How to Choose the Best Antidepressant for You

Effectively treating depression in anyone, but especially older adults, is very important, explains Dr. Badr Ratnakaran, chair of the American Psychiatric Association’s Council on Geriatric Psychiatry and a geriatric psychiatrist with the Pennsylvania Psychiatric Institute in Harrisburg. Depression is always a risk factor for diseases that become more common with age, including heart disease, diabetes and stroke.

What’s more, depression can make it more difficult to engage in exercise due to symptoms of fatigue, and it can keep patients from attending medical appointments that could help prevent, detect or treat physical health issues. It can also trigger changes in the body, including increased inflammation, reduced blood circulation, and altered heart rate and stress hormone levels.

Finding the right antidepressant

Experts highlight several factors you and your doctor can look at when choosing an antidepressant medication:

Ask about side effects. Then talk to your doctor honestly about the ones you want to avoid — say, weight gain — and the ones that don’t bother you as much, like fatigue.

Side effects are often the main reason why people stop taking their antidepressant medication, says Dr. Michelle DiBlasi, chief of inpatient psychiatry at Tufts Medical Center in Boston. Doing so, however, can cause symptoms of withdrawal or symptoms of depression to recur.

Disclose other medications and health conditions. You’ll also want to let your doctor know about any and all health conditions you have, as well as every medication you take, including supplements, says Dr. Kostas G. Lyketsos, a geriatric psychiatrist and professor of psychiatry at the Johns Hopkins School of Medicine.

Drug interactions are more common after age 65, Lyketsos says, “making it important for your doctor to choose an antidepressant that doesn’t interact with a health condition or a drug you take.”

Consider family members. How a medicine worked for a blood relative, such as a parent or sibling, can indicate how well it might work for you. “There is a certain genetic component to drug metabolism and tolerance of medications,” says Dr. Helen Lavretsky, a geriatric psychiatrist at UCLA Health. “I always ask about other family members taking antidepressants and what worked for them.”

Don’t rule out previous medications. If an antidepressant has been effective for your depression in the past, it may work well again, though it’s possible for some people to develop a tolerance to their medications, Lavretsky says.

Think about your symptoms. They may help guide you to the right treatment. Depression looks different for different people; some have trouble with sleep, while others feel more irritable. Because certain medications work better for specific symptoms, make sure your doctor is aware of everything you’re experiencing.

Finally, your doctor may also order tests — for example, blood work to monitor liver enzymes in patients taking certain antidepressants — to ensure the medication doesn’t pose any risks, Lavretsky says.

Despite the recent review’s emphasis on side effects, Pillinger says there will certainly be instances when patients and doctors may choose the most effective antidepressant despite side effects.

For example, if the best drug for you is one that raises your blood pressure, your doctor can closely monitor it. If your blood pressure goes up, “but you’re still getting the benefits [of the antidepressant], and you want to continue that treatment, we can treat the high blood pressure,” Pillinger says. 

“We’re not demonizing any treatment in this study,” he adds. “We’re just highlighting the differences across these different medications and recognizing that those differences can inform prescription decisions and can inform monitoring physical health when people are prescribed certain [antidepressants].”

Don’t give up on antidepressants

When you’re prescribed an antidepressant, ask your doctor when you should expect to see a change in symptoms. It usually takes three to four weeks for antidepressants to be effective, though some medications are faster.

“Have patience and do not discontinue medications too early,” Lavretsky says.

If you find your antidepressant isn’t working or is less effective than it was previously, there are different options that can be pursued, DiBlasi says. Your doctor may want to add an additional medication to help bolster the effect of your antidepressant, or they may switch you to another antidepressant that may be more effective or target different receptors in your brain.

Don’t give up when it comes to treating depression, Lyketsos says. “There are many [medications] available and more in late-stage testing, so your doctor is very likely to come up with an effective treatment for you.”