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:-
- 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