11 Truths About Depression and Antidepressants

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Almost 10% of Americans will battle depression over their lifetime.  Some people will find themselves depressed after a traumatic life event; for others, it’s a constant battle.
While depression can happen to anyone, here are some surprising statistics:

The Good News
Antidepressant medications, in conjunction with therapy, actually work for the majority of people that try them.
Before you start taking an antidepressant, keep in mind:

Ok, you’ve got it, so now—what works?
These 11 facts will help help you and your doctor figure out the most effective treatment for your depression.

  1. Starting two drugs at the onset of depression is no better than one.
  2. Antidepressants generally work. Initial treatment of mild to moderate major depression with antidepressants leads to response or remission in roughly 50 to 60 percent of patients.
  3. Will antidepressants help me? Treatment for 6 to 12 weeks with any SSRI, SNRI, atypical antidepressant, or serotonin modulator, results in remission of symptoms 47 percent of the time, with some improvement in 63 percent of people. “Remission of your depression” means you have no more symptoms, and it’s more likely if your treatment begins soon after your symptoms start.
  4. There are 4 common classes of antidepressants. Some examples to help you keep them straight:
  5. Surprise! Multiple reviews have shown that different antidepressants are generally comparable—both across and within classes. Side effects are what makes the difference—and cost. Some of these drugs are very expensive, especially those that are brand-only.
  6. Which is the best to start with? For patients with mild to moderate major depression, initial treatment should be an SSRI.
  7. Sertraline (generic Zoloft) is the most widely prescribed SSRI. There is some evidence that sertraline and escitalopram (generic Lexapro) provide the best combination of efficacy (how well they work) and acceptability (how well they are tolerated).
  8. Which has the “best” side effect profile? More people can tolerate citalopram, escitalopram, and sertraline than other antidepressants.
  9. Which antidepressants may not work as well? Some studies have shown response was more likely with escitalopram (Lexapro), mirtazapine (Remeron), sertraline (Zoloft), and venlafaxine (Effexor), compared with duloxetine (Cymbalta), fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil).
  10. Use side effects to your advantage. Trazodone can be used for people with insomnia, bupropion for those who want to avoid sexual dysfunction or want to quit smoking. Weight gain may occur with mirtazapine, fluoxetine, paroxetine, trazodone and venlafaxine, but bupropion may actually result in weight loss.
  11. Patience is a virtue. Even if you seek help for depression, and receive a prescription, you may find it hard to stay on your antidepressant. Why? Side effects can be a huge factor—they’re at their worst during the first few days, but you should know they’ll likely get better, regardless of the drug you’re taking. Antidepressants may also seem like they aren’t working—but did you know there can be a 2 – 3 week lag before they start to take effect?

Tell us about your experience.
Dr O.

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