How to Choose the Best Antidepressant

There are 23 antidepressants available today, and new medications are being manufactured all the time. You definitely want to use medications that will bring minimum problems and maximum effects. So, is there the best antidepressant suitable for everyone?

Is It Possible to Choose the Best Antidepressant?

It is impossible to name only one medication that is perfect for every person. The right medication can only be prescribed by a healthcare provider based on different factors. Your ideal drug will work well for you and cause fewer or no side effects. There are several classes of antidepressants, and each of them works on the brain chemistry in a certain way. All of them can increase certain neurotransmitters in the brain, and each does it in different parts of the brain. For instance, it is enough for one person to use a drug boosting serotonin, but another one may need medications affecting both serotonin and norepinephrine. Even medications from the same class may not be equally effective for the same person. Usually, the only way to check if the medication is effective for you is using it for some time.

If you need to use antidepressants for the treatment of certain health condition, you may be recommended to use one of the following by your healthcare provider:

• Tricyclics (TCAs);
• Monoamine oxidase inhibitors (MAOIs);
• Selective serotonin reuptake inhibitors (SSRIs);
• A range of newer medications.

You can read more on these medications to ask your doctor right questions and help determine the right drug for you.


Tricyclics were introduced in the 1950’s. These medications are able to inhibit the ability of nerve cells to reuptake norepinephrine and serotonin, which allows nerve cells to obtain more of these two substances. Tricyclics work in a similar way on acetylcholine and histamine, which may cause a range of side effects, including the following:

• Blurry vision;
• Dry mouth;
• Sedation;
• Weight gain

These medications may worsen pre-existing heart conditions and cause orthostatic hypotension. They should be used very carefully by patients with head injury and seizures.


Monoamines (norepinephrine, serotonin, etc.) are neurotransmitters responsible for mood, and monoamine oxidase belongs to enzymes that can break down these substances. MAOIs can inhibit this enzyme, which is needed to achieve the greater supply of these chemicals in the brain.

MAOIs do not belong to first-line medications for several reasons. They may cause fatal drug interactions if used along with a range of medications that belong to norepinephrine or serotonin agonists. People taking these medications should also consume foods rich in tyramine to avoid hypertensive crisis. In fact, hypotension is one of its adverse reactions, and that is why your blood pressure should be checked regularly if you use these medications.


SSRIs are pretty popular antidepressants because of their safety and effectiveness. The following medications belong to SSRIs:

• Citalopram (Celexa);
• Fluoxetine (Prozac);
• Sertraline (Zoloft);
• Escitalopram (Lexapro);
• Fluvoxamine (Luvox);
• Paroxetine (Paxil).

These drugs are able to block the presynaptic serotonin transporter receptor. They only act on serotonin, which makes them different from other classes of antidepressants. They also affect norepinephrine indirectly through serotonin. SSRIs do not affect acetylcholine and histamine, which is one of their greatest advantages. It does not mean that these drugs cause no side effects at all.

New Medications

There are 5 newer medications that do not belong to any of the mentioned above classes, including:

• Nefazodone (Serzone);
• Trazodone (Desyrel);
• Bupropion (Wellbutrin);
• Venlafaxine (Effexor);
• Mirtazapine (Remeron).

Both Nefazodone and Trazodone are able to inhibit neuronal reuptake of serotonin and norepinephrine. These antidepressants also block postsynaptic 5-HT2 receptors. Nefazodone has less orthostasis and sedation than trazodone.

Bupropion is an antidepressant that acts through dopaminergic or/and noradrenergic pathways. It does not cause sexual side effects, and it is very effective for people with psychomotor slowness, lack of energy and excessive sleep.

Venlafaxine has an unusual for antidepressants structure. It can inhibit the neuronal uptake of both norepinephrine and serotonin. The effects of the medication depend on the dosage. For instance, if taken in the dosage of 75 mg per day, it acts as SSRIs, and if it is taken in the dosage of 375 mg per day, it works as NSRIs.

Mirtazapine does not involve enzyme blockade or inhibition of neurotransmitter reuptake, but it increases the release of norepinephrine by blocking the presynaptic inhibitory α2 autoreceptors. It increases noradrenergic transmission by sparing the α1 postsynaptic receptor. Mirtazapine can also block the inhibitory α2 heteroreceptors, which leads to increase in serotonin. Mirtazapine comes with a low affinity for the 5-HT1A receptor, but it is able to block postsynaptic 5-HT2 and 5-HT3 receptors.

Stimulation of 5-HT2 receptor may be responsible for the following side effects:

• Agitation;
• Insomnia;
• Sexual dysfunction.

Simulation of 5-HT3 may cause nausea. This means that thanks to its ability to block these receptors, Mirtazapine does not cause many side effects typical for some other antidepressants.