The selection of an antidepressant is not nearly so "hit or miss" as it might feel. There is a definite logic behind the sequence of antidepressants that a doctor proceeds to try as he/she seeks the best one for you. One tool available to help in selection is what's called an "algorithm," which is a flow chart that provides the best antidepressant selection based upon the answers provided to certain questions. These selections are based upon current knowledge in the field of psychiatry about what antidepressant is best for which type of depression. This process is very well illustrated by a Web site provided by Mental Health Connections. To get an overall view of the complexity of this process, first take a look at the flowchart provided.
Looks complicated, doesn't it? Now, let's take a closer look using a program called "Algorithm for the Pharmacotherapy of Depression", a computer program prepared by Dr. David N. Osser, which automates the process of going through these questions. Take a few moments to go through and answer the questions using yourself as the patient. Does it match up with your own treatment?
The Patient's Say
Just as important as whether a drug relieves depression is how good a fit a drug is for the individual. A patient may find that a particular drug makes them feel the best they have in years, but the side-effects are intolerable. What happens now? 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, or trying a new medication. The important thing is for the patient to be open about their expectations, but also realistic. One should try to find the drug which gives the best depression relief with the fewest side-effects, but keep in mind that no drug is going to be perfect.
Worst Offenders List
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, just about all medications used to treat depression can also potentially cause sexual side-effects. If these problems affect you, Serzone, Wellbutrin and Remeron are medications which have fewer sexual side-effects.
Weight gain is another commonly complained about side-effect. In this department, Paxil and Remeron are the worst offenders. Effexor, Wellbutrin, and Prozac do not seem to cause weight gain as badly, and may even cause patients to lose a few pounds.
Side-Effects Can Be a Good Thing
Believe it or not, side-effects are not necessarily a bad thing. They can be good or bad, depending upon other illnesses or conditions that the patient has. If a patient has an eating disorder, a drug like Prozac that suppresses appetite may not be desirable. However, if a patient is diabetic, this same side-effect may be helpful in controlling their diabetes because they will have fewer cravings for forbidden foods. Conversely, if you need to put on some weight, Paxil or Remeron might be the best antidepressants to use.
Pulling Double Duty
Certain antidepressants have been found to be effective for conditions other than depression. If you have another condition along with depression that might be benefited by a particular antidepressant, a doctor may opt to try that medication.. Wellbutrin is actually the same drug as Zyban, the popular stop-smoking medication. For a smoker, Wellbutrin might be a logical choice. Do you also suffer from Obsessive Compulsive Disorder? Try an SSRI. Are you painfully shy? Paxil may be a good choice. Do you suffer from PMS? Zoloft or Prozac may be for you.