How to Know Which Antidepressant Is Best for You

Pills in a hand

Towfiqu Photography / Moment / Getty Images

The quest to find the right antidepressant medication can feel very "hit or miss." 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.

Still, there is no telling what you may or may not respond to. In fact, many people don't respond to their first antidepressant, or they experience undesirable side effects, so they have to try a second, third, or fourth option.

Up to 80 percent of people do eventually respond to depression treatment, so there is every reason to have hope that you will land on the right one for you.

Factors to Consider When Choosing An Antidepressant

There many factors that are considered when a physician chooses an antidepressant for you, beyond simply the type of depression you are living with.

The best thing you can do is to work together with your doctor as a team to find the right antidepressant. Nobody knows your body better than you do or understands your preferences as well as you.

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.

Other examples in which antidepressants may have double-duty functions include:

  • Smoking cessation. Wellbutrin (bupropion) is actually the same drug as the popular stop-smoking medication with the brand name Zyban. For a smoker, Wellbutrin may be the logical choice by lifting depression and aiding in smoking cessation.
  • Neuropathy. Both tricyclic antidepressants and the serotonin-norepinephrine reuptake inhibitors (SNRIs) duloxetine (Cymbalta) and venlafaxine (Effexor) have been found to be helpful. 
  • Bedwetting. Though tricyclic antidepressants tend to be used less often than some of the newer formulations, for those who are struggling with bedwetting, imipramine may help with both problems.
  • Learning disabilities. It's thought that some of the antidepressants may have a secondary benefit of helping with some learning disabilities. If this is you, talk to your physician about whether or not one of these medications may work for you.

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, including antibiotics and steroids, can interact with antidepressants, so your doctor needs to know what other medication (including over-the-counter, prescription, vitamins, and supplements) you're taking 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 chronic pain, your doctor might prescribe Cymbalta (duloxetine) because it can help with both pain and depression. 

When prescribing an antidepressant, the first goal should be the best control of the depression. Sometimes this may mean choosing an antidepressant, which is more likely to cause weight gain even in someone who is overweight, and that does not cover another condition he is suffering from, even if that option appears to be available.

Family HIstory

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.

Health Insurance and Cost

Some newer antidepressants don't have a generic form available yet and maybe costly, which may influence your doctor's choice.

On and Off-Label Uses

It's also important to make a distinction between on-label and off-label uses of medications. On-label use means that the medication has received FDA-approval for that indication. Off-label use does not mean that a medication is not useful—and may even have been found useful to treat a condition—but that it does not yet have FDA-approval for that indication. It's also important for people to know that some physicians are more willing than others to consider prescribing off-label medications.

Barriers to Finding the Right Treatment

Side effects, as mentioned above, can present major barriers to finding the right medication for you. This is the point when the physician and the patient must work together to find a solution that the patient can live with.

Depression Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Mind Doc Guide

Options might include the following:

  • Accepting the side effect as a trade-off for depression relief
  • Augmenting with other medications (using more than one medication together to control depression and/or relieve side effects)
  • Trying a new medication

Your doctor should always try to find the drug that gives the best depression relief with the fewest antidepressant side effects for you—but keep in mind that, unfortunately, no drug is going to be perfect.

There are two side effects that people seem to find the most troubling: 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 cause sexual side-effects. If these problems affect you and you cannot tolerate them, nefazodone (Serzone), bupropion, and mirtazapine are medications that have fewer sexual side-effects. Of course, these medications may have other side effects.

Weight Gain

Weight gain on antidepressants is another commonly complained about side-effect. In this department, paroxetine (Paxil) and mirtazapine are two of the worst offenders. Venlaxafine, bupropion, and fluoxetine (Prozac) are antidepressants that are not as likely to cause weight gain, and many people even lose a few pounds. But again, everyone is different, and some people gain weight on medications unlikely to cause weight gain and lose weight on those that often cause weight gain.

Side Effects Are Not Always Bad

Believe it or not, side effects are not necessarily a bad thing. If a patient has an eating disorder and is too thin, a drug like Prozac that suppresses appetite may not be desirable. But a drug that increases appetite, such as paroxetine or mirtazapine, could really benefit this patient. And if a patient is diabetic and overweight, a drug that lowers appetite may be helpful in controlling their diabetes because they will have fewer cravings for forbidden foods.

This also applies to antidepressants that are stimulating and those that are sedating. An antidepressant that tends to be stimulating such as bupropion may be helpful for someone with a vegetative depression or someone who seems to have no energy—but could be the wrong choice for someone living with an anxiety disorder in addition to depression.

By the same token, a sedating antidepressant such as mirtazapine could work well for someone who is anxious but might be the wrong choice for someone who is already feeling a total lack of energy with their depression. Again, it is important to remember that every person is different.

A Word From Verywell

Finding the best medication for you may take some trial and error, so when you start a new medication, give the side effects a couple of 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 time and patience.

Was this page helpful?

Article Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.