Table of ContentsView AllTable of ContentsAntidepressant Selection FactorsBarriers to Finding TreatmentOvercoming Antidepressant BarriersThe Importance of Open Communication
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Table of Contents
Antidepressant Selection Factors
Barriers to Finding Treatment
Overcoming Antidepressant Barriers
The Importance of Open Communication
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The quest to find the bestantidepressant medicationcan feel very “hit or miss.” Sometimes it takes trying several different options to find the one that provides the desired response.So, how do physicians know which antidepressants to try when prescribing them to patients?
They often consider several factors, such as the symptoms experienced and whether any other health conditions are present. While there are some barriers to treatment, including negative side effects, solutions do exist—enabling healthcare providers to find the best antidepressant possible.
At a GlanceWhen deciding which antidepressant to prescribe, physicians consider the patient’s symptoms, family history, health conditions, and several other factors. While it’s often a trial-and-error process based on side effects and patient response, having an open and honest patient-physician relationship can go a long way in finding the best antidepressant possible.
At a Glance
When deciding which antidepressant to prescribe, physicians consider the patient’s symptoms, family history, health conditions, and several other factors. While it’s often a trial-and-error process based on side effects and patient response, having an open and honest patient-physician relationship can go a long way in finding the best antidepressant possible.
Many factors are considered when a physician chooses an antidepressant for patients to try—beyond thetype of depressionexperienced.Here are several on their list.
Patient Symptoms
Some antidepressants provide benefits for multiple symptoms. So, if other symptoms are present, a physician may lean more toward a certain medication.
For instance, if a patient has been losing weight because they’re not eating, the physician might try anantidepressant known to cause weight gain. If a patient has trouble sleeping, they might choose anantidepressant that causes drowsinessso it can be taken before bedtime.
Co-Occurring Conditions
Because antidepressants can treat multiple symptoms, this makes them potentially helpful for treating co-occurring disorders. This is important because depression often co-exists with other health conditions, some of which include cancer, stroke, and acute coronary syndrome.
For example, if someone hasattention-deficit/hyperactivity disorder(ADHD) and depression, an antidepressant such as Wellbutrin (bupropion) may be preferred.For patients with fibromyalgia or chronic pain, Cymbalta (duloxetine) may be prescribed because it can help with both pain and depression.
Other examples of antidepressants that may have double-duty functions include:
Potential Side Effects
If the patient has previously taken an antidepressant, the physician will want to know about any potential side effects experienced, including those that were particularly bothersome. If anantidepressant’s side effectsare intolerable, a person is more likely to stay on it.So, choosing one with the fewest adverse effects is the goal.
Other Medications Being Taken
Taking an antidepressant with certain other medications can lead todrug interactions. Categories of drugs that may increase or inhibit antidepressant effects include antiarrhythmic drugs, some blood clotting medications, and medications prescribed for migraines.
Therefore, a physician needs to know about any other medications a patient is taking to decide the best antidepressant to prescribe. This includes not only prescription drugs but also over-the-counter medicines, vitamins, and dietary supplements.
Family History
Not everyone responds to depression medication the same way. However, if a particular antidepressant worked well for a patient’sparent or sibling diagnosed with depression, it may hold more promise that it will also work for them.
Pregnancy or Breastfeeding
SSRI and SNRI antidepressants can have negative effects during both pregnancy and lactation, including those related to premature birth, growth retardation, and neonatal adaptive syndrome.Therefore, the use of a different type of antidepressant may be suggested for new or expecting mothers.
Are Antidepressants Safe in Pregnancy?
Antidepressant Cost
Some newer antidepressants don’t yet have a generic form available. So, they may be costly. If the patient’s health insurance doesn’t cover the cost, this can change which medication the physician may want to prescribe.
On and Off-Label Uses
It’s also important to make a distinction between on-label and off-label uses of antidepressants.
A lack of FDA approval means that a medication has not passed the required safety and efficacy standards for that specific condition, yet it may supply some benefits. Some physicians are more willing to consider prescribing off-label medications than others.
No one knows our bodies and preferences like we do, making it important to work together with our care provider to help find the best antidepressant for us.
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Barriers to Finding the Best Antidepressant
For some, side effects can present a barrier to finding the right antidepressant medication.Two adverse effects that can be troubling are sexual dysfunction and weight gain.
Sexual Side Effects
One of the classic symptoms of depression is a loss of sex drive. Rather ironically, many of the medications used to treat depression can also potentially havesexual side effects.
Certain antidepressant medications have fewer sexual side effects than others. They include Serzone (nefazodone), Trintellix (vortioxetine), Wellbutrin (bupropion), and Remeron (mirtazapine).So, these may be options if this is a concern.
Weight Gain
Weight gainis another commonly complained about side effect of antidepressants. An increase in weight can be uncomfortable physically, also affecting one’s confidence and self-esteem.
Two antidepressants associated with weight gain are Paxil (paroxetine) and Remeron (mirtazapine).Conversely, Effexor (venlafaxine), Wellbutrin (bupropion), and Prozac (fluoxetine) are not as likely to lead to an increase in weight.
Two people can respond to the same medication differently. So, while some medications may be more or less likely to have a certain side effect, not everyone has the same response.
Discussing thepros and cons of antidepressantscan be helpful in overcoming the side effect barrier. It can also help the patient understand more of the potential effects of this form of depression treatment.
Several courses of action can be taken based on this discussion:
While no drug is guaranteed to be free of side effects, a physician can help find the best antidepressant with the fewest adverse effects.
Side Effects Aren’t Always Bad
Some antidepressant side effects can actually be helpful. A person with health issues due to being overweight, for instance, may benefit from an antidepressant that suppresses appetite. Conversely, a patient who is underweight can benefit from a drug that causes appetite to increase.
By the same token, a sedating antidepressant could work well for someone who is anxious but may not be the best choice for someone who has a total lack of energy with their depression. Again, it is important to remember that every person is different.
Press Play for Advice On Coping With Depression
Finding the best antidepressant can take some trial and error. When starting a new medication, it’s important to share with the prescribing physician whether it is improving bothersome symptoms and if any side effects are experienced.
Having an open and honest conversation can make it easier to figure out which antidepressant has the greatest opportunity for working with the fewest side effects. It enables the patient and physician to work together as a team to find the bestdepression treatmentpossible.
Why Are My Antidepressants Not Working?
12 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Mental Health.Mental health medications.Carvalho A, Sharma M, Brunoni A, Vieta E, Fava GA.The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: A critical review of the literature.Psychother Psychosom. 2016;85(5):270-88. doi:10.1159/000447034Mental Health America.Co-occurring disorders and depression.Kang HJ, Kim SY, Bae KY, et al.Comorbidity of depression with physical disorders: research and clinical implications.Chonnam Med J. 2015;51(1):8-18. doi:10.4068/cmj.2015.51.1.8de Vries Y, de Jonge P, Kalverdijk L, Bos J, Schuiling-Veninga C, Hak E.Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose.Eur Child Adolesc Psychiatry. 2016;25:1161-1170. doi:10.1007/s00787-016-0836-3Tatsiopoulou P, Porfyri GN, Bonti E, Diakogiannis I.School failure in a girl with specific learning difficulties, suffering from childhood depression: interdisciplinary therapeutic approach.Brain Sci. 2020;10(12):992. doi:10.3390/brainsci10120992Obata H.Analgesic mechanisms of antidepressants for neuropathic pain.Int J Mol Sci. 2017;18(11):2483. doi:10.3390/ijms18112483Khan SR, Berendt RT, Ellison CD, et al.Chapter one - bupropion hydrochloride.Prof Drug Substanc Excipients Rel Methodol. 2016;41:1-30. doi:10.1016/bs.podrm.2015.12.001Low Y, Setia S, Lima G.Drug-drug interactions involving antidepressants: focus on desvenlafaxine.Neuropsychiatr Dis Treat. 2018;14:567-589. doi:10.2147/NDT.S157708National Library of Medicine.Antidepressants.Dubovicky M, Belovicova K, Csatlosova K, Bogi E.Risks of using SSRI / SNRI antidepressants during pregnancy and lactation.Interdiscip Toxicol. 2017;10(1):30-34. doi:10.1515/intox-2017-0004González de León B, Abt-Sacks A, Acosta Artiles FJ, et al.Barriers and facilitating factors of adherence to antidepressant treatments: An exploratory qualitative study with patients and psychiatrists.Int J Environ Res Public Health. 2022;19(24):16788. doi:10.3390/ijerph192416788Additional ReadingNosengo N.Can you teach old drugs new tricks?Nature. 2016. 2016;534(7607):314-6. doi:10.1038/534314aPrus AJ, Porter JH.The discriminative stimulus properties of drugs used to treat depression and anxiety.Current Topics in Behavioral Neuroscience. 2018;39:213-241. doi:10.1007/7854_2016_27
12 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Mental Health.Mental health medications.Carvalho A, Sharma M, Brunoni A, Vieta E, Fava GA.The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: A critical review of the literature.Psychother Psychosom. 2016;85(5):270-88. doi:10.1159/000447034Mental Health America.Co-occurring disorders and depression.Kang HJ, Kim SY, Bae KY, et al.Comorbidity of depression with physical disorders: research and clinical implications.Chonnam Med J. 2015;51(1):8-18. doi:10.4068/cmj.2015.51.1.8de Vries Y, de Jonge P, Kalverdijk L, Bos J, Schuiling-Veninga C, Hak E.Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose.Eur Child Adolesc Psychiatry. 2016;25:1161-1170. doi:10.1007/s00787-016-0836-3Tatsiopoulou P, Porfyri GN, Bonti E, Diakogiannis I.School failure in a girl with specific learning difficulties, suffering from childhood depression: interdisciplinary therapeutic approach.Brain Sci. 2020;10(12):992. doi:10.3390/brainsci10120992Obata H.Analgesic mechanisms of antidepressants for neuropathic pain.Int J Mol Sci. 2017;18(11):2483. doi:10.3390/ijms18112483Khan SR, Berendt RT, Ellison CD, et al.Chapter one - bupropion hydrochloride.Prof Drug Substanc Excipients Rel Methodol. 2016;41:1-30. doi:10.1016/bs.podrm.2015.12.001Low Y, Setia S, Lima G.Drug-drug interactions involving antidepressants: focus on desvenlafaxine.Neuropsychiatr Dis Treat. 2018;14:567-589. doi:10.2147/NDT.S157708National Library of Medicine.Antidepressants.Dubovicky M, Belovicova K, Csatlosova K, Bogi E.Risks of using SSRI / SNRI antidepressants during pregnancy and lactation.Interdiscip Toxicol. 2017;10(1):30-34. doi:10.1515/intox-2017-0004González de León B, Abt-Sacks A, Acosta Artiles FJ, et al.Barriers and facilitating factors of adherence to antidepressant treatments: An exploratory qualitative study with patients and psychiatrists.Int J Environ Res Public Health. 2022;19(24):16788. doi:10.3390/ijerph192416788Additional ReadingNosengo N.Can you teach old drugs new tricks?Nature. 2016. 2016;534(7607):314-6. doi:10.1038/534314aPrus AJ, Porter JH.The discriminative stimulus properties of drugs used to treat depression and anxiety.Current Topics in Behavioral Neuroscience. 2018;39:213-241. doi:10.1007/7854_2016_27
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Institute of Mental Health.Mental health medications.Carvalho A, Sharma M, Brunoni A, Vieta E, Fava GA.The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: A critical review of the literature.Psychother Psychosom. 2016;85(5):270-88. doi:10.1159/000447034Mental Health America.Co-occurring disorders and depression.Kang HJ, Kim SY, Bae KY, et al.Comorbidity of depression with physical disorders: research and clinical implications.Chonnam Med J. 2015;51(1):8-18. doi:10.4068/cmj.2015.51.1.8de Vries Y, de Jonge P, Kalverdijk L, Bos J, Schuiling-Veninga C, Hak E.Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose.Eur Child Adolesc Psychiatry. 2016;25:1161-1170. doi:10.1007/s00787-016-0836-3Tatsiopoulou P, Porfyri GN, Bonti E, Diakogiannis I.School failure in a girl with specific learning difficulties, suffering from childhood depression: interdisciplinary therapeutic approach.Brain Sci. 2020;10(12):992. doi:10.3390/brainsci10120992Obata H.Analgesic mechanisms of antidepressants for neuropathic pain.Int J Mol Sci. 2017;18(11):2483. doi:10.3390/ijms18112483Khan SR, Berendt RT, Ellison CD, et al.Chapter one - bupropion hydrochloride.Prof Drug Substanc Excipients Rel Methodol. 2016;41:1-30. doi:10.1016/bs.podrm.2015.12.001Low Y, Setia S, Lima G.Drug-drug interactions involving antidepressants: focus on desvenlafaxine.Neuropsychiatr Dis Treat. 2018;14:567-589. doi:10.2147/NDT.S157708National Library of Medicine.Antidepressants.Dubovicky M, Belovicova K, Csatlosova K, Bogi E.Risks of using SSRI / SNRI antidepressants during pregnancy and lactation.Interdiscip Toxicol. 2017;10(1):30-34. doi:10.1515/intox-2017-0004González de León B, Abt-Sacks A, Acosta Artiles FJ, et al.Barriers and facilitating factors of adherence to antidepressant treatments: An exploratory qualitative study with patients and psychiatrists.Int J Environ Res Public Health. 2022;19(24):16788. doi:10.3390/ijerph192416788
National Institute of Mental Health.Mental health medications.
Carvalho A, Sharma M, Brunoni A, Vieta E, Fava GA.The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: A critical review of the literature.Psychother Psychosom. 2016;85(5):270-88. doi:10.1159/000447034
Mental Health America.Co-occurring disorders and depression.
Kang HJ, Kim SY, Bae KY, et al.Comorbidity of depression with physical disorders: research and clinical implications.Chonnam Med J. 2015;51(1):8-18. doi:10.4068/cmj.2015.51.1.8
de Vries Y, de Jonge P, Kalverdijk L, Bos J, Schuiling-Veninga C, Hak E.Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose.Eur Child Adolesc Psychiatry. 2016;25:1161-1170. doi:10.1007/s00787-016-0836-3
Tatsiopoulou P, Porfyri GN, Bonti E, Diakogiannis I.School failure in a girl with specific learning difficulties, suffering from childhood depression: interdisciplinary therapeutic approach.Brain Sci. 2020;10(12):992. doi:10.3390/brainsci10120992
Obata H.Analgesic mechanisms of antidepressants for neuropathic pain.Int J Mol Sci. 2017;18(11):2483. doi:10.3390/ijms18112483
Khan SR, Berendt RT, Ellison CD, et al.Chapter one - bupropion hydrochloride.Prof Drug Substanc Excipients Rel Methodol. 2016;41:1-30. doi:10.1016/bs.podrm.2015.12.001
Low Y, Setia S, Lima G.Drug-drug interactions involving antidepressants: focus on desvenlafaxine.Neuropsychiatr Dis Treat. 2018;14:567-589. doi:10.2147/NDT.S157708
National Library of Medicine.Antidepressants.
Dubovicky M, Belovicova K, Csatlosova K, Bogi E.Risks of using SSRI / SNRI antidepressants during pregnancy and lactation.Interdiscip Toxicol. 2017;10(1):30-34. doi:10.1515/intox-2017-0004
González de León B, Abt-Sacks A, Acosta Artiles FJ, et al.Barriers and facilitating factors of adherence to antidepressant treatments: An exploratory qualitative study with patients and psychiatrists.Int J Environ Res Public Health. 2022;19(24):16788. doi:10.3390/ijerph192416788
Nosengo N.Can you teach old drugs new tricks?Nature. 2016. 2016;534(7607):314-6. doi:10.1038/534314aPrus AJ, Porter JH.The discriminative stimulus properties of drugs used to treat depression and anxiety.Current Topics in Behavioral Neuroscience. 2018;39:213-241. doi:10.1007/7854_2016_27
Nosengo N.Can you teach old drugs new tricks?Nature. 2016. 2016;534(7607):314-6. doi:10.1038/534314a
Prus AJ, Porter JH.The discriminative stimulus properties of drugs used to treat depression and anxiety.Current Topics in Behavioral Neuroscience. 2018;39:213-241. doi:10.1007/7854_2016_27
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