Which AntiDepressant??

Dear Dr. Guterson - I’m depressed. Which medication would you recommend?

A: The first question to ask is: am I really depressed, or am I just going through a hard time. Because everyone goes through hard times, it’s part of life. And sometimes the feelings of depression or sadness can be a necessary step in one’s journey toward growth. It’s called ‘the healthiness of depression’. I’ve often wondered if this was the case with Abraham Lincoln, who went through some profound depressions.

Next, medication is not always the way to go. Daily exercise (within reason, as authorized by your PCP or cardiologist) can be a huge antidepressant.

As can therapy; real good therapy, therapy that helps us understand our inner world so that we can navigate life in a more healthy and joyous way.

And then there’s spirituality, having an awareness and connection with our soul, a purpose and mission in life. To wake up every morning with a sense of this can be a huge life changer.

But - getting to your question - there is no set answer, no special antidepressant that fits everyone. The general rule is to focus on the main presenting symptoms of depression:

If anxiety and/or irritability are major additional factors of depression, then the Serotonin medications (likes Prozac, Zoloft, Celexa, and Lexapro), especially in high dosages, would be my top choice.

With lethargy and/or poor concentration, choose Wellbutrin, which can also help with smoking cessation and ADHD.

With poor appetite and/or insomnia, choose Remeron.

With fibromyalgia and diabetic neuropathy, Cymbalta is a good bet. The tricyclic antidepressants (like Amitriptyline and Nortriptyline) also can help with pain syndromes and sometimes migraines.

All these are of course general rules. Nothing is set in stone, as each of us is wonderfully unique. One also has to consider side effects.

And of course, there’s always family history - if a particular antidepressant has worked well for one family member, that might be a good direction to go.

Obviously, for all of my above suggestions, you must ultimately consult with your own psychiatrist before making any decisions.

When all is said and done, knowing that difficulties are an intrinsic part of life is a great mindset to have. When we work through our struggles, and don’t avoid them, we become better people.

Wishing you the very best,

Dr. John Yaakov Guterson