Antidepressants: Selecting one that's right for you
By Mayo Clinic staff
Nov. 27, 2007
Antidepressants: Selecting one that's right for you
Daunted by the choice in antidepressants? With persistence, you and your doctor should find one that works so you can enjoy life more fully again.
Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. Although antidepressants may not cure depression, they can help you achieve remission — the disappearance or nearly complete reduction of depression symptoms.
With scores of antidepressants available, finding the right medication for your situation can be challenging, though. Explore the decision-making process that may help you and your doctor find the best antidepressant for your situation.
Finding the right antidepressant for you
Finding the right antidepressant for your situation might take time. Each antidepressant has its own pros and cons, and until you try one, you won't know exactly how it'll affect you or how well it'll work. You may need to try several antidepressants before finding the one, or the combination, that works best for you.
In general, most antidepressants work pretty well for most people. So which antidepressant you and your doctor choose depends largely on:
A blood test may help make the antidepressant decision somewhat easier. The test, called the cytochrome P450, helps pinpoint genetic factors that influence your response to certain antidepressants (as well as some other medications). The test doesn't predict which antidepressant will work best for you. But it does help suggest which ones may not work, and which ones may have the greatest side effects specifically for you.
Approach to antidepressant treatment
Antidepressants are generally prescribed in a step-by-step treatment approach. When you're beginning treatment for the first time, doctors typically start by prescribing a type of antidepressant that's thought to be very effective and has the fewest side effects. If this doesn't work, your doctor may prescribe different types of antidepressants or combinations of two or more antidepressants and other medications. Don't give up until you find an antidepressant that's suitable for you — you have a good chance of finding one that works and doesn't have intolerable side effects.
First choices in antidepressants
Many doctors start by prescribing antidepressants known as SSRIs — selective serotonin reuptake inhibitors. This is because the side effects of these kinds of antidepressants are generally more tolerable than those of other types of antidepressants, and they also generally work well.
Other common first choices include:
The class of antidepressants called tricyclic antidepressants (TCAs) has been around longer than SSRIs, but TCAs are still effective. However, because TCAs tend to have more numerous and more severe side effects, they're often not used until you've tried SSRIs first without an improvement in your depression.
Last choices in antidepressants
The type of antidepressants called monoamine oxidase inhibitors (MAOIs) is often used as a last resort, when other medications haven't worked. That's because MAOIs can have serious side effects and require strict dietary restrictions because of rare but potentially fatal interactions. However, MAOIs can be very effective for some forms of depression. And newer versions of MAOIs that you stick on your skin as a skin patch rather than swallowing may have fewer side effects.
Trying out antidepressants
Once you and your doctor have selected an antidepressant — whether you start with a first, second or last choice — it may take four to eight weeks for it to be fully effective in controlling your depression symptoms. In rare cases, it may take 12 to 14 weeks to achieve the full effects of an antidepressant. And with some medications, you can take the full dosage immediately. With others, you may need to gradually increase your dose. Talk to your doctor or therapist about coping with depression symptoms as you wait for medications to take effect.
If you have no significant improvement in your symptoms after six weeks, talk to your doctor about trying a different antidepressant or adding a second antidepressant or another medication. A medication combination may work better for you than does a single antidepressant.
You may have to taper off one medication before starting another. This is because potentially dangerous medication interactions, such as serotonin syndrome, and withdrawal-like symptoms can occur from an abrupt switch.
In rare cases, antidepressants simply might not work for you. You may need to consider other forms of treatment.
Side effects of antidepressants
All antidepressants can cause unwanted side effects. Not everyone experiences the same number or intensity of side effects, though. You may find that your side effects are so mild that you don't need to stop taking the antidepressant. Coping strategies also can help you manage side effects. In addition, side effects often go away or lessen within several weeks of starting an antidepressant.
If you experience unpleasant or intolerable side effects, don't just stop taking an antidepressant without consulting your doctor first. Some antidepressants can cause withdrawal-like symptoms unless you slowly taper off your dose.
Some antidepressants have the potential of causing serious or even life-threatening problems, such as liver failure or a dangerous drop in white cell count. While such cases are rare, it's important to get blood work or other tests on schedule and stick to your treatment regimen.
Precautions when taking antidepressants
Although studies have shown that antidepressants are generally safe, some precautions are in order when taking them. The Food and Drug Administration (FDA) now requires that all antidepressant medications carry black box warnings. These are the strictest warnings that the FDA can issue for prescription medications.
The antidepressant warnings note that in some cases, children, adolescents and young adults ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting an antidepressant or changing a dosage. Because of this risk, they must be closely monitored by loved ones, caregivers and health care providers while taking antidepressants.
In addition, if you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child. Talk to your doctor about any concerns you have, and together you can explore options to get your depression symptoms under control.
By Mayo Clinic staff
Nov. 27, 2007
Antidepressants: Selecting one that's right for you
Daunted by the choice in antidepressants? With persistence, you and your doctor should find one that works so you can enjoy life more fully again.
Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. Although antidepressants may not cure depression, they can help you achieve remission — the disappearance or nearly complete reduction of depression symptoms.
With scores of antidepressants available, finding the right medication for your situation can be challenging, though. Explore the decision-making process that may help you and your doctor find the best antidepressant for your situation.
Finding the right antidepressant for you
Finding the right antidepressant for your situation might take time. Each antidepressant has its own pros and cons, and until you try one, you won't know exactly how it'll affect you or how well it'll work. You may need to try several antidepressants before finding the one, or the combination, that works best for you.
In general, most antidepressants work pretty well for most people. So which antidepressant you and your doctor choose depends largely on:
- Anticipated side effects
- Your ability to tolerate these side effects and stick with the treatment
- Cost and health insurance coverage
- Previous experiences you or family members have had with antidepressants
- Whether you're pregnant or breast-feeding
- Your age
- Your other medical and psychiatric conditions
A blood test may help make the antidepressant decision somewhat easier. The test, called the cytochrome P450, helps pinpoint genetic factors that influence your response to certain antidepressants (as well as some other medications). The test doesn't predict which antidepressant will work best for you. But it does help suggest which ones may not work, and which ones may have the greatest side effects specifically for you.
Approach to antidepressant treatment
Antidepressants are generally prescribed in a step-by-step treatment approach. When you're beginning treatment for the first time, doctors typically start by prescribing a type of antidepressant that's thought to be very effective and has the fewest side effects. If this doesn't work, your doctor may prescribe different types of antidepressants or combinations of two or more antidepressants and other medications. Don't give up until you find an antidepressant that's suitable for you — you have a good chance of finding one that works and doesn't have intolerable side effects.
First choices in antidepressants
Many doctors start by prescribing antidepressants known as SSRIs — selective serotonin reuptake inhibitors. This is because the side effects of these kinds of antidepressants are generally more tolerable than those of other types of antidepressants, and they also generally work well.
Other common first choices include:
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Norepinephrine and dopamine reuptake inhibitors (NDRIs)
- Combined reuptake inhibitors and receptor blockers
- Tetracyclic antidepressants
The class of antidepressants called tricyclic antidepressants (TCAs) has been around longer than SSRIs, but TCAs are still effective. However, because TCAs tend to have more numerous and more severe side effects, they're often not used until you've tried SSRIs first without an improvement in your depression.
Last choices in antidepressants
The type of antidepressants called monoamine oxidase inhibitors (MAOIs) is often used as a last resort, when other medications haven't worked. That's because MAOIs can have serious side effects and require strict dietary restrictions because of rare but potentially fatal interactions. However, MAOIs can be very effective for some forms of depression. And newer versions of MAOIs that you stick on your skin as a skin patch rather than swallowing may have fewer side effects.
Trying out antidepressants
Once you and your doctor have selected an antidepressant — whether you start with a first, second or last choice — it may take four to eight weeks for it to be fully effective in controlling your depression symptoms. In rare cases, it may take 12 to 14 weeks to achieve the full effects of an antidepressant. And with some medications, you can take the full dosage immediately. With others, you may need to gradually increase your dose. Talk to your doctor or therapist about coping with depression symptoms as you wait for medications to take effect.
If you have no significant improvement in your symptoms after six weeks, talk to your doctor about trying a different antidepressant or adding a second antidepressant or another medication. A medication combination may work better for you than does a single antidepressant.
You may have to taper off one medication before starting another. This is because potentially dangerous medication interactions, such as serotonin syndrome, and withdrawal-like symptoms can occur from an abrupt switch.
In rare cases, antidepressants simply might not work for you. You may need to consider other forms of treatment.
Side effects of antidepressants
All antidepressants can cause unwanted side effects. Not everyone experiences the same number or intensity of side effects, though. You may find that your side effects are so mild that you don't need to stop taking the antidepressant. Coping strategies also can help you manage side effects. In addition, side effects often go away or lessen within several weeks of starting an antidepressant.
If you experience unpleasant or intolerable side effects, don't just stop taking an antidepressant without consulting your doctor first. Some antidepressants can cause withdrawal-like symptoms unless you slowly taper off your dose.
Some antidepressants have the potential of causing serious or even life-threatening problems, such as liver failure or a dangerous drop in white cell count. While such cases are rare, it's important to get blood work or other tests on schedule and stick to your treatment regimen.
Precautions when taking antidepressants
Although studies have shown that antidepressants are generally safe, some precautions are in order when taking them. The Food and Drug Administration (FDA) now requires that all antidepressant medications carry black box warnings. These are the strictest warnings that the FDA can issue for prescription medications.
The antidepressant warnings note that in some cases, children, adolescents and young adults ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting an antidepressant or changing a dosage. Because of this risk, they must be closely monitored by loved ones, caregivers and health care providers while taking antidepressants.
In addition, if you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child. Talk to your doctor about any concerns you have, and together you can explore options to get your depression symptoms under control.
