Depression and Bipolar info explaining the latest research in everyday English

Which antidepressant do I take first?

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The Harvard Mental Health Letter in its May 2009 issue looks at the issue of choosing which antidepressant may be the best one to begin a pharmacological regime.

Recognising that each different type of antidepressant carries with it different types of possible side-effects, the Letter reports on a large meta-analysis which shows two antidepressants having a slight (emphasis on ’slight’) edge of the rest in terms of efficacy and tolerability.

But that is not to say that side-effects are not to be considered when thinking about which drug with which to start treatment.

The study showed that escitalopram (Lexapro, Cipralex) and sertraline (Zoloft) demonstrated a very slight overall edge over other second-generation antidepressants, in terms of efficacy and least amount of side-effects.

Here’s the list of side-effects most likely to be encountered, and the drugs most likely to induce them:

Nausea and vomiting:
venlafaxine (Effexor)

Diarrhoea:
sertraline (Zoloft)

Weight gain:
mirtazapine (Remeron) and paroxetine (Paxil)

Sexual side effects:
paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), with bupropion (Wellbutrin) the least likely of those drugs that did report a sexual side effect to do damage. But bear in mind that dosage can also play a part; my own high dosage of Effexor certainly doesn’t make for wonderful bedroom happiness and a libido like a rugby player!

Conclusion

I know from personal experience that over a course of treatment, or lifetime in my case, a person is likely to move from one to the other as the positive effects of one type start to wane due to tolerance and your practitioner and yourself try a different drug to see if that can kick-start the recovery process again. But keep a watch on the side effects and report anything to your GP or treating physician.