Antidepressants: Selecting one that's right for you

Confused by the choice in antidepressants? With persistence, you and your health care provider can find one that works so that you can enjoy life more fully again.

By Mayo Clinic Staff

Antidepressants are a popular treatment choice for depression. Although antidepressants may not cure depression, they can reduce symptoms. The first antidepressant you try may work fine. But if it doesn't relieve your symptoms or it causes side effects that bother you, you may need to try another.

So don't give up. Many kinds of antidepressants are available, and chances are you'll be able to find one that works well for you. And sometimes a combination of medicines may be an option.

Finding the right antidepressant

There are many types of antidepressants available that work in slightly different ways and have different side effects. When choosing an antidepressant that's likely to work well for you, your health care provider may consider:

  • Your particular symptoms. Symptoms of depression can vary, and one antidepressant may relieve certain symptoms better than another. For example, if you have trouble sleeping, an antidepressant that causes some people to be calm or somewhat sleepy may be a good option.
  • Possible side effects. Side effects of antidepressants vary from one medicine to another and from person to person. Bothersome side effects, such as dry mouth, nausea, weight gain or sexual side effects, can make it difficult to stick with treatment. Discuss possible major side effects with your health care provider or pharmacist.
  • Whether it worked for a close relative. How a medicine worked for a blood relative, such as a parent or sibling, can indicate how well it might work for you. Also, if an antidepressant has been effective for your depression in the past, it may work well again.
  • Interaction with other medicines. Some antidepressants can cause dangerous reactions when taken with other medicines.
  • Pregnancy or breastfeeding. A decision to use antidepressants during pregnancy and breastfeeding is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of people who take antidepressants during pregnancy is low. Still, certain antidepressants, such as paroxetine (Paxil, Pexeva), are discouraged during pregnancy. Work with your health care provider to find the best way to manage your depression when you're expecting or planning on becoming pregnant.
  • Other health conditions. Some antidepressants may cause problems if you have certain mental or physical health conditions. On the other hand, certain antidepressants may help treat other physical or mental health conditions along with depression. For example, many antidepressants may relieve symptoms of anxiety disorders. Bupropion may help you stop smoking. Other examples include using duloxetine (Cymbalta, Drizalma Sprinkle) to help with pain symptoms or fibromyalgia, or using amitriptyline to prevent migraines.
  • Cost and health insurance coverage. Some antidepressants can be expensive, so ask if there's a generic version available and discuss its effectiveness. Also find out whether your health insurance covers antidepressants and if there are any limitations on which ones are covered.

Types of antidepressants

Many mental health experts believe that certain brain chemicals called neurotransmitters are associated with depression — particularly serotonin (ser-o-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-meen). Most antidepressants help relieve depression by affecting these neurotransmitters, sometimes called chemical messengers, which aid in communication between brain cells. Each type of antidepressant affects these neurotransmitters in slightly different ways.

Many types of antidepressants are available to treat depression, including:

  • Selective serotonin reuptake inhibitors (SSRIs). Health care providers often start by prescribing an SSRI. These antidepressants generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs include duloxetine (Cymbalta, Drizalma Sprinkle), venlafaxine (Effexor XR), desvenlafaxine (Pristiq) and levomilnacipran (Fetzima).
  • Atypical antidepressants. These antidepressants are called atypical because they don't fit neatly into any of the other antidepressant categories. More-commonly prescribed antidepressants in this category include trazodone, mirtazapine (Remeron), vortioxetine (Trintellix), vilazodone (Viibryd) and bupropion (Forfivo XL, Wellbutrin SR, others). Bupropion is one of the few antidepressants not frequently associated with sexual side effects.
  • Tricyclic antidepressants. Tricyclic antidepressants — such as imipramine, nortriptyline (Pamelor), amitriptyline, doxepin and desipramine (Norpramin) — tend to cause more side effects than newer antidepressants. So tricyclic antidepressants generally aren't prescribed unless you've tried other antidepressants first without improvement.
  • Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, often when other medicines haven't worked. This is because they can have serious side effects. Using an MAOI requires a strict diet because of dangerous (or even deadly) interactions with foods that contain tyramine — such as certain cheeses, pickles and wines — and some medicines, including pain medicines, decongestants and certain herbal supplements. Selegiline (Emsam), an MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs. These medicines can't be combined with SSRIs or other medicines that increase serotonin.
  • Other medications. Your health care provider may recommend combining two antidepressants. Or your provider may add other medicines to improve antidepressant effects. This is called augmentation. Examples of antidepressant augmentation medicines include aripiprazole (Abilify), quetiapine (Seroquel) and lithium (Lithobid).

Antidepressants and risk of suicide

Most antidepressants are generally safe, but the U.S. Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your health care provider or get emergency help.

Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Making antidepressants work for you

To get the best results from an antidepressant:

  • Be patient. Once you and your health care provider have selected an antidepressant, you may start to see improvement in a few weeks, but it may take six or more weeks for it to be fully effective. With some antidepressants, you can take the full dose immediately. With others, you may need to gradually increase your dose. Talk to your provider or therapist about coping with depression symptoms as you wait for the antidepressant to take effect.
  • Take your antidepressant consistently and at the correct dose. If your medicine doesn't seem to be working or is causing bothersome side effects, call your health care provider before making any changes.
  • See if the side effects improve. Many antidepressants cause side effects that improve with time. For example, initial side effects when starting an SSRI can include dry mouth, nausea, loose bowel movements, headache and insomnia, but these side effects usually go away as your body adjusts to the antidepressant.
  • Explore options if it doesn't work well. If you have bothersome side effects or no significant improvement in your symptoms after several weeks, talk to your health care provider about changing the dose, trying a different antidepressant, or adding a second antidepressant or another medicine. A medicine combination may work better for you than a single antidepressant.
  • Try psychotherapy. In many cases, combining an antidepressant with talk therapy, called psychotherapy, is more effective than taking an antidepressant alone. It can also help prevent your depression from returning once you're feeling better.
  • Don't stop taking an antidepressant without talking to your health care provider first. Some antidepressants can cause significant withdrawal-like symptoms unless you slowly taper off your dose. Quitting suddenly may cause a worsening of depression.
  • Avoid alcohol and recreational drugs. It may seem as if alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat. Talk with your health care provider or therapist if you need help with alcohol or drug problems.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Sept. 23, 2022 See more In-depth

See also

  1. Addison's disease
  2. Adjustment disorders
  3. Adrenal fatigue: What causes it?
  4. Alzheimer's: New treatments
  5. Alzheimer's 101
  6. Understanding the difference between dementia types
  7. Alzheimer's disease
  8. Alzheimer's drugs
  9. Alzheimer's genes
  10. Alzheimer's prevention: Does it exist?
  11. Alzheimer's stages
  12. Ambien: Is dependence a concern?
  13. Antidepressant withdrawal: Is there such a thing?
  14. Antidepressants and alcohol: What's the concern?
  15. Antidepressants and weight gain: What causes it?
  16. Antidepressants: Can they stop working?
  17. Antidepressants: Side effects
  18. Antidepressants: Which cause the fewest sexual side effects?
  19. Antidepressants and pregnancy
  20. Atypical antidepressants
  21. Back pain
  22. Binge-eating disorder
  23. Blood Basics
  24. Borderline personality disorder
  25. Breastfeeding and medications
  26. Dr. Wallace Video
  27. Dr. Mark Truty (surgery, MN) better outcomes with chemo
  28. Can zinc supplements help treat hidradenitis suppurativa?
  29. Hidradenitis suppurativa wound care
  30. Celiac disease
  31. Child abuse
  32. Chronic traumatic encephalopathy
  33. CJD - Creutzfeldt-Jakob Disease
  34. Clinical depression: What does that mean?
  35. Clinical trials for hidradenitis suppurativa
  36. Coconut oil: Can it cure hypothyroidism?
  37. Complete blood count (CBC)
  38. Complicated grief
  39. Compulsive sexual behavior
  40. Concussion
  41. Concussion in children
  42. Concussion Recovery
  43. Concussion Telemedicine
  44. Coping with the emotional ups and downs of psoriatic arthritis
  45. Coping with the stress of hidradenitis suppurativa
  46. COVID-19 and your mental health
  47. Creating a hidradenitis suppurativa care team
  48. Creutzfeldt-Jakob disease
  49. Cushing syndrome
  50. Cyclothymia (cyclothymic disorder)
  51. Delirium
  52. Depression and anxiety: Can I have both?
  53. Depression, anxiety and exercise
  54. What is depression? A Mayo Clinic expert explains.
  55. Depression during pregnancy
  56. Depression in women: Understanding the gender gap
  57. Depression (major depressive disorder)
  58. Depression: Supporting a family member or friend
  59. Diabetes and depression: Coping with the two conditions
  60. Diagnosing Alzheimer's
  61. Did the definition of Alzheimer's disease change?
  62. Dissociative disorders
  63. Vitamin C and mood
  64. Drug addiction (substance use disorder)
  65. Electroconvulsive therapy (ECT)
  66. Fatigue
  67. Fibromyalgia
  68. HABIT program orientation
  69. Hangovers
  70. Hashimoto's disease
  71. Headache
  72. Hidradenitis suppurativa
  73. Hidradenitis suppurativa and biologics: Get the facts
  74. Hidradenitis suppurativa and diet: What's recommended?
  75. Hidradenitis suppurativa and sleep: How to get more zzz's
  76. Hidradenitis suppurativa: Tips for weight-loss success
  77. Hidradenitis suppurativa: What is it?
  78. Hidradenitis suppurativa: When does it appear?
  79. Hidradenitis suppurativa: Where can I find support?
  80. How opioid use disorder occurs
  81. How to tell if a loved one is abusing opioids
  82. Hyperparathyroidism
  83. Hypoparathyroidism
  84. Hypothyroidism: Can calcium supplements interfere with treatment?
  85. Hypothyroidism diet
  86. Hypothyroidism and joint pain?
  87. Hypothyroidism: Should I take iodine supplements?
  88. Hypothyroidism symptoms: Can hypothyroidism cause eye problems?
  89. Hypothyroidism (underactive thyroid)
  90. Insomnia
  91. Insomnia: How do I stay asleep?
  92. Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills
  93. Intervention: Help a loved one overcome addiction
  94. Is depression a factor in rheumatoid arthritis?
  95. Kratom for opioid withdrawal
  96. Lack of sleep: Can it make you sick?
  97. Lecanemab for Alzheimer's disease
  98. Living better with hidradenitis suppurativa
  99. Low blood pressure (hypotension)
  100. Male depression: Understanding the issues
  101. Managing Headaches
  102. Managing hidradenitis suppurativa: Early treatment is crucial
  103. Hidradenitis suppurativa-related health risks
  104. MAOIs and diet: Is it necessary to restrict tyramine?
  105. Marijuana and depression
  106. Mayo Clinic Minute: 3 tips to reduce your risk of Alzheimer's disease
  107. Mayo Clinic Minute: Alzheimer's disease risk and lifestyle
  108. Mayo Clinic Minute: New definition of Alzheimer's changes
  109. Mayo Clinic Minute: Prevent migraines with magnetic stimulation
  110. Mayo Clinic Minute: Restless legs syndrome in kids
  111. Mayo Clinic Minute: Weathering migraines
  112. Mayo Clinic Minute: Women and Alzheimer's Disease
  113. Medication overuse headaches
  114. Meditation
  115. Memory loss: When to seek help
  116. Mental health: Overcoming the stigma of mental illness
  117. Mental health providers: Tips on finding one
  118. Mental health
  119. Mental illness
  120. Migraine
  121. What is a migraine? A Mayo Clinic expert explains
  122. Migraine medicines and antidepressants
  123. Migraine FAQs
  124. Migraine treatment: Can antidepressants help?
  125. Migraines and gastrointestinal problems: Is there a link?
  126. Migraines and Vertigo
  127. Migraines: Are they triggered by weather changes?
  128. Alleviating migraine pain
  129. Mild cognitive impairment (MCI)
  130. Mindfulness exercises
  131. Monoamine oxidase inhibitors (MAOIs)
  132. Natural remedies for depression: Are they effective?
  133. Nervous breakdown: What does it mean?
  134. New Alzheimers Research
  135. Nicotine dependence
  136. Occipital nerve stimulation: Effective migraine treatment?
  137. Ocular migraine: When to seek help
  138. Opioid stewardship: What is it?
  139. Oppositional defiant disorder (ODD)
  140. Pain and depression: Is there a link?
  141. Pancreatic cancer
  142. Pancreatic Cancer
  143. What is pancreatic cancer? A Mayo Clinic expert explains
  144. Infographic: Pancreatic Cancer: Minimally Invasive Surgery
  145. Pancreatic Cancer Survivor
  146. Infographic: Pancreatic Cancers-Whipple
  147. Perimenopause
  148. Pituitary tumors
  149. Polymyalgia rheumatica
  150. Poppy seed tea: Beneficial or dangerous?
  151. Post COVID syndrome
  152. Premenstrual dysphoric disorder
  153. Premenstrual syndrome (PMS)
  154. Prescription drug abuse
  155. Prescription sleeping pills: What's right for you?
  156. Progressive supranuclear palsy
  157. Psychotherapy
  158. Reducing the discomfort of hidradenitis suppurativa: Self-care tips
  159. Restless legs syndrome
  160. Salt craving: A symptom of Addison's disease?
  161. Schizoaffective disorder
  162. Seasonal affective disorder (SAD)
  163. Seasonal affective disorder treatment: Choosing a light box
  164. Selective serotonin reuptake inhibitors (SSRIs)
  165. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  166. Sleep disorders
  167. Sleep tips
  168. Soy: Does it worsen hypothyroidism?
  169. Staying active with hidradenitis suppurativa
  170. Stress symptoms
  171. Sundowning: Late-day confusion
  172. Support groups
  173. Surgery for hidradenitis suppurativa
  174. Symptom Checker
  175. Tapering off opioids: When and how
  176. Tinnitus and antidepressants
  177. Transcranial magnetic stimulation
  178. Traumatic brain injury
  179. Treating hidradenitis suppurativa: Explore your options
  180. Treating hidradenitis suppurativa with antibiotics and hormones
  181. Treatment of parathyroid disease at Mayo Clinic
  182. Treatment-resistant depression
  183. Tricyclic antidepressants and tetracyclic antidepressants
  184. Unexplained weight loss
  185. Vagus nerve stimulation
  186. Valerian: A safe and effective herbal sleep aid?
  187. Vascular dementia
  188. Video: Alzheimer's drug shows early promise
  189. Video: Vagus nerve stimulation
  190. Vitamin B-12 and depression
  191. What are opioids and why are they dangerous?
  192. What are the signs and symptoms of hidradenitis suppurativa?
  193. Wilson's disease
  194. Xylazine
  195. Young-onset Alzheimer's