Antidepressant Treatment

Antidepressants (ATD) are the first line of therapy available for clinical depression. They do not “cure” depression but alleviate its symptoms, and you may have to try two or three until you find the one that works for you. The right ATD will be the one that reduces the symptoms and has tolerable side effects. For this reason, patients may be prescribed different ones at different doses.

What is the right antidepressant for you?

Finding the right antidepressant is not a one-size-fits-all process. It requires a careful evaluation of multiple factors to ensure both safety and effectiveness. Whether you're dealing with depression, anxiety, or looking for PTSD medication, your doctor will tailor treatment based on your unique needs.

Key Considerations Before Choosing an Antidepressant

Primary symptoms

Specific symptoms often guide the initial prescription. For instance, sertraline (Zoloft) is frequently used to treat persistent anxiety, while mirtazapine (Remeron) or trazodone may be recommended for insomnia.

Side effects

Antidepressants can cause side effects such as dry mouth, weight gain, or sexual dysfunction. While tricyclic antidepressants like amitriptyline are effective, they often come with more side effects than newer options like SSRIs.

Drug Interactions

If you are on medication for chronic conditions like diabetes or hypertension, your doctor will consider possible drug interactions. For example, SSRIs should be used cautiously with NSAIDs (e.g. ibuprofen) due to the risk of bleeding.

Pregnancy and breastfeeding

Some antidepressants are generally safe during pregnancy, though certain ones, such as paroxetine, are typically avoided.

Genetic factors

Your family's response to certain antidepressants may provide clues to what could work best for you, due to inherited metabolic and neurochemical traits.

Other medical conditions

Certain antidepressants can offer additional benefits. Venlafaxine may help with anxiety, duloxetine with fibromyalgia, and bupropion with smoking cessation. These options are also sometimes used as part of PTSD medication plans, especially when multiple conditions are present.

Types of Antidepressants

Antidepressants, often referred to as ATDs, are categorised by the way they influence neurotransmitter chemicals that affect mood, sleep, and cognition. Understanding the different types can help you and your doctor determine the best fit, particularly if you're exploring PTSD medication options.

SSRIs (Selective Serotonin Reuptake Inhibitors)

These are typically the first-line treatment due to their safety and tolerability. SSRIs include:

Escitalopram
Citalopram
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)

SSRIs are commonly used as PTSD medication due to their ability to regulate mood and reduce anxiety.

SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)

These dual-action antidepressants address imbalances in both serotonin and norepinephrine. Examples include:

Duloxetine (Cymbalta)
Venlafaxine (Effexor XR)
Desvenlafaxine
Levomilnacipran

SNRIs are often recommended when SSRIs prove ineffective, and are also used in treating PTSD symptoms related to physical pain or hyperarousal.

Tricyclic antidepressants

TCAs were among the first antidepressants developed and remain effective for some people, although they are less commonly prescribed due to side effects:

Amitriptyline
Imipramine (Tofranil)
Nortriptyline
Doxepin
Desipramine

TCAs may be considered for treatment-resistant depression or chronic pain associated with PTSD.

MAOIs (Monoamine Oxidase Inhibitors)

MAOIs are effective but require strict dietary restrictions and can interact dangerously with other medications:

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)

Due to their risk profile, MAOIs are rarely used and typically reserved for cases where other treatments have failed.

Atypical antidepressants

These don't fit neatly into the above categories and offer unique mechanisms of action:

Bupropion (Wellbutrin)
Mirtazapine (Remeron)
Trazodone
Vilazodone

Mirtazapine and trazodone are commonly used PTSD medications, particularly for managing insomnia and anxiety without causing significant sexual side effects.

Other Treatments

In more complex cases, other psychiatric medications may be recommended:

Esketamine (Spravato) nasal spray for treatment-resistant depression
Mood stabilisers like lithium or lamotrigine for patients with co-occurring mood disorders
Antipsychotics for severe or psychotic features associated with PTSD

Start your path to better mental health today. Book an online consultation or contact The OAD Clinic to find the right antidepressant treatment for you.

The OAD Clinic is an internationally recognised provider of expert-led antidepressant treatment and mental health care. We support patients from across the United States, Egypt, India, Kuwait, Saudi Arabia, and the United Arab Emirates, offering both in-person treatment in London and remote consultations to begin your journey to recovery wherever you are in the world. Get in touch now.