Antidepressants: How to Choose an Antidepressant

Things Your Doctor Will Think About When Prescribing an Antidepressant

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Which Antidepressant Is the Right One for Me?

There are more than 20 medications approved by the U.S. Food and Drug Administration for the treatment of depression. All of these medications have unique side effects and may work differently in different people.

How Will My Doctor Choose an Antidepressant?

If you have been diagnosed with depression and need to take medication, you and your doctor will need to choose an appropriate antidepressant.

You and your doctor should think about the following issues when choosing an antidepressant medication for you:

Your doctor may want to choose an antidepressant that she has experience prescribing. That way, your doctor will be very familiar with the medication’s side effects and the possibility of drug interactions.

If you have a past history of depression and you used an antidepressant that worked well, your doctor will most likely prescribe the same medication for you to use again.

Some types of depression tend to run in families. If any immediate members of your family (such as your parents, brothers or sisters) have been treated for depression with a medication that worked well for them, your doctor may suggest that you also try that medication for your depression.

Your doctor will think about all of your health issues and will avoid giving you an antidepressant that could have an effect on any of your other health conditions.

For example: The tricyclic antidepressants – such as Elavil (amitriptyline), Sinequan (doxepin), and Tofranil (imipramine) – usually are not given to people with some heart conditions, such as an irregular heartbeat or low blood pressure.

All of the medications used to treat depression may cause side effects.

Knowing your health concerns will help your doctor choose the right medicine for you – the one with the fewest side effects.

For example: Many men with depression have sexual issues such as ejaculatory or orgasmic problems. Several commonly used antidepressants belonging to a class of medications known as selective serotonin reuptake inhibitors (SSRIs) – such as Paxil (paroxetine) and Zoloft (sertraline) – can cause erectile dysfunction. Another antidepressant such as Wellbutrin (bupropion), which may be less likely to cause erectile dysfunction, can be used instead of, or in addition to, an SSRI.

Antidepressant medications may interact with other medications you are taking. Before prescribing a medication to treat your depression, your doctor will consider which antidepressant will work with your other medications.

For example: If you also have migraine headaches, you may be taking a medication know as a triptan. This class of medications includes Imitrex (sumatriptan), Maxalt (rizatriptan), Relpax (eletriptan) and Zomig (zolmitriptan). Taking these medications together with an SSRI can cause a very rare but serious condition called serotonin syndrome.

Your doctor may also consider your depression-related symptoms when choosing an antidepressant.

If you have anxiety as part of your depression, your doctor may recommend that you take an antidepressant – such as Remeron (mirtazapine) – at bedtime that has a sedating effect.

Or, if you have fatigue or lethargy as part of your depression, your doctor may recommend an antidepressant – such as Wellbutrin (bupropion) – that can help you be more active.

While most antidepressants are taken once a day, some people have a problem remembering to take their medication if it is prescribed for more than once each day. If this is a problem for you, your doctor may prescribe a longer-acting antidepressant such as Wellbutrin XL (bupropion) or Paxil CR (paroxetine).

Some medications used to treat depression are expensive. Your doctor will work with you to choose an antidepressant that works for you and that you can afford. Many of the commonly used antidepressants are available in a generic version.

For example: Recently, a large drugstore chain charged $287 for a 90-day supply of the antidepressant Paxil 10 mg. At the same drugstore, the generic version (paroxetine) cost $90; however, Wal-Mart offered a 90-day supply of paroxetine for $10.

What Should I Expect When Starting an Antidepressant?

Many medications used to treat depression take time to work and your depression symptoms may start to get better within one to three weeks of using your antidepressant medicine. However, it can take as long as six to eight weeks to see improvement. If the medication is not working, your doctor may want to increase the dose or, perhaps, have you switch to a different antidepressant.

After starting your antidepressant, you may experience side effects of the medication. Many of these side effects are temporary and go away with your continued use of the medication, although some side effects – such as constipation and sexual problems – may persist.

Talk to your doctor if you have questions or concerns about your medications, including how well the medication is working and if you have any side effects. And, do not stop taking your antidepressant medication without talking with your doctor first. Stopping your antidepressant medications abruptly could cause harmful effects or the symptoms of your depression may return.

Original article updated by Naveed Saleh, MD, MS, on 4/29/2016. Original article written by another author.

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