How to Know Which Antidepressant Is Best for You

The quest to find the best antidepressant medication can feel very "hit or miss." Sometimes it takes trying several different options to find the one that provides the desired response. So, how do physicians know which antidepressants to try when prescribing them to patients?

They often consider several factors, such as the symptoms experienced and whether any other health conditions are present. While there are some barriers to treatment, including negative side effects, solutions do exist—enabling healthcare providers to find the best antidepressant possible.

Antidepressant Selection Factors

Many factors are considered when a physician chooses an antidepressant for patients to try—beyond the type of depression experienced. Here are several on their list.

Patient Symptoms

Some antidepressants provide benefits for multiple symptoms. So, if other symptoms are present, a physician may lean more toward a certain medication.

For instance, if a patient has been losing weight because they're not eating, the physician might try an antidepressant known to cause weight gain. If a patient has trouble sleeping, they might choose an antidepressant that causes drowsiness so it can be taken before bedtime.

Co-Occurring Conditions

Because antidepressants can treat multiple symptoms, this makes them potentially helpful for treating co-occurring disorders. This is important because depression often co-exists with other health conditions, some of which include cancer, stroke, and acute coronary syndrome.

For example, if someone has attention-deficit/hyperactivity disorder (ADHD) and depression, an antidepressant such as Wellbutrin (bupropion) may be preferred. For patients with fibromyalgia or chronic pain, Cymbalta (duloxetine) may be prescribed because it can help with both pain and depression. 

Other examples of antidepressants that may have double-duty functions include:

• Bedwetting: For individuals with enuresis, also known as bedwetting, tricyclic antidepressants may be prescribed to help with both conditions.
• Learning disabilities: Certain antidepressants, namely selective serotonin reuptake inhibitors (SSRIs), may be beneficial for individuals with depression who also have learning disabilities.
• Neuropathy: Both tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors (SNRIs) are used as depression treatments as well as for treating neuropathic pain. 
• Smoking cessation: The antidepressant Wellbutrin (bupropion) is approved for treating depression and smoking cessation. Therefore, it may be a good choice for someone with depression who wants to quit smoking.

Potential Side Effects

If the patient has previously taken an antidepressant, the physician will want to know about any potential side effects experienced, including those that were particularly bothersome. If an antidepressant's side effects are intolerable, a person is more likely to stay on it. So, choosing one with the fewest adverse effects is the goal.

Other Medications Being Taken

Taking an antidepressant with certain other medications can lead to drug interactions. Categories of drugs that may increase or inhibit antidepressant effects include antiarrhythmic drugs, some blood clotting medications, and medications prescribed for migraines.

Therefore, a physician needs to know about any other medications a patient is taking to decide the best antidepressant to prescribe. This includes not only prescription drugs but also over-the-counter medicines, vitamins, and dietary supplements.

Family History

Not everyone responds to depression medication the same way. However, if a particular antidepressant worked well for a patient's parent or sibling diagnosed with depression, it may hold more promise that it will also work for them.

Pregnancy or Breastfeeding

SSRI and SNRI antidepressants can have negative effects during both pregnancy and lactation, including those related to premature birth, growth retardation, and neonatal adaptive syndrome. Therefore, the use of a different type of antidepressant may be suggested for new or expecting mothers.

Antidepressant Cost

Some newer antidepressants don't yet have a generic form available. So, they may be costly. If the patient's health insurance doesn't cover the cost, this can change which medication the physician may want to prescribe.

On and Off-Label Uses

It's also important to make a distinction between on-label and off-label uses of antidepressants.

• On-label use means that the medication has received approval from the U.S. Food and Drug Administration (FDA) for treating the condition for which it was prescribed. 
• Off-label means that the medication does not have FDA approval for that purpose.

A lack of FDA approval means that a medication has not passed the required safety and efficacy standards for that specific condition, yet it may supply some benefits. Some physicians are more willing to consider prescribing off-label medications than others.

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Barriers to Finding the Best Antidepressant

For some, side effects can present a barrier to finding the right antidepressant medication. Two adverse effects that can be troubling are sexual dysfunction and weight gain.

Sexual Side Effects

One of the classic symptoms of depression is a loss of sex drive. Rather ironically, many of the medications used to treat depression can also potentially have sexual side effects.

Certain antidepressant medications have fewer sexual side effects than others. They include Serzone (nefazodone), Trintellix (vortioxetine), Wellbutrin (bupropion), and Remeron (mirtazapine). So, these may be options if this is a concern.

Weight Gain

Weight gain is another commonly complained about side effect of antidepressants. An increase in weight can be uncomfortable physically, also affecting one's confidence and self-esteem.

Two antidepressants associated with weight gain are Paxil (paroxetine) and Remeron (mirtazapine). Conversely, Effexor (venlafaxine), Wellbutrin (bupropion), and Prozac (fluoxetine) are not as likely to lead to an increase in weight.

Overcoming Antidepressant Barriers

Discussing the pros and cons of antidepressants can be helpful in overcoming the side effect barrier. It can also help the patient understand more of the potential effects of this form of depression treatment.

Several courses of action can be taken based on this discussion:

• The patient may accept and learn to cope with the side effects as a trade-off for depression relief.
• The care provider may augment with other medications (use a combination of medications to control depression while also relieving the drug's side effects).
• The care provider may have the patient switch to a new antidepressant in an effort to reduce the current one's effects.

While no drug is guaranteed to be free of side effects, a physician can help find the best antidepressant with the fewest adverse effects.

Side Effects Aren't Always Bad

Some antidepressant side effects can actually be helpful. A person with health issues due to being overweight, for instance, may benefit from an antidepressant that suppresses appetite. Conversely, a patient who is underweight can benefit from a drug that causes appetite to increase.

By the same token, a sedating antidepressant could work well for someone who is anxious but may not be the best choice for someone who has a total lack of energy with their depression. Again, it is important to remember that every person is different.

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The Importance of Open Communication

Finding the best antidepressant can take some trial and error. When starting a new medication, it's important to share with the prescribing physician whether it is improving bothersome symptoms and if any side effects are experienced.

Having an open and honest conversation can make it easier to figure out which antidepressant has the greatest opportunity for working with the fewest side effects. It enables the patient and physician to work together as a team to find the best depression treatment possible.