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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.

By Mayo Clinic staff

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

Blood test may help in choosing antidepressants

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
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Nov. 27, 2007

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