Antidepressant Information to discuss with your doctor

Important Disclaimer:

This site is offering information/opinion only, not individual advice or treatment.

Best Antidepressant

BRAND NAME GENERIC NAME PROBLEMS ON STOPPING WEIGHT INCREASE SEXUAL PROBLEMS DAYTIME DROWSINESS DRY MOUTH EXCESSIVE PERSPIRATION PERSONAL IMPRESSIONS BY DR DAVID HORGAN (DEPRESSION.COM.AU, DAVIDHORGAN.COM)
Valdoxan Agomelatine _ _ _ _ _ _ The fewest side_effects. Safe with other drugs.  Liver issues (usually mild) in 1_2%.
Zoloft Sertraline + 30% + _ _ + Less risk of weight gain than other SSRIs. More nausea and diarrhoea 
Lexapro Escitalopram + 30% + _ _ + Popular with psychiatrists
Aropax Paroxetine + 75% + ? _ + Strongly anti_anxiety and ant_panic. Most weight gain of SSRIs. Avoid in pregnancy
Luvox Fluvoxamine + 30% + + _ + Needs to be taken at night as it is mildly sedative. Reputed to be good for OCD
Prozac Fluoxetine _ 30% + _ _ + No problem if taken intermittently. Slower to start working perhaps. 5 weeks to clear.
Cipramil Citalopram + 30% + _ _ + Do not exceed 40 mg due to cardiac arrest risk
Pristiq Desvenlafaxine + 30% + _ _ + High doses often needed in my experience
Cymbalta Duloxetine + 40% + _ _ + Can be taken morning or night. Fast acting in my experience
Efexor Venlafaxine + 30% + _ ? + Powerful. Withdrawals can be severe.
Brintellix Vortioxetine _ 20% ? _ _ ?  Much less nausea if taken at bedtime initially. Sexual problems at higher doses.
Zyban Bupropion _ _ _ _ _ _ Risk of epileptic seizures above recommended doses.
Avanza Mirtazepine _ 90% _ + _ _ Powerful. Highly sedative with high weight gain. Seems safe with other antidepressants.
Edronax Reboxetine _ _ _ _ + _ Energising so take morning and lunch. Effectiveness?  Agitation and irritability risk.
Tofranil Imipramine _ 40% ? ? + ? Old but powerful. Helps anxiety and depression. May be sedative or energising
Anafranil Clomipramine _ 80% ? ? + + Very powerful. Causes shaking in higher doses.
Prothiaden Dothiepin _ 60% ? ? + ? Sedation and weight gain are moderate
Tryptanol Amitriptyline  _ 90% ? + + ? Highly sedative. Marked weight gain
Allegron Nortriptyline _ 90% ? + + ? Take at night as it is highly sedative
Sinequan Doxepin _ 90% ? + + ? Sedative. High doses often needed as blood levels are low.
Tolvon Mianserin _ 90% _ + _ _ Sedative. Marked weight gain. Safest tricyclic type.
Aurorix Moclobemide _ _ _ _ _ _ Weak. May cause low blood pressure, especially in warm weather.
Parnate Tranylcypromine _ _ _ _ _ _ DANGEROUS (stroke!)  unless strict diet and precautions. Rare reports spontaneous
Nardil Phenelzine _ _ _ _ _ _ DANGEROUS (stroke!)  unless strict diet and precautions. Rare reports spontaneous

Which is the best antidepressant?

There are 3 important facts to remember about our current state of knowledge:-

      • We do not know what is wrong in depression.

      • We do not know how antidepressants fix depression

      • Therefore, there is no way of predicting which antidepressant will be “the best”.

     

    Any antidepressant has the same unpredictable chance of producing the following results:-

        1. Long term very good effect called remission – 40%

        1. Short term very good effect – 15%

        1. Partial benefit only – 15%

        1. No benefit – 30%

       

      So, in the inevitable sequence of trial and error, please remember a few points

          • This site guides you to the antidepressants with the fewest side-effects in the clinical opinion of the author

          • The antidepressant with fundamentally no side-effects (Valdoxan, the one I would try first if I had depression..David Horgan) has been shown in a recent Cochrane review (the most prestigious reference source in Medicine in general) to be as effective as any other antidepressant .

          • Start with a low dose of any antidepressant for the first 2-4 days, especially in those under 25

          • If no brief periods of improvement occur in the first 3 weeks, it is 90% certain that antidepressant is never going to work in that patient, and a trial of another antidepressant is indicated.

          • Depression is like mental cancer, and needs prolonged “chemotherapy” to prevent it recurring (which will happen in 50% of cases), so antidepressants should be taken for 12 months initially according to research!

          • Keep long-term side-effects in mind, not reported in initial drug trials. 30-40% of patients on SSRIs or SNRIs will gain weight (mainly due to metabolic changes), 30-40% will develop sexual side-effects, and about 30% will develop withdrawal symptoms as if they were addicted.

         

        Disclosure: I have received lecturing fees, consultancy fees and travel grants from multiple different pharmaceutical companies…David Horgan