Antidepressant information to discuss with your doctor
This site is offering information/opinion only, not individual advice or treatment.
|wdt_ID||Brand Name||Generic Name||Dosage||Problems on stopping||Weight increase||Sexual problems||Daytime drowsiness||Dry Mouth||Excessive perspiration||Personal Impressions by Dr David Horgan(depression.com.au, davidhorgan.com)||Type of antidepressant|
|1||Valdoxan||Agomelatine||25-50 mg||The fewest side effects of all. Safe with other drugs. Check LFT's||Unique|
|2||Zoloft||Sertraline||50-250 mg||+||?||+||+||Less risk of weight gain than other SSRIs. More nausea and diarrhoea||SSRI|
|3||Lexapro||Escitalopram||10-40 mg||+||?||+||+||Popular with psychiatrists||SSRI|
|4||Aropax||Paroxetine||10-40 mg||+||+||+||?||+||Strongly anti anxiety and anti panic. Most weight gain of SSRIs. Avoid in pregnancy||SSRI|
|5||Luvox||Fluvoxamine||50-200 mg||+||?||+||+||+||Needs to be taken at night as it is mildly sedative. Reputed to be good for OCD||SSRI|
|6||Prozac||Fluoxetine||20-60 mg||?||+||+||No problem if taken intermittently. Slower to start working perhaps. 5 weeks to clear.||SSRI|
|7||Cipramil||Citalopram||10-40 mg||+||?||+||+||Do not exceed 40 mg due to cardiac arrest risk||SSRI|
|8||Pristiq||Desvenlafaxine||50-200 mg||+||?||+||+||High doses often needed in my experience. Monitor BP.||SNRI|
|9||Cymbalta||Duloxetine||60-120 mg||+||?||+||+||Can be taken morning or night. Fast acting in my experience. Take with food.||SNRI|
|10||Efexor||Venlafaxine||75-225 mg||+||?||+||+||Powerful. Withdrawals can be severe. Monitor BP.||SNRI|
|Generic Name||Dosage||Problems on stopping||Weight increase||Sexual problems||Daytime drowsiness||Dry Mouth||Excessive perspiration||Personal Impressions by Dr David Horgan(depression.com.au, davidhorgan.com)||Type of 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:-
- Long term very good effect called remission – 40%
- Short term very good effect – 15%
- Partial benefit only – 15%
- 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