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Antidepressants form the foundation of depression treatment, together with talk therapy. How well do they work, though, and how does your doctor determine which antidepressant is right for you?

Antidepressants represent, together with talk therapy, one of two main approaches to treatment and paths to recovery from depression. If you are diagnosed with moderate to severe depression, chances are that you'll be offered both. How effective are these medications, though? How do antidepressants compare with talk therapy? Which antidepressant is right for you? How does your doctor determine that?

Let's delve right into these questions. 

How effective are antidepressants?

While research suggests that antidepressants don't make that much of a difference in people with mild depression, who can benefit from lifestyle changes and therapy instead, they play an incredibly important role in treating those with moderate, severe, and long-term depression.

Data shows, for instance, that:

  • 20 to 40 percent of people suffering from moderate to severe depression who took a placebo rather than an antidepressant noticed symptom improvement within six to eight weeks. 
  • 40 to 60 percent of folks with moderate to severe depression who started an antidepressant enjoyed a some symptom relief within that same time frame. 

This means that in general, 20 percent of people who do not get better without antidepressants will make strides toward recovery if they do start on antidepressants. While that may actually sound like a low number, it does mean two in every 10 people who would otherwise still be just as depressed as before feel better when offered antidepressants.

Not all antidepressants will be equally effective for everyone, of course. Research shows that you'll have about a 50 percent chance of "responding" to any particular antidepressant — meaning it does something to reduce your symptoms. If the antidepressant prescribed is not doing its job, another antidepressant or combination of several will be tried.

It is also important to keep in mind that a reduction in the severity of your symptoms doesn't mean that you're not now depressed — that may take a while longer. Some people, however, notice an improvement within a few weeks, and continue to feel better steadily thereafter. 

How do antidepressants compare with talk therapy?

To start with, receiving either therapy or antidepressants is, research makes it perfectly clear, much more helpful than a placebo. From that, you can conclude that it's also better than not receiving any treatment at all. 

Multiple studies have found that talk therapy — particularly cognitive behavioral therapy — is about as effective as antidepressants in the treatment of moderate depression. In people with severe symptoms, however, it does seem that starting with antidepressants is the approach most likely to relieve depression. These patients will still benefit from therapy as their antidepressants kick in. 

Interestingly, it seems like antidepressants and therapy both equally address physical and cognitive or emotional symptoms of depression — it's not like you need antidepressants to deal with the fatigue, insomnia, appetite changes, and other changes your body goes through when depressed, while therapy helps you come to a healthier state of mind. Both treatment approaches can help you with both physical and mental symptoms. 

While either antidepressants or therapy will be helpful for people with moderate rather than severe depression, the best approach will lie in combining the two for many patients. 

What antidepressant is right for you?

There's plenty of choice when it comes to antidepressants today. This is good news, because it means that if one antidepressant either doesn't help you or gives you unbearable side effects, your doctor can consider many other options. Apart from the most commonly used classes of antidepressants — tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and selective serotonin noradrenaline reuptake inhibitors (SSNRIs) — there are also monoamine oxidase (MAO) inhibitors, selective noradrenaline reuptake inhibitors, alpha-2 blockers, and some other classes. 

Your prescribing doctor will consider these factors when deciding which antidepressant is right for you:

  • Co-existing medical conditions you may have. (This matters because some antidepressants may raise your blood pressure, for instance, so they're not as suitable for people with hypertension, while others are more likely to cause constipation, which would be unfortunate if you already deal with that.)
  • The side effects a particular drug is likely to cause. You play a role here too — tell your doctor which side effects would bother you most.
  • Your history of depression — if you were previously depressed and took an antidepressant that worked well for you, you will likely be prescribed the same medication again.
  • Which antidepressants are most likely to work well in general. Research has found that escitalopram (Lexapro), paroxetine (Seroxat), sertraline (Zoloft), agomelatine, and mirtazapine are most effective. Specifically, they generally relieve depression symptoms well, and cause fewer side effects than some other medications — which in turn means you're more likely to stick with them. 
After you and your doctor decide on an antidepressant, they'll monitor your progress to see how you are getting on. The lowest possible dose will be suggested initially, and this can be adjusted later on if necessary. If you do not see any improvement in your symptoms, or experience concerning side effects, you and your healthcare provider may choose to try a different medication instead. 

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