Finding the Right Antidepressant for Your Depression

Special report on why people with major depression sometimes switch antidepressant medications, why you should never suddenly stop your antidepressant and how to change antidepressants safely.

Amy* was 21 and a college student when she experienced her first major depression. When she felt so bad she had to drop out of the school and move home, she finally saw a doctor. It was the golden years for Prozac (fluoxetine), one of the first selective serotonin reuptake inhibitors (SSRIs) to hit the market. With its relatively low risk of side effects and efficacy similar to those of the older antidepressants, Prozac was touted as a miracle drug for depression.

There was just one problem. It didn't work for Amy. She was part of a small percentage of people in whom Prozac triggered feelings of agitation, nervousness, and restlessness, a condition called "akathisia."

Thus began a journey through antidepressant land as Amy and her doctor struggled to find the right medication. She went through nearly all the SSRIs, including and Paxil (paroxetine), most of the tricyclic antidepressants, including Elavil (amitriptyline), Norpramin (desipramine) and Pamelor (nortriptyline), and the norepinephrine reuptake inhibitor Effexor (venlafaxine). Her doctor tried adding other medications to the antidepressants, including the anti-epilepsy drug Depakote (divalproex), the stimulant Ritalin (methylphenidate), the antipsychotic Abilify (aripiprazole), and even lithium, a medication which may help with depression but is typically prescribed for bipolar disorder, which Amy did not have.

When even a round of electroconvulsive shock therapy didn't fully pull Amy out of her depression, her doctor figuratively threw up his hands and said, "Let's go old school." He started her on one of the oldest antidepressants, the monoamine oxidase inhibitors (MAOIs) Parnate (tranylcypromine), together with Ritalin and Abilify - a combination that was both potentially risky and potentially beneficial. Bingo! Finally, the depression lifted.

"Throughout the whole process I was frustrated," she recalls. "I felt hopeless and helpless most of the time, like I would never find anything that would work for me."

Amy's story is not as unusual as it might sound. One of the largest studies ever conducted of antidepressant treatment for depression, the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) found that only a third of patients fully recover from their depression on the first antidepressant tried. Most need at least two, sometimes three or more.