Which antidepressant?

Finding the best antidepressant for you

When tested in large numbers of people in clinical trials, different antidepressants were all about as effective as each other. However, individuals can have very different responses to one antidepressant compared with another — so it can be a case of trial and error to find one that works best for you.

Selective serotonin reuptake inhibitors (SSRIs) are often one of the first choices when someone is starting an antidepressant, because they are about as effective as other types of antidepressants but tend to have less troublesome side effects compared to some of the older types, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).

Tricyclic antidepressants, MAOIs (phenelzine and tranylcypromine) and mianserin are often reserved for people who find that other antidepressants do not work for them, and for people who have had a good response to these medicines in the past.

Side effects can help you decide about an antidepressant

Talk to your doctor about which side effects are more important for you to avoid. Clinical trials have found that the rates of particular side effects differ between different antidepressants. The rates of some side effects with individual antidepressants are shown in How do the side effects of different antidepressants compare?. Keep in mind that your own experience of side effects with a particular antidepressant may differ from that seen in clinical trials, and from other people’s experiences.

Your other illnesses and medicines

Other factors your doctor will take into account when prescribing an antidepressant include any other illnesses you have, your age, and other medicines you take (some medicines can interact with each other).

See the individual antidepressant medicine pages for a list of interactions. See What to do if you regularly use several medicines to read about how interactions happen.

It’s not working — what do I do?

Often you will start to feel better within 1 to 3 weeks of starting an antidepressant, but it can take 6 to 8 weeks to feel the full effect. If you are not feeling better within this time, go back to your doctor — your doctor might need to increase your dose or prescribe you another type of antidepressant.

Finding an antidepressant that works for you is sometimes a matter of trial and error (only 50% of people respond to the first antidepressant they try). Alternatively, your doctor might feel it is worthwhile trying a higher dose of the antidepressant you are already taking. Psychological therapy, such as cognitive behavioural therapy (CBT), may also be an option.

For more information

References
  • National Collaborating Centre for Mental Health. Depression: the NICE guideline on the treatment and management of depression in adults (updated edition). London: National Institute for Health and Clinical Excellence, 2010. www.nice.org.uk/nicemedia/live/12329/45896/45896.pdf,(accessed 9 February 2012).
  • Psychotropic Expert Group. Therapeutic Guidelines: Psychotropic, Version 6. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2008. (Accessed 9 February 2012).
  • Rossi S, ed. eAMH [online]. Adelaide: Australian Medicines Handbook, 2012. shop.amh.net.au. (Accessed 9 February 2012).