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 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
Valdoxan Agomelatine 25-50 mg The fewest side effects of all. Safe with other drugs. Check LFT’s Unique
Zoloft Sertraline 50-250 mg + ? + + Less risk of weight gain than other SSRIs. More nausea and diarrhoea SSRI
Lexapro Escitalopram 10-40 mg + ? + + Popular with psychiatrists SSRI
Aropax Paroxetine 10-40 mg + + + ? + Strongly anti anxiety and anti panic. Most weight gain of SSRIs. Avoid in pregnancy SSRI
Luvox Fluvoxamine 50-200 mg + ? + + + Needs to be taken at night as it is mildly sedative. Reputed to be good for OCD SSRI
Prozac Fluoxetine 20-60 mg ? + + No problem if taken intermittently. Slower to start working perhaps. 5 weeks to clear. SSRI
Cipramil Citalopram 10-40 mg + ? + + Do not exceed 40 mg due to cardiac arrest risk SSRI
Pristiq Desvenlafaxine 50-200 mg + ? + + High doses often needed in my experience. Monitor BP. SNRI
Cymbalta Duloxetine 60-120 mg + ? + + Can be taken morning or night. Fast acting in my experience. Take with food. SNRI
Efexor Venlafaxine 75-225 mg + ? + + Powerful. Withdrawals can be severe. Monitor BP. SNRI

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%
  2. Short term very good effect – 15%
  3. Partial benefit only – 15%
  4. 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