When it comes to depression, most people are looking for a treatment that allows them to feel happier, while minimizing potential side effects. There are many antidepressants on the market, and while some may work slightly better than others, most research indicates that the efficacy among approved drugs is very similar. If you are looking to find the “best” antidepressant, it is important to realize that there is no utopian treatment – it is up to you to find what is most effective for you.
What is the best antidepressant? Whatever works.
The section below should be prefaced by stating if you have found something to help you overcome your bout of depression, then the best antidepressant is really whatever is working for you. Although certain medicines on the market may work slightly better than others, the difference in efficacy among approved antidepressants is relatively insignificant. It is important to not get too caught up in what works for your friend, spouse, or someone on forums; instead focus on finding something that works for you.
Best overall antidepressants: Lexapro / Zoloft
A 2009 meta-analysis demonstrated that the best antidepressants for efficacy and acceptability were Lexapro (Escitalopram) and Zoloft (Sertraline). Researchers suggested that Zoloft may be the best choice when starting treatment for major depression in adults. They made this suggestion based on benefits, acceptability, as well as costs. Although this analysis involved nearly 26,000 individuals, further research has suggested there is no single most effective antidepressant.
In a 2011 meta-analysis, researchers stated that based on current findings, there is no support for recommending a specific antidepressant based on differences in efficacy. The researchers did recommend selecting a medication based on how the drug worked as well as its side effect profile. Although Lexapro and Zoloft may be recommended, not everyone that tries these drugs is going to find them effective and/or tolerable.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/19185342
Choosing an antidepressant can be difficult because most drugs carry unwanted side effects. The two biggest “deal breakers” for people in regards to side effects are: weight gain and sexual dysfunction. Although putting up with these side effects may be a small price to pay for feeling happier, some people are not going to tolerate experiencing these symptoms.
Best antidepressant for weight loss: Wellbutrin (Bupropion)
I have already written an article about Wellbutrin being the best antidepressant for weight loss. The reason this drug works so well at helping people either lose weight or stay weight neutral is because it tends to have a stimulating effect. The stimulating effect from the drug can minimize appetite, boost energy, and speed up the metabolism.
Although an antidepressant shouldn’t be chosen for the specific purpose of losing weight, many people will not tolerate significant weight gain as a side effect. Therefore, it may be wise to start with a drug like Wellbutrin (Bupropion) if your goal is to keep the weight off. It should be noted that SNRI’s and other medications like Viibryd are associated with less weight gain than SSRIs.
Best antidepressant for sexual dysfunction: Wellbutrin (Bupropion)
If you are worried about sexual dysfunction (e.g. low libido, inability to orgasm, loss of interest, etc.), then Wellbutrin should be considered as a first-line option. In addition to this drug being the best for losing or maintaining weight, it is also a medication that shouldn’t affect your sex life. That’s because it works on norepinephrine as well as dopamine, without affecting serotonin levels. The increase in stimulation that you get from this drug could actually boost your interest in sex and sexual performance.
Keep in mind that Wellbutrin is not for anxiety, so if you have comorbid anxiety, you’d likely need something with serotonin. Other drugs in the SNRI classes contain norepinephrine, which is thought to help balance out sexual dysfunction caused by serotonin reuptake inhibition. Unfortunately many people still experience sexual dysfunction with the SNRI class. If you don’t want a drug to affect your sex life, it’s best to stay away from serotonin reuptake inhibitors.
Best antidepressant for depression: Remeron, Lexapro, Effexor, Zoloft
In a major 2009 meta-analysis of comparability and efficacy, Remeron was found to be the most effective antidepressant for treating depression. However, the degree to which Remeron was more effective was not statistically significant compared to Lexapro, Effexor, and Zoloft. Therefore all of these drugs were essentially “upper echelon” in regards to effectiveness.
These results shouldn’t necessarily make anyone super gung-ho about Remeron. Despite its effectiveness, the side effects associated with it are often too much for certain individuals to handle. It should also be noted that all four of the drugs found to be “effective” in this 2009 study were significantly better for depression than Cymbalta, Prozac, Luvox, and Paxil. The least effective medication as cited by this study was Reboxetine.
Although certain medications have been found to be more helpful than others for minimizing certain symptoms or carrying less side effects, most people won’t know how they’re going to respond to a drug until they try it. Unless you’ve given some antidepressants a legitimate chance to work, you really won’t know whether you are going to exhibit all of the unwanted side effects.
Recommendation: Choose an antidepressant based on what you think will be best for your situation. Work with a psychiatrist to talk about whether you have any “deal breakers” in regards to side effects. Some people will not take a drug if they know it’s going to deaden their sex life. Additionally, to further minimize side effects, it is always recommended to start at the lowest possible dose and slowly titrate upwards until you receive an effect. Many people start their antidepressants at high dosages, which leads to more severe side effects.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/22147715
- Source: http://www.ncbi.nlm.nih.gov/pubmed/19017592
- Source: http://www.ncbi.nlm.nih.gov/pubmed/18759509
There is NO “best” treatment for depression
If I asked thousands of people what the best antidepressant is, there probably wouldn’t be one clear-cut answer. One person may say “laughter,” while another may say “exercise,” and third person may say “Prozac.” There’s really no one utopia when it comes to treating depression. For this reason I’ve always thought that using a single approach to treat depression is not usually the best solution. The best solution is targeting the depression holistically, focusing on making positive changes in all areas of life that could be contributing to the problem.
Best Antidepressant: A Combination of Treatments
Typically people get so caught up in using medicinal treatments for their depression that they forget many other factors can play a role in helping improve mood. Targeting various chemicals in the brain can be a good start towards treating depression, but for best results you should be focusing on other things in your control.
For many people this means improving their daily habits. Getting adequate exercise, socializing with friends, staying productive, setting goals, getting sunlight, and eating a healthy diet can go a long way towards improving mood. Additionally most evidence suggests that cognitive behavioral therapy (CBT) can work just as well as an antidepressant.
It is my hypothesis that taking a holistic approach to treat the depression will result in the “best” effect towards reducing unfavorable symptoms. For many this may mean forcing themselves to go to the gym, supplement Omega-3 fatty acids, go for CBT (cognitive behavioral therapy), and eat a diet high in fruits, veggies, meats, fish, and whole grains.
1. Cognitive Behavioral Therapy (CBT) – Before trying medication, you should always consider seeing if the depression can be addressed better in therapy. Usually in cases of mild or situational depression, a skilled therapist can get to the root of the problem and help you come up with ways to overcome it. It may take awhile to retrain your thinking, but therapy has been proven just as effective as medication in some studies.
2. Antidepressant Drugs – Finding the right medication can take lots of hard work and experimentation. In many cases you have to be willing to play a game of neurotransmitter “roulette” hoping that the drug you are giving your brain works. Eventually, most people will find a medication that works in the SSRI or SNRI class of drugs. However, older medications in the TCA or MAOI class may be necessary if a person doesn’t respond well to SSRIs.
3. Exercise – I wrote an article citing the Psychological Benefits of Exercise. One of the major benefits is a boost in mood. Typically people feel better when they do cardio exercise because it stimulates the production of “endorphins” or the brain’s natural “feel good” chemicals. If you aren’t getting adequate exercise, this may be a reason why you are feeling depressed. Your body is made to move and be active. Even strength training can have a beneficial effect on mental health.
4. Socialization – How’s your social life? Isolating yourself from society can kind of be a catch-22 when it comes to depression. You’re depressed so you isolate yourself OR did you isolate yourself and then notice depression slowly setting in? Either way it’s important for our overall mood to socialize with other people. Those who don’t get adequate socialization are going to feel depressed as a result of the lack of social contact. Humans are social beings – if you avoid people for a long enough time, depression is inevitable. Do what you can do maintain friendships and stay socially active even if it’s difficult.
5. Diet – What types of foods do you eat? There is sufficient evidence linking certain dietary habits with increases in depression and mood disorders. People who eat more of a “western” diet with processed foods, fried foods, sugary foods, refined grains, and beer tend to have increases in depression. Evidence suggests that the best diet for mental health is one that consists of veggies, fruits, meats, fish, and whole grains. It can be tough for people to believe that their diets may be a culprit for depression. Most people think well food’s only purpose is to fill me up. When you eat higher quality foods, your body and brain receive more nutrients, vitamins, and energy that they need for optimal functioning. If you know you eat a poor diet, take the time to healthier and see if it improves your mood.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/20048020
- Source: http://www.ncbi.nlm.nih.gov/pubmed/21715296
6. Productivity – Are you staying productive by holding down a job? Many people who don’t have jobs struggle with depression merely as a result of not having a job or lacking finances. If part of the reason you are depressed is because you don’t have a job, your first mission should be to find one. Staying productive can go a long way towards helping a person cope with depression and wards off feeling down. Even if you feel depressed, staying busy will likely (at least temporarily) take your mind off of it.
7. Sunlight – There is clear evidence that lack of sunlight can cause depression. Although many people believe the misconception that lack of vitamin D causes depression, this is more of a correlation and not necessarily a causation. Most clinical research shows that low vitamin D is linked to depression, but the depression itself isn’t improved by taking vitamin D supplements. Depression tends to be worse in severity when a person doesn’t get enough sunlight. As soon as they begin getting more sun exposure, their vitamin D levels improve as does the depression. Make sure you are doing activities outside and aren’t staying cooped up in the house. Something as simple as going for a walk or jog outside may help fight the blues.
8. Intimacy – Not having a loving relationship with a significant other can be another cause for depression. If you currently are feeling alone because you don’t have a relationship, make a conscious effort to connect intimately with another person. Intimacy is something every human needs, and lacking it can lead us to feel depressed. It should also be stated that abusive relationships can also cause us to feel depressed. Many people fear leaving an abusive relationship because they don’t want to be alone. If you know you are in a bad relationship, the best option for your long-term mental health is to leave. Abusive relationships can cloud our judgment and make us accept depression as a personal problem rather than realizing we are being abused.
9. Sleep / Arousal – How are your sleep habits? Improving your sleep habits and making an effort to get at least 8 hours per night may have a drastic effect on your mood. Additionally it should be noted that some people who get too much sleep (hypersomnia) may benefit from cutting back on sleep. If you are consistently getting over 10 hours of sleep per night, you may want to try getting less sleep and determine if it improves your mood. Part of improving your sleep may involve seeing a sleep specialist and/or evaluating your arousal. If you have high anxiety with your depression, you may need to find ways to lower your arousal so that you can get adequate sleep. If you feel tired all the time and low energy, you may benefit from increasing your level of arousal.
10. Augmentation Strategies – If you aren’t responding well to a single antidepressant, your psychiatrist may want to pursue various antidepressant augmentation strategies. This typically involves prescribing another therapy and/or medication that has been proven effective as an adjunct treatment for depression. Common examples of adjunct treatments include: CBT, Thyroid hormone (T3), Lithium, and psychostimulants (e.g. Adderall).
Many people who don’t respond to antidepressant monotherapy end up responding to an adjunct treatment option. It may take awhile to find the right combination of drugs to work, but there is a high likelihood that something will end up working.
For more information, be sure to read the article I wrote awhile back called “10 Natural Cures for Depression.” It has some other suggestions that you may find helpful to pull you out of a depressed rut.
Prediction: Best antidepressant of the future: Gene therapy
As we discover more about the human genome, specifically which genes are involved in depression, researchers can come up with more targeted treatments. At the end of the day, most people that suffer from major depression have tried everything recommended. They’ve taken the supplements, gotten more exercise, forced themselves to attend therapy, and have been through cocktail upon cocktail of psychiatric medications.
One thing that is known is that depression tends to run in families and has a large genetic basis and/or certain traits that make us more prone to it. If scientists could devise a way to use gene therapy to turn on and off certain genes that may be contributing to depression, we could essentially “cure” the problem. Until gene therapy for treating mental illness comes to fruition, we are stuck with modern day medicines and natural therapies.
Science and medicine have come a long way in regards to mental health in the past 20 years. Researchers are constantly experimenting with new treatments and hypotheses as to what may crack this devastating mental illness. New treatments such as ALKS 5461 are in the works, and even unexpected alternative therapies like Botox injections are showing some promise towards helping those with major depression.
Final thoughts on treating depression
Treatment for depression will never be perfect. It’s all about finding what methods work best for you and applying them so that you can feel normal, productive, and get more pleasure out of life. Antidepressant drugs are imperfect and tend to only work for so long before our physiology builds up a tolerance and their initial mood boost wears off.
No treatment is perfect, and no single antidepressant should be considered a utopian option. In the meantime, keep putting up a fight against depression and realize that through lifestyle changes, self-discovery, medication, therapy, and/or a combination of all these, you maximize your individual potential to experience happiness.