The "easiest" antidepressants to get used to are generally considered to be in the class of selective serotonin reuptake inhibitors (SSRIs), with sertraline (Zoloft) and escitalopram (Lexapro) often cited as having the best balance of efficacy and tolerability.
For most patients, sertraline and escitalopram are more effective and better tolerated than other antidepressants.
Zoloft seems to cause diarrhea more than other antidepressants. One study found that 14% of people taking Zoloft developed diarrhea, compared to about 7% for other SSRIs.
Dizziness is more common with tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) than with other antidepressants. These medications can cause low blood pressure, resulting in dizziness. Consider these strategies: Rise slowly from sitting to standing positions.
Unlike more common antidepressants, which target serotonin, bupropion works primarily on the neurotransmitters norepinephrine and dopamine – two chemicals that play a key role in focus, reward, and motivation. This can make it a good option for those struggling with low energy and a lack of motivation.
Prozac's stimulating effects can lead to increased energy and alertness. It makes it beneficial for patients experiencing low energy or fatigue due to depression. Whereas Lexapro has a more neutral or calming effect. It can improve energy levels and mood, but it's less likely to cause stimulation.
Citalopram is usually favoured if your main struggle is agitation or anxiety. It has a gentler, more calming effect. Sertraline is often chosen if low energy or lack of motivation are part of the picture, because its mild dopamine activity can give you more drive.
Antidepressants such as mirtazapine (Remeron), tricyclic antidepressants (TCAs), and selective serotonin reuptake inhibitors (SSRIs) have all been associated with vertigo. Antipsychotic medications can also cause dizziness and vertigo.
Pay attention to physical side effects such as nausea, dizziness, headaches, or a rapid heartbeat. These can be signs of too much antidepressant in your body. Although some side effects fade over time, others indicate that your system is not tolerating the current dose.
The answer is in your genes. Not all patients experiencing mood swings or depression have abnormally low levels of serotonin in the brain. Even though they have normally functioning liver enzymes that metabolize SSRIs properly, they are still unable to tolerate these medicines, even at low concentrations.
Both tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) might improve overall IBS symptoms.
People without depression who take antidepressants commonly report feeling emotionally “flat” or “numb.” This happens because the medications alter normal neurotransmitter function: Reduced ability to feel both positive and negative emotions. Decreased emotional reactivity to normally joyful events.
Overall, citalopram appears to be the best-tolerated SSRI, followed by fluoxetine, sertraline, paroxetine, and fluvoxamine. The latter 2 drugs are associated with the most side effects and the highest discontinuation rates because of side effects in clinical trials.
6 Signs You Might Need Antidepressants
Antidepressants like escitalopram, sertraline, or fluoxetine can be crucial for helping people through depression, but they may also lead to unwanted, disruptive side effects. These might include weight gain, upset stomach, increased anxiety, sexual symptoms, or sleep-related issues like insomnia or drowsiness.
It's normal to have some side effects when using antidepressants. Some could be worth living with or let up after your medical professional adjusts your medicine. But if your medication side effects are wreaking havoc on your life or causing you to feel out of sorts, your antidepressant isn't right for you.
In fact, some studies have shown mirtazapine can start reducing anxiety and depression symptoms as early as the first week – one clinical trial specifically comparing mirtazapine and sertraline found a significant improvement with mirtazapine by the 4th day of treatment versus sertraline.
Talk to a Mental Health Provider About Your Dosage
If you've been taking your antidepressant as prescribed for longer than 4 to 6 weeks but are still experiencing unwanted or new side effects, talk to your provider about possibly altering your dosage or trying a new drug.
There's a paradoxical period when a person first starts an antidepressant: they may actually begin to feel worse before feeling better. The underlying cause of this phenomenon is a bit of a mystery, but a new study from researchers at Otto-von-Guericke University in Germany explains why this might occur.
Loss of balance or unsteadiness
Losing your balance while walking, or feeling imbalanced, can result from: Vestibular problems. Abnormalities in your inner ear can cause a sensation of a floating or heavy head and unsteadiness in the dark. Nerve damage to your legs (peripheral neuropathy).
It's thought that your chance of getting severe depression may be partly affected by the genes you inherit from your parents.
It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away.
Most people take citalopram for 6 months. But in some instances, a doctor may prescribe this substance for 9 months. Long-term use of antidepressants may put people at risk for type 2 diabetes, and SSRIs may cause heart rhythm abnormalities at higher doses.
Common reasons for switching from Lexapro to Zoloft include inadequate symptom relief, troublesome side effects (especially sexual dysfunction or weight changes), insurance coverage changes, or the need to target symptoms for which Zoloft has specific FDA approval, such as OCD or PTSD.