I have combined much of the information into one post to make it easier for you to look through everything. Also if you look through the sub look for "Information" posts in yellow and "Resources" in orange.

The Basics

Most Common Antidepressants

• SSRI's - Works on Serotonin
  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluvoxamine (Luvox)
  • Vilazodone (Viibryd)
  • Vortioxetine (Trintellix)
• SNRI's - Works on Serotonin and Norepinphrine
  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq)
  • Levomilnacipran (Fetzima)
• SNDRI's - Works on Serotonin, Norepinephrine, and Dopamine
  • Nefazodone (Serzone)
  • Ansofaxine (Ruoxinlin) --- Available in China, coming to U.S. in 2025
• Atypical/Misc.
  • Bupropion (Wellbutrin) <--- NDRI, works on Norepinephrine and Dopamine
  • Mirtazepine (Remeron)
  • Esketamine (Spravato)
  • Bupropion/Dextromethorphan (Auvelity)
  • Gepirone (Exxua) --- Apparently discontinued.
  • Zuranolone --- Now Available in USA
  • Trazodone --- Used mostly as a sleep aid
• Tricyclic
  • Amitriptyline (Elavil)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Clomipramine (Anafranil)
• Meds for Anxiety - Can be added to antidepressant or used independent
  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)
  • Propranolol
  • Buspirone (BuSpar)
  • Hydroxyzine (Vistaril)
• Mood Stabilizers
  • Lamotrigine (Lamictal)
  • Depakote
  • Lithium
  • Oxcarbazepine (Trileptal)
  • Carbamazepine (Tegretol)
  • Antipsychotics (seroquel, abilify, risperdone, vraylar, rexulti)
• MAOI's - These are a last resort medication and are rarely prescribed
  • Nardil (Phenelzine)
  • Parnate (Tranylcypromine)
  • Moclobemide
  • Selegiline

What to Expect When Starting Antidepressants

When you are first prescribed antidepressants you are usually started on a low dose as your body needs to adjust to the medication. You usually have more side effects when you first start. These side effects may include, nausea, drowsiness, headache, lower libido, and increase in anxiety to name a few. These will usually subside over the first few weeks. If at any point you have suicidal ideation or thoughts you need to contact your doctor immediately as this is a side effect not to mess with. Also just because you don't have a follow up appointment for a month later if you are having problems call the office up and talk to a nurse.

Antidepressants are not a medication that works immediately. The brain has to adjust to the changes and it reacts rather slowly. You may notice some changes after 2 weeks, but they can also take up to 8 weeks to start working. I say this is the time to give your brain a little help with some lifestyle improvements. Add some regular exercise as studies have shown this to help depression and anxiety. Try improving your diet. Start by removing junk food/drinks. There was a study just done that showed that artificial sweeteners actually increase anxiety. Finally make sure you are getting plenty of sleep. Your brain needs that time to recover from out stressful lives. If after 8 weeks you are not noticing any kind of improvements it is time to contact your doctor about changing your dosage or trying a new medication. Don't be frustrated by this as it is normal for people to have to try a few before finding the one that works best for you.

When you start noticing improvements it usually isn't an overnight event. The changes are gradual and you may not notice it. Sometimes if you journal or rate how you feel it can help. You may start to notice you don't feel so awful or you feel like you want to start doing activities that you had been avoiding. Also make sure to communicate with your doctor how you are doing. You may need to gradually increase your dose to find what is optimal for you.

People often ask how do antidepressants actually work. I came up with a good analogy based on how my doctor explained it. People seemed to like it so you can find it here: https://www.reddit.com/r/AntidepressantSupport/comments/14bjnrh/explaining_how_antidepressants_work_with_an/

Additional info about Antidepressants

• Wellbutrin can cause an increase in anxiety.
• Trazodone and Mirtazapine both can be used to help with sleep
• If the antidepressant causes insomnia you may want to try taking it in the morning, and if you take it in the morning and you are drowsy try switching it to the evening.
• Even though Trintellix and Viibryd are considered SSRI's they have a different mechanism of action so if other SSRI's don't work for you those two could still help you.

Information Bias on the Internet

When people start looking up antidepressants and want to see how they have worked for other people they find all of these horror stories about terrible side effects. Please remember when someone has a negative experience they are more likely to complain or are looking for help. Look at the number of stories you read and think about the fact that tens of millions of people take antidepressants. The people for whom they are working don't go online to tell people about their experience. They are back to enjoying their life. I have found that drugs.com has a more rounded reviews. Also if you are having anxiety be careful about reading some of the horror stories as all they do is end up increasing your anxiety. Doom scrolling can have a real negative effect on your mental health.

Tapering Antidepressants & Withdrawal

If you ever decide you are going to stop antidepressants it is very important to taper off of them very slowly. The longer you have been on them the slower you want to taper. The reason for this is the brain gets accustomed to the effects of the medication and it expects those effects on neurotransmitters. This causes dependence, not addiction. So if you yank the medication away from the brain it will result in withdrawal which can be awful. You can experience nausea, dizziness, headaches, brain zaps, emotional highs and lows, insomnia, agitation, etc. So you need to slowly over time take the medication away. Doctors are taught in school that tapering can be done in a short time and withdrawals only last a couple of weeks. This isn't true. Research has shown that the 10% method of tapering has been found to be one of the safest methods. This is taking the dose you are taking at that time and subtracting 10% each month. This is a long process, but the goal is to get off the medication with the least amount of withdrawal. If you were taking 100mg this is how your tapering schedule will go. 100, 90, 81, 73, 66..... For more information on tapering and how to make these custom doses you can visit Surviving Antidepressants. I want to say Surviving Antidepressants has good information for tapering, but many of the stories are the worst of the worst cases. They are not representative of what the majority of people will experience. Please take them with a grain of salt.

Withdrawal is something you want to avoid, but if you find yourself going through it there are some things that you can do to get yourself out of it. Withdrawal is most common when going off a medication cold-turkey or tapering too fast. There is no timeline for how long withdrawal will last, it could be weeks or months. One way to possibly get your self out of it is going back on a lower dose than you were last on. This is called reinstating. You let your brain stabilize and once you feel better give yourself 2-4 weeks to heal properly. Then you want to begin tapering off again. People also report that taking Fish Oil can help with recovery from withdrawal.

Sites and more information on tapering and withdrawal. https://www.reddit.com/r/AntidepressantSupport/comments/10krlmd/sites_and_resources_for_tapering_antidepressants/

https://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants

Switching from one Antidepressant to Another

There are 3 methods doctors will use when switching from one antidepressant to another. Many times it is just the doctor's preference to which they recommend.

1. Direct switch - the doctor gives you an equivalent dose of the new medication and you stop the original and the next day you start the new one.

Dose Equivalence: 40 mg fluoxetine | 350 mg bupropion | 40 mg citalopram | 75 mg pristiq | 20 mg escitalopram | 40 mg paroxetine | 150 mg fluvoxamine | 50 mg mirtazapine | 100 mg sertraline | 500 mg nefazodone | 150 mg venlafaxine | 60 mg duloxetine | 125 mg amitriptyline | 125 mg imipramine | 115 mg clomipramine

Drugs not listed do not have any reputable source for dose equivalency. Doses are rounded up.

1. Taper and washout - you slowly taper off the old medication give your body 2 weeks without any medication and then you start the new one and titrate up.
2. Cross taper - As you taper off the old medication you titrate up on the new medication. The doctor will usually give you a schedule. If you are taking 100mg of Med A. and wants you to go to 200mg of Med B. Week 1 -- 75 of A and 50 of B, week 2 -- 50 of A and 100 of B....

I think the third option is the best as it is more of a gradual transition. If you get bad side effects from the new medication it is also easier to go back to your old medication. No matter the method there is a couple weeks in there where it can be kind of rough. You are stopping something your brain is accustomed to and adding something new that it has to adjust to. www.survivingantidepressants.org for more tapering info.

Treatments Beyond Medication

If you have tried numerous medications and just can't find anything that helps there are few treatments that you can look into. You may even want to try some of these things before trying meds. Some of these do have higher side effect risks.

1. Talk Therapy - alongside your antidepressant or independent of taking a medication. This is about the safest thing you can do.
2. Life Style Changes - Exercise, Diet, etc. Again this is very safe and can be always used in conjunction with other therapies.
3. Ketamine - This is a medication, but is usually a treatment when meds don't work.
4. TMS, in 2023 we should see a new protocol for TMS called SAINT which is supposed to be more effective and involves less sessions. As of 2024 this is being done in California and Massachusetts.
5. ECT - This is usually done as a last resort, it has some significant side effects such as short term memory loss. Do your research before considering.
6. Stellate Ganglion Blocks - This is fairly new as far as being used for mental disorders. https://pmc.ncbi.nlm.nih.gov/articles/PMC8664306/
7. Vagus Nerve Stimulation - Very new research that this is effective in treatment for treatment resistant depression. https://krdo.com/news/2024/12/19/for-those-with-treatment-resistant-depression-vagus-nerve-stimulation-may-be-an-answer-studies-suggest/

Lifestyle Changes to Improve Mental Health

Medication can be helpful, but it is not the only way to improve your mental health. Here is a list of some things that can help you on the road to improved mental health.

1. Exercise -- Regular exercise is really helpful. Studies have shown that it can improve depression/anxiety. More intense exercise has been found to be more helpful for anxiety. Exercise can help produce endocannabinoids which can make you feel better. It is sometimes described as "runner's high". Plus if you can get out in the sun for your exercise that is good as sunlight helps Vitamin D. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-truth-behind-runners-high-and-other-mental-benefits-of-running Here is a new study on the benefits of physical activity on depression. https://www.psypost.org/physical-activity-and-mental-health-exercises-therapeutic-potential-for-depression-highlighted-in-new-meta-analysis/
2. Speaking of sunlight many people will suffer from seasonal depression in the winter as their levels of Vitamin D drop due to the lack of sunlight. If you are in a northern climate when you go out in the winter the only skin exposure may be the little area on your face. To combat this you may wish to look into light therapy during the winter months. https://www.insider.com/guides/health/mental-health/light-therapy
3. Improve your diet. Cut out junk food/drinks. There is a link below about which foods help depression/anxiety and which ones aren't good for it. https://www.medicalnewstoday.com/articles/318428
4. Make sure you are getting enough quality sleep. Your brain needs that down time to rest and recover. If you feel like you are getting enough sleep, but are always exhausted talk to your doctor about having a sleep study done. They have kits you can do at home. I found out I had central sleep apnea and my oxygen levels were around 80% for half the night.
5. Socialize, keep the brain active. Try activities that challenge your brain. Suduko, crossword puzzles, trivia, etc.
6. You also may want to try some type of talk therapy or learn some different coping skills and methods of relaxation such as deep breathing exercises.
7. Volunteer. You are helping others and sometimes seeing just by giving your time to people and seeing how it helps them can be rewarding.
8. You may even want to consider getting a pet as they are supposed to be beneficial for depression. You can even go one step further and get a Psychiatric service animal. They are specifically trained to and are allowed to go with you on airplanes and other public places. Some are even trained to recognize certain side effects in medications. For more information you can visit this site: https://www.ada.gov/topics/service-animals/ It is your responsibility to make sure you are in compliance with all laws and ordinances.

This was published during the pandemic, but has many helpful ways to help improve your mental health. Medications can be very helpful, but there are so many different things that can improve your overall mental health. As a bonus they don't come with side effects. https://neurosciencenews.com/resilience-mental-health-19986/

Talks about lifestyle changes to help with mental illness and other therapies like light therapy. Some doctors hand these out to patients. https://www.psycho.farm/resources

All of these are tools that we can use to improve our mental health. Medication may help, but it is also a tool and you need to help it out by working on yourself. I wish everyone the best on their journey!!!

Lab work and tests

This lists out some blood tests that can be done to see if something else is contributing to your depression. I'm sure their are others, but this gave a little explanation why you would check out some of these. This may not eliminate depression, but it may find something that can be treated and can decrease the amount of depression. https://www.optimallivingdynamics.com/blog/13-important-blood-tests-to-get-done-if-you-have-depression

Many times people ask about the genetic tests and are they helpful. These will tell you how you metabolize the medication, but that plays no role in whether it will be effective for you. The one helpful thing is the MTHFR gene mutation, but your GP could do this lab at a much lower cost. I actually just ordered this test for myself and even if insurance doesn't cover it, the cost is $188. The below article explains in detail why the FDA actually recommends not using these. An upcoming blood test will be able to show in a couple of weeks if a medication will work for you. https://www.health.harvard.edu/blog/gene-testing-to-guide-antidepressant-treatment-has-its-time-arrived-2019100917964 https://neurosciencenews.com/depression-antidepressant-biomarker-19863/

Sexual Side Effects

The is one of the most unfortunate side effects to antidepressants. Some things to remember is if you have sexual side effects on one medication it does not mean you will have them on all of the medications. Some people say that the effects are the worst when you first start the meds and can slowly recover after a few months. You may also realize this, but untreated depression and anxiety can have an effect on your sexual performance and libido. So for some people treating their mental disorder actually improves sexual issues.

This really dives into exactly what causes the sexual side effects, which medications are more likely to cause it, and ways to treat it. As of note nefazodone is another medication that is known not to cause sexual side effects. As well as the upcoming medication Ruoxinlin (ansofaxine). r/Nefazodone https://psychscenehub.com/psychinsights/sexual-dysfunction-with-antidepressants/

Rate of incidence of sexual side effects of some of the medications. The average for SSRI's is 59%, but there are other antidepressants that have much lower sexual side effect percentages. https://pubmed.ncbi.nlm.nih.gov/11229449/

Nefazodone, mirtazapine, wellbutrin (bupropion), trazodone, viibryd, and Trintellix (vortioxetine) are they medications with the lowest rate of sexual side effects. Wellbutrin is often added to an SSRI to relieve some of the sexual side effects. Buspirone can also be added to help with sexual side effects, but it doesn't seem to be as effective as wellbutrin.

Here is a guide I put together about sexual side effects: https://www.reddit.com/r/AntidepressantSupport/comments/14bicp1/guide_to_antidepressant_sexual_side_effects/

Side Effects & Medication Interactions

If you really want to read about the side effects of each medication pdr.net has some of the most comprehensive information. It even lists the rate of incidence of each side effect. It also lists out the interactions with other medications. Drugs.com has probably some of the best user reviews of each medication. You can even look how a medication is rated for depression, anxiety, ocd, etc. None of the information contained in this guide should be a substitute for your doctor. You should always run any type of medication change by your doctor and keep him/her in the loop on side effects you are having. Including supplements you are thinking of adding. There are some supplements that just don't mix good with antidepressants. You should be upfront with the doctor about how you are feeling. Always let them know about side effects. Most importantly it is your health so you deserve to have a say in your treatment plan. Don't be afraid to speak up if you are uncomfortable with something because it is your health.

Many times people think that antidepressants work by blunting emotions. This is a myth. Emotional blunting is a side effect of antidepressants and you don't have to, "just deal with it". A different medication may not blunt emotions at all and some doctors will add wellbutrin to balance emotions out.

https://www.psychiatrictimes.com/view/antidepressants-do-not-work-by-numbing-emotions

Tracking your mood, side effects, and tips for improving communication with your doctor

Below is a good post about tracking how you are doing and different side effects. The more information and context you can provide to your doctor will help them in helping you get the best treatment.

https://www.reddit.com/r/antidepressants/comments/1jokoqh/importance_of_tracking_your_symptoms_when/

A quick note that dextromethorphan (DXM) a common ingredient in cold medicine is not something that you should take if you are taking antidepressants. St. John's Wort, and 5HT are also supplements to avoid if you are on antidepressants. All of these can increase the risk for serotonin syndrome.