There is no best antidepressant. It depends on you and what works for you. No research study studies have shown that any class of antidepressants works much better than other.
Here is my list of pro’s and con’s:
Selective Serotonin Reuptake Inhibitors (SSRI’s): fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa), paroxetine (Paxil) and fluvoxamine (Luvox).
SSRI’s work quite well with very little side effects (i.e. overall GI upset’s, weight gain, headache, diarrhea, and so on are not big concerns. Yes these side effects still take place but compared to, say, statin’s to deal with cholesterol problems, SSRI’s total are well endured). They can cause 3 different sexual negative effects: reduce in libido, difficulty achieving and preserving erection, and problems with delayed orgasm or complete absence of orgasm.
Out of all the SSRI’s, I like fluoxetine (Prozac), sertraline (Zoloft) and escitalopram (Lexapro) the best.
Fluoxetine (Prozac) has actually been around because1986 It is a plus that some clients have been taking it for 30 years and still succeeding. The longer the data exists, the more I feel comfy with the medication. It can be a bit triggering (i.e. causes some boost in energy level) and some patients discover that helpful while some discover that anxiety-provoking. As a result, fluoxetine (Prozac) tends to be dosed in the early morning. I have actually also seen fluoxetine (Prozac) causing sedation. If that’s the case it need to be dosed at bedtime. The greatest two pro’s of fluoxetine (Prozac) are a) cost. It has been around given that1986 It is dirt low-cost. Very economical. and b) absence of serotonin discontinuation/withdrawal signs. Fluoxetine (Prozac) has among the longest half-life out of all antidepressants, at about 3– 5 days. When you stop fluoxetine (Prozac), it acts as its own self taper. And let us be truthful with each other, do all of our clients take their medications daily? No, they have the tendency to avoid a dose or more occasionally. If they do that on fluoxetine (Prozac), they don’t feel any adverse effects at least (undoubtedly efficacy will wane because well, there is a reason it is still dosed daily).
Enjoyable reality about fluoxetine (Prozac). Due to its long half-life, Eli Lilly came out with Prozac weekly. You would think, that is a terrific concept! Why not? However as it turned out when you need to keep in mind taking one dose weekly (say on Saturday), then you tend to forget taking it. Taking a medication daily is better in regards to compliance.
Sertraline (Zoloft). Another preferred SSRI of mine. Fairly neutral, middle-of-the-road in regards to adverse effects, suggesting it is not generally activating or sedating. Very little drug-drug interactions, indicating it does not interact or disrupt the metabolic process of other medications like high blood pressure or cholesterol meds, and so on. Flexible dosing. You can dose as low as125 mg (1/2 tab of25 m which is the tiniest tab it comes in at) and all the way to 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, and 300 mg. You can go 37.5 mg, 125 mg and 250 mg if you require to however I am generally not that obsessive. Weight-neutral. When I say weight-neutral, it indicates that less than 10%of individuals gain weight on it. Nevertheless, it does not mean you can not be one of those 10%of individuals who do gain weight on it. Always be monitored by your doctor carefully.
Escitalopram (Lexapro). One of the newest SSRI’s. It utilized to be not my preferred due to cost. But it has actually by now been generic for a long time so expense has gone down enormously so it is now on my favorite list. Another middle-of-the-road antidepressant with very little drug-drug interaction, just like sertraline (Zoloft). Dosing sensible not as flexible as Zoloft so 5mg, 10 mg, 15 mg, 20 mg and 30 mg. Fairly weight neutral.
Citalopram (Celexa). It utilized to be my favorite. Nevertheless, it is very comparable to escitalopram (Lexapro) so if clients fail escitalopram (Lexapro) then I do not tend to change to citalopram (Celexa) next so it has actually fallen out of my preferred list.
Paroxetine (Paxil). It is not my favorite but I trained at UCLA Women’s life center where we deal with post-partum anxiety a lot. And my coaches there including Dr. Vivian Burt, simulate paroxetine (Paxil) quite a bit. Paroxetine (Paxil) tends to be more sedating so dosing at bedtime prevails (however I have actually also seen it disturbing people’s sleep and if that’s the case, you require to move it to the morning). Some psychiatrists actually like paroxetine (Paxil) because many clients are anxiously depressed and have trouble with sleep. Then the adverse effects of paroxetine (Paxil) can help counter anxiety and insomnia. Eliminating 2 birds with one stone so to speak. Paroxetine (Paxil) is not on my favorite list since it tends to trigger a) weight-gain, b) anticholingeric adverse effects (dry eyes, dry mouth, bladder retention, etc. but that’s why it benefits sleep. Think about diphenhydramine (Benadryl), then you understand about the negative effects in paroxetine (Paxil)., c) it can have some drug-drug interaction with other medications, and d) it tends to be tough to come off. Implying it has more issues with serotonin discontinuation/withdrawal symptoms compared to fluoxetine (Prozac).
Fluvoxamine (Luvox). My least preferred SSRI. It has to be dosed twice a day due to short half life. And you know the more times you need to dosage an antidepressant a day, the less compliant your patients will be taking that medication. It is FDA-approved for treating stress and anxiety disorder but it can be used to deal with anxiety too, of course.
Anyway, I have actually seen people whose lives are changed by fluoxetine (Prozac) and escitalopram (Lexapro) but only partially reacted to paroxetine (Paxil) while having excruciating negative effects on sertraline (Zoloft). I have likewise seen people who react extremely well to paroxetine (Paxil) and sertraline (Zoloft) however are very dissatisfied by escitalopram (Lexapro) and fluoxetine (Prozac).
Therefore it is necessary for you to work closely with your doctor to find the best antidepressant for you. Just your doctor can render you medical recommendations and guide you appropriately. My list of “preferred” or “best” antidepressant needs to be thrown out of the window due to the fact that just you and your experience count in your trials to find the best antidepressant for you.
Ok, I am tired of typing. Possibly I will add my opinions on other classes of antidepressants later on when I have more time.