Tips for choosing an antidepressant I Psych Central

The right choice of antidepressant can depend on your symptoms and many other factors.

Antidepressants are among the most commonly prescribed medications. Each can be used for a variety of symptoms.

Some can help with anxiety, while others can help with insomnia.

Choosing the right antidepressant is a shared decision between you and a mental health professional. Together, you will assess your symptoms, medical history, and other factors to determine which one is right for you and fits your lifestyle.

If you are considering starting a new antidepressant, consider doing some research to find out what antidepressants are available and how they can help you before deciding which one is best for you.

Antidepressants are generally considered safe and effective for most people.

Before deciding which antidepressant to prescribe, a doctor may try to determine the severity of your symptoms and the condition you may have.

Recent literature review suggests that certain types of antidepressants may be better suited for treating certain types of depression (i.e. major or psychotic). Different antidepressants target or work on different symptoms.

Preferred symptoms and antidepressants

  • anxiety: If you suffer from depression and symptoms of anxiety, a selective serotonin reuptake inhibitor (SSRI) may be a good option for you.
  • insomnia: If you have trouble sleeping, atypical antidepressants, such as mirtazapine or a tricyclic antidepressant, may be best.
  • inability to feel pleasure: SSRIs and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) may work if you’ve lost interest in doing things you once loved.
  • melancholy or severe depression: An SNRI, a tricyclic antidepressant, or an SSRI – such as vortioxetine (Trintellix, Brintellix) – may be better options for severe depression.
  • pain: If you have chronic pain from a disease, such as fibromyalgia, an SNRI, such as duloxetine (Cymbalta), or a tricyclic antidepressant may help.

While alleviating your symptoms is a goal of treatment, there is more to consider. For example, if you are having thoughts of suicide, this may be taken into consideration when deciding which antidepressant may work for you.

The US Food and Drug Administration (FDA) warns that some children and adolescents may experience an increase in suicidal thoughts or behavior when they start an antidepressant or change the doses or types of antidepressants.

When choosing an antidepressant, here are some questions to ask your doctor:

  • Which medicine is most likely to help reduce my symptoms?
  • How long will it take before I see improvement?
  • What are the possible side effects and will they be manageable?
  • Will this medicine interfere with other medicines that I take or make another disease that I have worse?
  • Is this medicine safe to take during pregnancy and breastfeeding?
  • This medicine did not work for my parent or brother. Will it work for me?
  • Is this medication covered by my insurance? Is there a certain brand or type that is covered? If so, will this drug work the same?
  • How long will I take this medicine? What if I want to stop taking it or switch to another?

Coexisting conditions like anxiety disorders, eating disorders, and substance use disorders can occur together in part because their causes (biological, environmental) may be similar.

People can also develop depression after another medical diagnosis such as arthritis, diabetes, or cancer.

According to the National Alliance on Mental Illness, when anxiety and depression occur together, treatment may require more trial and error, as symptoms tend to be more persistent and intense. Antidepressant treatment can still target your symptoms of depression, but additional medication may be needed.

Some antidepressants can reduce symptoms of both conditions. Sometimes when you are treating an illness, such as major depressive disorder, symptoms like restlessness, nervousness, irritability, and generalized anxiety may also improve.

But the way a medicine works for you won’t be exactly the same as it does for someone else. Some other types of antidepressants may not be a good mix with your other medications (including natural supplements like St. John’s Wort) or have coexisting health issues.

Before your appointment to discuss medications, remember to write these things down:

  • your symptoms
  • current or past conditions
  • current or past medications, including supplements like vitamins and minerals
  • allergies to drugs or foods

Having this list with you when you speak with a doctor can help you make the right antidepressant choice.

What is useful for one person may not be useful for you. It can take trial and error to determine if a certain antidepressant will work for you.

It may take several weeks to see the full effects of an antidepressant. So, it may take a while before you start to see improvement in your symptoms. It may also take time for the side effects to go away on their own or become manageable.

Remember, not everyone reacts the same to antidepressants or experiences the same side effects.

A 2018 Systematic review found that most antidepressants were more effective than placebos, but some were consistently more effective than others.

However, experts have identified these antidepressants as very effective:

Only you and a doctor can determine the right antidepressant to start with. But it is likely that you will discuss it by starting with one of the antidepressants from the very effective list.

A 2009 review of 117 high-quality randomized controlled trials (RCTs) clinical studies found that approximately 4 million people with depression over the age of 18 received new prescriptions for an antidepressant. Of these people, almost 12% were prescribed sertraline and 14.5% escitalopram.

Your first choice of antidepressants may work, but like many others who are considering antidepressants for the first time, you may need to try a few before you find the right one for you. Changes in your dosage or medications may also be necessary in the future.

Starting with an antidepressant doesn’t mean you’re going to stick with it. A doctor will be there to help you if you need to switch slowly and safely from one antidepressant to another.

Physician direction and ongoing monitoring are needed to monitor serotonin syndrome and symptom relapse and to monitor suicidal thoughts or self-injurious behaviors.

You can also prepare for your appointment by learning what questions to ask about antidepressant withdrawal.

Trying to find the right medicine that works for you can be overwhelming. But working closely with a doctor or mental health professional can help you determine the right antidepressant or drug combination that’s best for you.

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