Antidepressants

The Most Effective Antidepressants Explained

Find out which antidepressants are best for treating depression and anxiety. A simple guide to options, side effects, and choosing wisely.

This article explores the most effective antidepressants, the types available, and how to choose the right one.

Understanding the efficacy of antidepressants

Antidepressants are commonly prescribed to treat depression and related mental health conditions.

However, their effectiveness can vary depending on the individual.

Studies have shown that some antidepressants are more effective than others in alleviating symptoms of depression.

This article aims to guide you through the options and help you understand what might work best for you.

What are the most effective antidepressants?

Selective Serotonin Reuptake Inhibitors (SSRIs) are among the most widely prescribed due to their effectiveness and relatively mild side effect profile.

Examples include sertraline, fluoxetine, and escitalopram.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) like venlafaxine and duloxetine are also highly effective for many people.

These medications target multiple neurotransmitters, which can be beneficial for certain types of depression.

Tricyclic Antidepressants (TCAs) such as amitriptyline and nortriptyline are effective but often reserved for more severe cases due to their potential side effects.

Monoamine Oxidase Inhibitors (MAOIs) are another option, though they require dietary restrictions and are typically used when other treatments have failed.

Emerging medications and combination therapies are also being researched, offering new hope for individuals who struggle with traditional treatments.

5 most effective antidepressants

One study of the five most effective antidepressants has found that they are (Cipriani et al., 2018):

Amitriptyline (known as Elavil and others)
Agomelatine (known as Melitor, Thymanax and Valdoxan)
Escitalopram (known as Cipralex, Lexapro and others)
Mirtazapine (known as Remeron and others)
Paroxetine (known as Paxil, Pexeva, Seroxat and others)

The four least effective antidepressants (although they still worked) were:

Fluoxetine (known as Prozac, Sarafem, Adofen and others)
Fluvoxamine (known as Faverin, Fevarin, Floxyfral, Dumyrox and Luvox)
Reboxetine (known as Edronax and others)
Trazodone (known as Desyrel, Oleptro, Trazorel and many others)

Factors influencing antidepressant effectiveness

Each of these factors plays a crucial role in determining the success of an antidepressant regimen.

Severity of depression
Individual biology and genetics
Concurrent medical conditions
Adherence to prescribed dosage
Interaction with other medications

Ongoing monitoring and adjustments are often necessary to achieve optimal results.

Types of antidepressants

Understanding the different categories of antidepressants can help you and your healthcare provider make an informed choice.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs work by increasing the availability of serotonin, a neurotransmitter that influences mood.

They are usually the first-line treatment due to their safety and tolerability.

These medications are often prescribed for a variety of conditions beyond depression, including anxiety disorders and obsessive-compulsive disorder (OCD).

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs boost serotonin and norepinephrine levels, which can enhance mood and energy.

These medications are often used for individuals who do not respond to SSRIs.

They are also used in managing chronic pain conditions such as fibromyalgia, which can be linked to depressive symptoms.

Tricyclic antidepressants (TCAs)

TCAs are older antidepressants that are effective but associated with more side effects, such as dizziness and weight gain.

They are often prescribed for severe or treatment-resistant depression.

Despite their drawbacks, TCAs remain an important option for individuals with specific needs or conditions.

Monoamine oxidase inhibitors (MAOIs)

MAOIs are highly potent but require strict dietary restrictions to prevent adverse interactions.

These medications are typically used as a last resort.

For individuals with atypical depression, MAOIs can sometimes offer unique benefits where other medications fail.

Atypical antidepressants

This category includes medications like bupropion and mirtazapine, which work differently from other classes and may be suitable for certain patients.

Atypical antidepressants often have unique side effect profiles, making them a good choice for individuals with specific concerns.

Side effects and considerations

While antidepressants can be life-changing, they also come with potential side effects.

It is crucial to weigh the benefits and risks with your doctor.

Common side effects

Nausea
Fatigue
Insomnia
Weight changes
Sexual dysfunction

Managing side effects often involves adjusting dosages, switching medications, or incorporating lifestyle changes to improve tolerance.

Choosing the right antidepressant

The choice of medication depends on several factors, including your symptoms, medical history, and potential drug interactions.

Open communication with your doctor is essential to find the most suitable treatment.

Personalising antidepressant treatment

Not all antidepressants work the same way for everyone.

Personalised approaches can improve treatment outcomes.

Genetic factors

Advances in pharmacogenomics allow doctors to predict how your body might respond to specific medications based on your genetic profile.

This approach can reduce the trial-and-error process often associated with finding the right antidepressant.

Trial and error

It often takes time to find the right antidepressant and dosage.

Patience and ongoing communication with your healthcare provider are key.

Regular follow-ups and monitoring help identify what is working and what needs to be adjusted.

Alternative treatments beyond antidepressants

For some people, non-pharmacological options may complement or even replace traditional antidepressants.

Psychotherapy

Cognitive-behavioural therapy (CBT) and other forms of counselling can be highly effective in managing depression.

Therapy can provide tools to address underlying issues, build coping strategies, and improve overall mental health.

Lifestyle changes

Regular exercise
Healthy eating
Adequate sleep
Stress management techniques

These changes can enhance the effectiveness of antidepressants and reduce reliance on medication over time.

Other interventions

Mindfulness and meditation
Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation (TMS)

These therapies are often used for individuals with treatment-resistant depression and can provide significant relief.

Addressing myths and misconceptions about antidepressants

Many myths about antidepressants can discourage people from seeking treatment.

Myth: Antidepressants change your personality

Fact: Antidepressants aim to restore balance, not alter who you are.

They help reduce the symptoms of depression, enabling you to function more like yourself.

Myth: You must take them forever

Fact: Many people use antidepressants temporarily until they feel stable enough to manage without them.

Your doctor will guide you on when and how to taper off the medication safely if it is appropriate.

Myth: Antidepressants are the only solution

Fact: While they are a crucial tool, other therapies and lifestyle changes can also play a vital role in treatment.

Conclusion

Choosing the most effective antidepressant requires careful consideration and open dialogue with your healthcare provider.

Understanding the types, side effects, and personalisation options can empower you to make informed decisions about your mental health treatment.

For those exploring alternatives or concerned about myths, remember that help is available in many forms.

Your journey to better mental health is unique, and finding the right solution is a vital step toward recovery.

Whether you are just starting treatment or revisiting your options, stay informed and proactive in your care.

A brighter future is possible with the right support and resources.

Many Antidepressants Tied To Higher Dementia Risk, Large Study Finds

Safer alternatives should be considered by doctors, the researchers advise.

Antidepressants that have an anticholinergic effect are linked to an increased risk of dementia, research finds.

Anticholinergic antidepressants include drugs such as Amitriptyline (known as Elavil), Dosulepin and Paroxetine (known as Paxil and Seroxat).

(A longer list of drugs is at the bottom of this article.)

Although often older, many millions of people still take these type of antidepressants.

The longer people take these drugs, the researchers found, the higher their risk of dementia.

More modern antidepressants, like Prozac and Xanax, generally have a lower anticholinergic effect, and were not linked to a higher dementia risk.

Dr George Savva, who led the study, said:

“We studied patients with a new dementia diagnosis and looked at what anticholinergic medication they were prescribed between four and 20 years prior to being diagnosed.

We found that people who had been diagnosed with dementia were up to 30 per cent more likely to have been prescribed specific classes of anticholinergic medications.

And the association with dementia increases with greater exposure to these types of medication.

What we don’t know for sure is whether the medication is the cause.

It could be that these medications are being prescribed for very early symptoms indicating the onset of dementia.

But because our research shows that the link goes back up to 15 or 20 years before someone is eventually diagnosed with dementia, it suggests that reverse causation, or confounding with early dementia symptoms, probably isn’t the case.

The conclusions come from the medical records of 40,770 patients aged over 65 who were diagnosed with dementia.

These were compared to 283,933 without dementia.

The results showed the link between dementia and anticholinergic drugs.

Other common anticholinergic drugs also linked to dementia include those prescribed for bladder conditions and Parkinson’s (e.g. Tolterodine, Oxybutynin, Solifenacin and Procyclidine).

No link, though, was found between antihistamines (used to treat allergies) and dementia, as previous research had.

Dr Noll Campbell, study co-author, said:

“These results suggest we should prioritise safer alternatives to anticholinergic medications long before symptoms of dementia are recognised.”

Professor Chris Fox, study co-author, said:

“Doctors and patients should therefore be vigilant about using anticholinergic medications.

They need to consider the risk of long-term cognitive effects, as well as short-term effects, associated with specific drugs when weighing up risks and benefits.

We don’t know exactly how anticholinergics might cause dementia.

Further research is needed to understand possible reasons for this link.

In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their doctor or pharmacist.”

Here are some common drugs that have a definite anticholinergic effect:

Amitriptylline
Brompheniramine
Chlorpheniramine
Clomipramine
Clozapine
Dimenhydrinate
Diphenhydramine
Hydroxyzine
Paroxetine
Promethazine

These drugs also have an anticholinergic effect, although it is lower than the list above:

Amantadine
Belladona
Cyclobenzaprine
Cyproheptadine
Carbamazepine
Loxapine
Meperidine
Molindone
Oxcarbazine
Pimozide

These drugs may have an anticholinergic effect:

Alprazolam
Atenolol
Captopril
Codeine
Diazepam
Digoxin
Furosemide
Prednisone
Nifedipine
Warfarin

Note that this is not a complete list of drugs and it only contains the drug names not the brand names under which each is sold.

The study was published in the journal BMJ (Richardson et al., 2018).

The Herbal Antidepressant With Serious Side-Effects

Despite being perceived as safe by the general public, herbal medicines actually carry considerable risks.

St John’s Wort — a popular herbal treatment for depression — can have serious side-effects, research finds.

These include dangerous changes in body temperature and blood pressure.

The research compared the side-effects of St John’s Wort with those of fluoxetine — an antidepressant also known as Prozac, Animex-On, Sarafem, Adofen and Deprex.

The side-effects of St John’s Wort were just as serious as for the antidepressant.

These included:

anxiety,
panic attacks,
dizziness,
vomiting,
amnesia and aggression.

St John’s Wort can also interact with other drugs, such as blood thinners, the contraceptive pill and other antidepressants.

Mrs Claire Hoban, the study’s first author, said:

“There is a common belief that because something is natural and can be purchased from a health food shop without a prescription, it’s safe.

However, people need to start thinking of St John’s Wort, and other herbal medicines, as a drug and seek advice from a qualified healthcare practitioner to be sure they use it safely.

It’s concerning to see such severe adverse reactions in our population, when people believe they are doing something proactive for their health with little risk.

During 2000-2013, we found 84 reports of adverse reactions to St John’s Wort and 447 to fluoxetine.

While there were fewer confirmed cases of side effects for St John’s Wort, we know that less people use St John’s Wort and adverse reactions for herbal medicines largely go unreported because they are not considered drugs.

Furthermore, we found that the reported reactions for St John’s Wort were very similar to fluoxetine, which included anxiety, panic attacks, dizziness, vomiting, amnesia and aggression.”

St John’s Wort is available in many countries without a prescription.

Dr Ian Musgrave who co-authored, the study, said:

“It’s important that doctors and pharmacists know about all the drugs their patients take, not just prescription drugs, because herbal medicines like St John’s Wort can have serious reactions with some pharmacy medicines, like antidepressants, the contraceptive pill and some blood thinners.

Based on this research, I’d also like to see bottles of St John’s Wort containing improved warnings of the potential adverse reactions.”

The study was published in the journal Clinical and Experimental Pharmacology and Physiology (Hoban et al., 2015).

Antidepressant-Free: The Surprising Truth About Quitting Without Therapy (M)

Discover why many patients no longer need therapy to stop taking antidepressants.

Keep reading with a Membership

• Read members-only articles
• Adverts removed
• Cancel at any time
• 14 day money-back guarantee for new members

Become a member

The Antidepressant Side-Effect Doctors Fail To Mention

Largest ever survey of long-term antidepressant use.

Over half of people experience withdrawal symptoms when trying to quit antidepressants, research finds.

Antidepressant withdrawal symptoms — which typically last around two to three months — include headaches, nausea and anxiety.

In addition, almost one-third of people report becoming addicted to antidepressants.

Despite these high numbers, only 1% of people could recall the prescribing doctor mentioning withdrawal problems as a possible side-effect.

Particularly high rates of withdrawal symptoms were reported for Paroxetine, which is known commercially as Paxil, Seroxat and others.

Professor John Read, who led the study, said:

“This study was not designed to definitively answer the question of whether or not antidepressants are addictive because there are a range of expert definitions of addiction.

But what it did set out to do was make a significant contribution to the estimated rates of long-term usage in relation to self-reported withdrawal and addiction by directly asking users about their experience.

The results point to a significant number of people prescribed antidepressants who have experienced some withdrawal effects and who believe the drugs are addictive.”

The results come from a survey of 1,829 New Zealanders who were asked about their experience of antidepressants.

The results showed that 54.9% had experienced at least some withdrawal symptoms.

Among these, 25.1% reported severe withdrawal symptoms.

Of the 27.4% of people who reported some level of addiction, 6.2% rated it ‘severe’, 9.4% said it was ‘moderate’ and 11.8% said ‘mild’.

The remainder reported that they had not become addicted.

Some people went back on antidepressants to avoid the withdrawal symptoms.

Rise in antidepressant prescription

Around 10% of people in some countries, such as the US and the UK, are prescribed antidepressants each year.

Professor Read said:

“Given some evidence from research conducted in the UK, it appears that the rise in antidepressant prescriptions can be explained by repeat prescriptions rather than new patients.

So given that people are staying on antidepressants for longer, the issue of whether or not people feel addicted and whether or not those who stop taking them are experiencing withdrawal symptoms becomes important.”

The study was published in the International Journal of Mental Health Nursing (Read et al., 2018).

Coming Off Antidepressants: How Many Really Suffer Withdrawal Symptoms? (M)

How many people really experience withdrawal symptoms when coming off antidepressants. Can it be as high as 50 percent?

Keep reading with a Membership

• Read members-only articles
• Adverts removed
• Cancel at any time
• 14 day money-back guarantee for new members

Become a member

Antidepressants Change These Two Personality Traits

Two aspects of personality linked to depression are changed by antidepressants.

Antidepressants can change two aspects of personality that are linked to depression, research finds.

Neuroticism — which is characterised by negative thinking in a range of areas — was reduced in people taking a common antidepressant.

At the same time, people’s extroversion was increased, making them feel more outgoing and sociable.

Extroversion is also linked to feeling more positive emotions.

The antidepressant tested in the study is called paroxetine, which is known commercially as Paxil and Seroxat, among other names.

The studies authors write:

“Patients taking paroxetine reported 6.8 times as much change on neuroticism and 3.5 times as much change on extraversion as placebo patients matched for depression improvement.”

For the study, 120 depressed patients took paroxetine and were compared to people given cognitive therapy and a placebo over 12 months.

All three groups saw improvements, even the placebo group.

However, only those taking the antidepressant experienced changes to their personality.

They authors explain:

“Neuroticism and extraversion are 2 of the 5 primary personality dimensions in the Five-Factor Model of Personality.

Neuroticism refers to a tendency to experience negative emotions and emotional instability; extraversion encompasses social extraversion, dominance, and a tendency to experience positive emotions.”

While antidepressants can be effective, still relatively little is known about how they work.

The study’s authors write:

“One possibility is that the biochemical properties of SSRIs directly produce real personality change.

Furthermore, because neuroticism is an important risk factor that captures much of the genetic vulnerability for major depressive disorder, change in neuroticism (and in neurobiological factors underlying neuroticism) might have contributed to depression improvement.”

The study was published in the journal Archives of General Psychiatry (Tang et al., 2009).

The Hidden Social Impact Of Coming Off Antidepressants (M)

Turbulent emotions and social shifts—what happens when people say goodbye to antidepressants.

Keep reading with a Membership

• Read members-only articles
• Adverts removed
• Cancel at any time
• 14 day money-back guarantee for new members

Become a member

This Belief Triples The Odds That Antidepressants Will Work (M)

Antidepressants only work for around 50 percent of people.

Keep reading with a Membership

• Read members-only articles
• Adverts removed
• Cancel at any time
• 14 day money-back guarantee for new members

Become a member

Antidepressants vs. Running: Which Treats Depression Better? (M)

The 16-week study gave people the choice between group running or taking antidepressants.

Keep reading with a Membership

• Read members-only articles
• Adverts removed
• Cancel at any time
• 14 day money-back guarantee for new members

Become a member