Best Antidepressants for Depression in 2023
*Press control-F to find a specific antidepressant
The Level 1 Gamer sits in his room gaming late into the night binge eating a bowl of Cheetos. His mom or girlfriend keeps urging him to get treatment but he just snaps at them instead of listening. He’s isolated from all his friends who’ve stopped texting him. Deep down he knows he’s depressed but doesn’t do anything about it.
The Level 100 Gamer has a complete depression plan designed between him and his psychiatrist. He’s thriving in school and work, and has great friends he spends time with. He feels happy, eats healthy, and has a great relationship with his family. Best of all, he enjoys gaming without getting sucked into it like the past.
One of my patients was a 30 year old man dealing with severe depression and anxiety. Since his wife left him he had been dealing with crippling depression that caused him to quit his job and move in with his parents. When I saw him, he was laying in bed most mornings, had no motivation to find a new job, and was getting angry at his parents all the time. He also was visiting the emergency room for severe chest pain and breathing issues, which turned out to be panic attacks. He was already in therapy which wasn’t working, so he came to see me.
We started with Zoloft (sertraline) and slowly increased that from 50 mg to 150 mg. He began having side effects at 200 mg, so we kept it at 150 mg. He held up really well with this dose for a while, but felt like he was still having issues with motivation and sleep. We added Remeron (mirtazapine) 15 mg (the starting dose). The next visit, he came in smiling ear to ear, and said that combination was the best thing for him. He was able to sleep every night, said the emergency room visits stopped, and had just found a new job after a year at his parents house. He’ll keep this treatment for a while until we decide the right time to start reducing his medications.
Here’s what I tell concerned patients and families about medication. Imagine if you broke your leg in a car accident. To fix it you’d obviously gets lots of rest, do physical therapy, practice mobility exercises etc. But you’d absolutely still want a cast.
The cast is the medication here.
Part of the treatment, but not the whole treatment.
That’s why I believe in an integrative & holistic approach. Where medications are part of a whole-body treatment strategy.
So no BS - Here are the best medications for depression:
SSRI’s
Bread and butter. These are almost always the first medications we’ll try. These work by increasing serotonin, our “happy chemical” in our brain. (basic explanation; full explanation in FAQ).
Here’s the SSRI’s:
Prozac (fluoxetine) | Zoloft (sertraline) | Lexapro (escitalopram) | Celexa (citalopram) | Paxil (paroxetine) | Luvox (fluvoxamine)
These usually take 2 weeks to start noticing an effect, and 6-8 weeks to fully kick in.
Side Effects: Nausea, vomiting, diarrhea, headache, insomnia, sleepiness, sexual side effects
We adjust the dosing based on how fast you’re responding or if you’re having any side effects.
SNRI’s
These increase serotonin in our brain, but also norepinephrine.
Here they are:
Cymbalta (duloxetine) | Effexor (venlafaxine) | Pristiq (desvenlafaxine)
*These tend to be good for patients with chronic pain, headache, and anxiety issues in addition to depression.
Side Effects: High blood pressure, vomiting, diarrhea, headache, insomnia, sleepiness, sexual side effects
WARNING: These meds tend to have terrible withdrawal symptoms, so use a good taper plan with your psychiatrist.
Atypicals:
Wellbutrin (bupropion)
This increases Dopamine and Norepinephrine in our brains
*This works well for people with low energy and ADHD. As well as people who got sexual side effects from a different medication.
Side effects: High blood pressure, increased seizure rrisk, nausea, insomnia
Remeron (mirtazapine)
This increases serotonin and norepinephrine in our brains (but differently than SNRI’s.
*This works well for people who have trouble eating and/or sleeping
Side effects: Tiredness, drowsiness, increased appetite, low blood pressure
Serotonin Modulators
These are newer medications that increase serotonin in our brain, but through a different mechanism than SSRI’s
Studies show they’re roughly equal to SSRI’s (newer doesn’t mean better!). These can work well for people who didn’t respond to an SSRI or SNRI.
Trintillix (vortioxetine) | Viibryd (vilazodone)
Side Effects: Headache, diarrhea, nausea, dizziness
Tricyclic Antidepressants
“Old-school” antidepressants. They’re not used as frequently due to side effects, but they can work well for the right patient (especially if dosed slowly)
Elavil (amitriptyline) | Pamelor (nortriptyline) | Anafranil (clomipramine)
Side Effects: Dizziness, drowsiness, headache, insomnia, tremor, nausea, sweating
Antipsychotics
Studies have shown these have good mood stabilizing effects, and can work well alongside an antidepressant to bring someone closer to the “middle”
Zyprexa (olanzapine) | Abilify (aripiprazole) | Seroquel (quetiapine) | Risperdal (risperidone) | Rexulti (brexpiprazole) | Vraylar (cariprazine)
But they do have a lot of side effects, so have to be used carefully.
Side effects: Weight gain, restlessness, sedation, weird movements, nausea, headache
Mood Stabilizers
Lithium
Lithium is often added to an antidepressant to help with treatment-resistant depression. It often works really well.
But it tends to have side effects, which is one reason we measure its blood levels.
Side effects: Short-term - tremor, headache, nausea, diarrhea, constipation, vomiting. Long-term - kidney & thyroid issues
Lamictal (lamotrigine)
Many patients like Lamictal because it tends to have few side effects and patients have good response. But the main problem is it has to be increased very slowly to give it safely so it takes a while to get to a good dose.
Side effects: Steven-Johnson syndrome (intense rash) avoided by increasing slowly.
Conclusion
There’s a lot of treatments for depression, and medications are just one option. That said, I’ve seen MANY people recover from medications alone. It all depends on the individual person and the treatment right for them.
It takes a full psychiatric evaluation by a highly trained mental health clinician to assess for Depression. I’m a psychiatrist who’s mission is to help gamers beat their loneliness by fixing their mental health. I specialize in treating young men & gamers with depression, anxiety, ADHD and video game addiction. If you want to get assessed & treated for Depression, click below.
Remember, real life is the video game.
So let’s level up.
Agam
FAQ’s
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I’ve heard a lot of people ask this, and its a very reasonable question. Some people do report feeling numb with their medication. Usually this is a side effect that goes away within a week. It’s also usually depends on the dose; meaning that lowering the medication will likely fix it. And for a select few people, it may not be the right medication choice - which we can easily switch.
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No. What I tell people is imagine if you broke your arm. While you could heal on your own, practice moving your hand again… you’d absolutely want a cast. Same here. With severe depression we want to address it as fast as possible, and meds are a part of that strategy. But once you’re better, we’ll slowly taper you down and monitor you each step of the way.
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There ws a controversial black box warning that came out with antidepressants in 2004
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No evidence has shown this to be the case. I’d argue untreated depression would stunt your child’s brain development, not to mention ruin their future school & career goals.
