treatments for symptoms of depression as well as anxiety symptoms that can help.
Some research has shown the combination of psychotherapy and antidepressant medications can be beneficial.
A review of 52 studies involving over 3,600 patients found that a combined treatment of antidepressant medications and psychotherapy for those diagnosed with an anxiety or depressive disorder was slightly more effective than antidepressant medications alone.
Anxiety disorders, for example, are also typically treated with psychotherapy, medication (antidepressants in some cases) or a combination of the two.
Our guide on therapy for treating anxiety goes into more detail on how it works, the different types and its effectiveness.
If you’re interested in starting psychotherapy — sometimes known as talk therapy — our online mental health resources can help you find a therapist as well as anxiety and depression treatment plans that are best for you.
In a best-case scenario, the answer to “which antidepressant is best for me” is the one that gives you the most benefits with the fewest side effects. Everyone’s journey to finding the right antidepressant and overall treatment is unique.
But taking that first step of looking for an antidepressant is a step in the right direction. Just remember to have patience as the treatment process can take time.
Dr. Vicky Davis is a board-certified Family Nurse Practitioner with over 20 years of experience in clinical practice, leadership and education.
Dr. Davis' expertise include direct patient care and many years working in clinical research to bring evidence-based care to patients and their families.
She is also an active member of the American Academy of Nurse Practitioners.
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