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 and current health topics, like COVID-19, plus expertise on managing health.

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 disease: Can exercise prevent memory loss?
  9. Alzheimer's drugs
  10. Alzheimer's genes
  11. Alzheimer's nose spray: New Alzheimer's treatment?
  12. Alzheimer's prevention: Does it exist?
  13. Alzheimer's stages
  14. Ambien: Is dependence a concern?
  15. Antidepressant withdrawal: Is there such a thing?
  16. Antidepressants and alcohol: What's the concern?
  17. Antidepressants and weight gain: What causes it?
  18. Antidepressants: Can they stop working?
  19. Antidepressants: Side effects
  20. Antidepressants: Which cause the fewest sexual side effects?
  21. Antidepressants and pregnancy
  22. Atypical antidepressants
  23. Back pain
  24. Bedtime routines: Not just for babies
  25. Binge-eating disorder
  26. Blood Basics
  27. Borderline personality disorder
  28. Breastfeeding and medications
  29. Dr. Wallace Video
  30. Dr. Mark Truty (surgery, MN) better outcomes with chemo
  31. Parathyroid
  32. Can zinc supplements help treat hidradenitis suppurativa?
  33. Can't sleep? Try daytime exercise
  34. Hidradenitis suppurativa wound care
  35. Celiac disease
  36. Chase away the winter blues
  37. Child abuse
  38. Chronic traumatic encephalopathy
  39. CJD - Creutzfeldt-Jakob Disease
  40. Clinical depression: What does that mean?
  41. Clinical trials for hidradenitis suppurativa
  42. Coconut oil: Can it cure hypothyroidism?
  43. Coffee after dinner? Make it decaf
  44. Complete blood count (CBC)
  45. Complicated grief
  46. Compulsive sexual behavior
  47. Concussion
  48. Concussion in children
  49. Concussion Recovery
  50. Concussion Telemedicine
  51. Coping with the stress of hidradenitis suppurativa
  52. Coping with the emotional ups and downs of psoriatic arthritis
  53. COVID-19 and your mental health
  54. Creating a hidradenitis suppurativa care team
  55. Creutzfeldt-Jakob disease
  56. Cushing syndrome
  57. Cyclothymia (cyclothymic disorder)
  58. Delirium
  59. Depression and anxiety: Can I have both?
  60. Depression, anxiety and exercise
  61. What is depression? A Mayo Clinic expert explains.
  62. Depression: Diagnosis is key
  63. Depression during pregnancy
  64. Depression in women: Understanding the gender gap
  65. Depression (major depressive disorder)
  66. Depression: Provide support, encouragement
  67. Depression: Supporting a family member or friend
  68. Diabetes and depression: Coping with the two conditions
  69. Diagnosing Alzheimer's
  70. Did the definition of Alzheimer's disease change?
  71. Dissociative disorders
  72. Vitamin C and mood
  73. Drug addiction (substance use disorder)
  74. Electroconvulsive therapy (ECT)
  75. Fatigue
  76. Fibromyalgia
  77. Fibromyalgia and acupuncture
  78. HABIT program orientation
  79. Hangovers
  80. Hashimoto's disease
  81. Headache
  82. Hidradenitis suppurativa
  83. Hidradenitis suppurativa and biologics: Get the facts
  84. Hidradenitis suppurativa and diet: What's recommended?
  85. Hidradenitis suppurativa and sleep: How to get more zzz's
  86. Hidradenitis suppurativa: Tips for weight-loss success
  87. Hidradenitis suppurativa: What is it?
  88. Hidradenitis suppurativa: When does it appear?
  89. Hidradenitis suppurativa: Where can I find support?
  90. How opioid addiction occurs
  91. How to tell if a loved one is abusing opioids
  92. Hyperparathyroidism
  93. Hypoparathyroidism
  94. Hypothyroidism: Can calcium supplements interfere with treatment?
  95. Hypothyroidism diet
  96. Hypothyroidism and joint pain?
  97. Hypothyroidism: Should I take iodine supplements?
  98. Hypothyroidism symptoms: Can hypothyroidism cause eye problems?
  99. Hypothyroidism (underactive thyroid)
  100. Insomnia
  101. Insomnia: How do I stay asleep?
  102. Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills
  103. Intervention: Help a loved one overcome addiction
  104. Is depression a factor in rheumatoid arthritis?
  105. Kratom for opioid withdrawal
  106. Lack of sleep: Can it make you sick?
  107. Living better with hidradenitis suppurativa
  108. Low blood pressure (hypotension)
  109. Male depression: Understanding the issues
  110. Managing Headaches
  111. Managing hidradenitis suppurativa: Early treatment is crucial
  112. Hidradenitis suppurativa-related health risks
  113. MAOIs and diet: Is it necessary to restrict tyramine?
  114. Marijuana and depression
  115. Mayo Clinic Minute: 3 tips to reduce your risk of Alzheimer's disease
  116. Mayo Clinic Minute: Alzheimer's disease risk and lifestyle
  117. Mayo Clinic Minute New definition of Alzheimer's changes
  118. Mayo Clinic Minute: Prevent migraines with magnetic stimulation
  119. Mayo Clinic Minute: Restless legs syndrome in kids
  120. Mayo Clinic Minute Weathering migraines
  121. Mayo Clinic Minute: Women and Alzheimer's Disease
  122. Medication overuse headaches
  123. Meditation
  124. Memory loss: When to seek help
  125. Mental health: Overcoming the stigma of mental illness
  126. Mental health providers: Tips on finding one
  127. Mental health
  128. Mental illness
  129. Migraine
  130. What is a migraine? A Mayo Clinic expert explains
  131. Migraine medications and antidepressants
  132. Migraine FAQs
  133. Migraine treatment: Can antidepressants help?
  134. Infographic: Migraine Treatments: Botox & Nerve Blocking
  135. Migraines and gastrointestinal problems: Is there a link?
  136. Migraines and Vertigo
  137. Migraines: Are they triggered by weather changes?
  138. Alleviating migraine pain
  139. Mild cognitive impairment (MCI)
  140. Mindfulness exercises
  141. Monoamine oxidase inhibitors (MAOIs)
  142. Natural remedies for depression: Are they effective?
  143. Nervous breakdown: What does it mean?
  144. New Alzheimers Research
  145. Nicotine dependence
  146. Not tired? Don't go to bed
  147. Occipital nerve stimulation: Effective migraine treatment?
  148. Ocular migraine: When to seek help
  149. Oppositional defiant disorder (ODD)
  150. Pain and depression: Is there a link?
  151. Pancreatic cancer
  152. Pancreatic Cancer
  153. What is pancreatic cancer? A Mayo Clinic expert explains
  154. Infographic: Pancreatic Cancer: Minimally Invasive Surgery
  155. Pancreatic Cancer Survivor
  156. Infographic: Pancreatic Cancers-Whipple
  157. Perimenopause
  158. Pituitary tumors
  159. Polymyalgia rheumatica
  160. Premenstrual dysphoric disorder
  161. Premenstrual syndrome (PMS)
  162. Prescription drug abuse
  163. Prescription sleeping pills: What's right for you?
  164. Progressive supranuclear palsy
  165. Psychotherapy
  166. Reducing the discomfort of hidradenitis suppurativa: Self-care tips
  167. Restless legs syndrome
  168. Salt craving: A symptom of Addison's disease?
  169. Schizoaffective disorder
  170. Seasonal affective disorder (SAD)
  171. Seasonal affective disorder treatment: Choosing a light box
  172. Selective serotonin reuptake inhibitors (SSRIs)
  173. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  174. Skip booze for better sleep
  175. Sleep disorders
  176. Sleep tips
  177. Soy: Does it worsen hypothyroidism?
  178. Staying active with hidradenitis suppurativa
  179. Stop your next migraine before it starts
  180. Stress symptoms
  181. Sundowning: Late-day confusion
  182. Support groups
  183. Surgery for hidradenitis suppurativa
  184. Symptom Checker
  185. Tapering off opioids: When and how
  186. Tinnitus and antidepressants
  187. Transcranial magnetic stimulation
  188. Traumatic brain injury
  189. Treating hidradenitis suppurativa: Explore your options
  190. Treating hidradenitis suppurativa with antibiotics and hormones
  191. Treatment-resistant depression
  192. Tricyclic antidepressants and tetracyclic antidepressants
  193. Unexplained weight loss
  194. Vagus nerve stimulation
  195. Valerian: A safe and effective herbal sleep aid?
  196. Vascular dementia
  197. Video: Alzheimer's drug shows early promise
  198. Video: Vagus nerve stimulation
  199. Vitamin B-12 and depression
  200. What are opioids and why are they dangerous?
  201. What are the signs and symptoms of hidradenitis suppurativa?
  202. Wilson's disease
  203. Young-onset Alzheimer's