How Do Doctors Decide Which Antidepressant to Prescribe?

Doctor consulting with patient
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While it might seem a bit random how doctors choose which antidepressant to prescribe for you, there really is some logic to it. In fact, there are even flow charts, called algorithms, which outline a logical progression that doctors might follow in determining what the best antidepressant is for you. These algorithms are based on the current knowledge in the medical field about which type of antidepressant works best for which patient.

Factors Doctors Consider When Prescribing Antidepressants

Choosing your antidepressant isn't quite that simple, however. Doctors will also use their knowledge and experience to tailor their antidepressant choices to your particular situation. You can discuss how your treatment option was chosen with your doctor.

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In choosing an antidepressant, your physician will likely consider:

  • Your Symptoms: Some antidepressants can do a bit of double duty. For instance, if you have been losing weight because you're not eating, your doctor might decide to put you on an antidepressant that also causes weight gain. If you're having trouble sleeping, your doctor might choose one that you can take before bed that makes you sleepy.
  • Potential Side Effects: If you've been on an antidepressant before, your doctor will want to know what side effects were particularly bothersome. If you are on a medication that has side effects you find intolerable, you're less likely to stay on it, so choosing one that gives you the least side effects is the goal. This can take some trial and error.
  • Other Medications You're Taking: Some medications interact with antidepressants, so your doctor needs to know what else you're on to make the best decision.
  • Any Other Health Conditions You Have. Again, some antidepressants can do double duty with both physical and mental illnesses, so, for example, if you have attention-deficit/hyperactivity disorder and depression, taking a medication like Wellbutrin (bupropion) can help both. On the physical side, if you have fibromyalgia or problems with pain, your doctor might prescribe Cymbalta (duloxetine) because it can help with both pain and depression. 
  • If You Have a Close Relative Who Has Taken a Particular Antidepressant: Especially for parents or siblings, how a medication worked for them is a good indicator of how it might work, or not, for you.
  • Whether You're Pregnant or Breastfeeding: Since antidepressants can have an effect on the baby, your doctor will want to steer clear of antidepressants that have been shown to be harmful. You and your doctor will have to figure out the best plan to manage your depression while you are pregnant or thinking of becoming pregnant or breastfeeding.
  • Your Health Insurance Coverage and the Medication's Cost: Some newer antidepressants don't have a generic form available yet and may be costly, which may influence your doctor's choice.

Finding the Right Antidepressant Can Take Trial and Error

Remember that finding the best medication for you may take some trial and error. When you start a new medication, give the side effects a couple weeks to go away.

If they don't and you're finding them to be intolerable, be sure to tell your doctor to see if you can try a different antidepressant. There are many different kinds out there, in several different classes, so finding one that works for you may just take some patience and time.

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