How Do I Know Which Antidepressant Is Best For Me?

Which side effects you can tolerate and other conditions you have factor in

female student looking at depression pills
How can you choose the best antidepressant for you alone?. Istockphoto.com/Stock Photo©Ximagination

The quest to find the right antidepressant medication can feel very "hit or miss." While there is a definite logic behind the sequence of antidepressants that a doctor recommends, 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. But up to 80 percent of people eventually respond to depression treatment, so there is every reason to 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 you, beyond simply the type of depression you are living with. Some of these include learning what has worked for you in the past (if this is not your first major depression), what may have worked for other members of your family (genetics may play a role in how well you respond to one medication over another), other medications you are taking, and much more.

Some side effects, such as weight gain or sexual dysfunction, may not pose a huge problem for some but may be intolerable for others, so this must be considered. And some medications may work for other conditions you have in addition to depression. For example, duloxetine (Cymbalta) is known to help with physical pain, so if you suffer from fibromyalgia or arthritis in addition to depression, this may be a good choice for you.

Or if you suffer from insomnia, you may benefit from choosing an antidepressant with sedating properties, such as mirtazapine (Remeron). You may be able to kill two birds with one stone, so-to-speak. 

Other examples in which antidepressants 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 pull double duty and be the logical choice by lifting depression and helping smoking cessation.
  • Neuropathy. Both tricyclic antidepressants and the serotonin-norepinephrine reuptake inhibitors (SNRIs), duloxetine (Cymbalta) and venlafaxine (Effexor), 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, imipramine may help with both problems.
  • Learning disabilities. It's thought that some of the 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.

It's important to note that in prescribing an antidepressant, the first goal should be the best control of the depression. Sometimes this may mean choosing an antidepressant which is more likely to cause weight gain even in someone who is overweight, and that does not cover another condition he is suffering from, even if that option appears to be available.

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—and may even have been found useful to treat a condition—but 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.

It is very important that you work together with your doctor as a team in making these choices. 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 physician and patient must work as a team to find a solution that the patient can live with. Options might include accepting the side effect as a trade-off for depression relief, augmenting with other medications (using more than one medication together to control depression and/or relieve side effects), or trying a new medication.

Your doctor should always try to find the drug that gives the best depression relief with the fewest antidepressant 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. One of the classic symptoms of depression is 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, nefazodone (Serzone), bupropion, and mirtazapine are medications that have fewer sexual side-effects. Of course, these medications may have other side effects.

Weight gain on antidepressants is another commonly complained about side-effect. In this department, paroxetine (Paxil) and mirtazapine are two of the worst offenders. Venlaxafine, bupropion, and fluoxetine (Prozac) 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.

Side Effects Are Not Always a Bad Thing

Believe it or not, side effects are not necessarily a bad thing. If a patient has an eating disorder and is too thin, a drug like Prozac that suppresses appetite may not be desirable. But a drug that increases appetite, such as paroxetine or mirtazapine, could really benefit this patient. And if a patient is diabetic and overweight, a drug that lowers appetite may be helpful in controlling their diabetes because they will have fewer cravings for forbidden foods. 

This also applies to antidepressants that are stimulating and those that are sedating. An antidepressant that tends to be stimulating such as 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 and may 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. 

Sources:

Carvalho, A., Sharma, M., Brunoni, A., Vieta, E., and G. Fava. The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. Psychotherapy and Psychosomatics. 2016. 85(5):270-88.

Mental Health America. Co-Occurring Disorders And Depression.

Nosengo, N. Can You Teach Old Drugs New Tricks?. Nature. 2016. 534:7607.

Prus, A., and J. Porter. The Discriminative Stimulus Properties of Drugs Used to Treat Depression and Anxiety. Current Topics in Behavioral Neuroscience. 2016 Jun 29. (Epub ahead of print).

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