Fast Facts

• The antidepressants in this guide work for treating depression. Most people can find one that makes them feel better.
• Six out of 10 people will feel better with the first antidepressant they try. The rest of the people will need to try other antidepressants before they find the one that is right for them.
• Most people taking antidepressants have at least one side effect.
• The most common side effects are constipation, daytime sleepiness, diarrhea, dizziness, dry mouth, headache, nausea, sexual problems, shakiness, trouble sleeping, and weight gain.

What does this guide cover?

This guide can help you work with your doctor or nurse to choose medicines for depression. It covers:

• Common medicines for adults with depression.
• Side effects.
• Price.

This guide is based on a government-funded review of research about the medicines often used to treat adults with depression. The antidepressants are listed on page 8.

What is not covered in this guide?

This guide does not cover:

• Treatment of depression in children or teens.
• Postpartum depression ("baby blues").
• Depression that is part of other mental health conditions like bipolar disorder (previously called manic-depressive disorder).
• Older antidepressant medicines like amitriptyline (Elavil^®)
  and phenelzine (Nardil^®).
• Other ways to treat depression such as counseling, light therapy, and herbal supplements like St. John’s Wort.

What are the common signs or symptoms of depression?

Depression is a deep sadness that won't go away. It can also be the loss of interest in doing things you usually enjoy. Common symptoms include:

• Sad, anxious, or "empty" mood that lasts more than 2 weeks.
• Trouble sleeping.
• Appetite changes —either less appetite and weight loss, or eating more and weight gain.
• Loss of interest in doing things you once enjoyed, including sex.
• Feeling restless and cranky.
• Nagging physical symptoms that don't get better with treatment (like chronic pain).
• Trouble paying attention, making decisions, or remembering.
• Feeling tired all the time or like you have no energy.
• Feeling guilty, hopeless, or worthless.
• Thoughts of suicide or death.

Depression is treatable. You can get better. The most common treatments for depression are antidepressant drugs, counseling, or a combination of the two.

What should I tell my doctor or nurse

• Tell your doctor or nurse how you feel.
• Describe any symptoms you have, like no appetite, feeling tired all the time, trouble getting to sleep or staying asleep, no interest in sex, or feeling worried a lot.
• Tell them which symptoms bother you the most.
• Let them know about any other health or mental health conditions you have.
• Bring a list of all your prescription and nonprescription drugs. Be sure to tell them if you are taking herbal products, like St. John's Wort, or any other supplements.
• Tell your doctor or nurse whether you have taken an antidepressant before and how it worked for you.

Benefits of antidepressants

Understanding side effects

All of the antidepressants in this guide can cause side effects. If side effects become a problem, your doctor or nurse may be able to help you find another medicine.

• Most people taking these medicines will get at least one side effect. It is hard to predict which drug will cause which side effect for any one person.
• The most common side effects are constipation, daytime sleepiness, diarrhea, dizziness, dry mouth, headache, nausea, sexual problems, shakiness, trouble sleeping, and weight gain.
• Many side effects go away after a few weeks. But some only go away after you stop the medicine.

Research comparing side effects

Some of the medicines in this guide have been compared with each other in research studies. Here's what we know from these studies:

Don't stop your medicine suddenly

Never stop taking an antidepressant medicine suddenly. If you quit your medicine all at once, it can make you feel sick, as if you have the flu. You may get headaches, dizziness, and nausea. Work with your doctor or nurse to decrease your dose a little at a time before you stop.

• Paroxetine (Paxil^®) and venlafaxine (Effexor^®) are more likely than the other antidepressants in this guide to cause these flu-like symptoms when you stop suddenly.
• Fluoxetine (Prozac^®) is less likely than the others to cause these symptoms.

Serious risks

What is still not known?

• We do not know very much about using these drugs for a long time because research studies generally only last 3 months to 1 year.
• We don't know if any of these antidepressants are better than the others for symptoms that sometimes come along with depression, like trouble sleeping and pain.
• We don't know if any antidepressant works better for men versus women or in people of different races.
• We don't know if any one of these antidepressants is more likely than another to raise the risk of suicide.

How can I use the information in this guide?

When talking with your doctor or nurse about antidepressants, think about:

For more information

For an electronic copy of this guide and materials about choosing treatments and medicines for other medical conditions, visit this Web site: www.effectivehealthcare.ahrq.gov

For a free print copy, call the AHRQ Publications Clearinghouse (800) 358-9295

Ask for AHRQ Publication Number 07-EHC007-2A

For more information about depression, visit the Medline Plus Web site: www.nlm.nih.gov/medlineplus/depression.html

For information about mental health services and resources in your state, try the Mental Health Services Locator at this Web site: mentalhealth.samhsa.gov/databases

Source

The information in this guide comes from a detailed review of 293 research reports. The detailed review is called Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression (2007) and was written by RTI International-University of North Carolina Evidence-based Practice Center.

The Agency for Healthcare Research and Quality (AHRQ) created the Eisenberg Center at Oregon Health & Science University to make research useful for consumers. This guide was prepared by Sandra Robinson, M.S.P.H., Valerie King, M.D., Martha Schechtel, R.N., Theresa Bianco, Pharm.D., and David Hickam, M.D., of the Eisenberg Center. People with depression helped them write this guide.