ANTIDEPRESSANT 

MEDICINES

A GUIDE for ADULTS 

With DEPRESSION

August 2007 
FAST FACTS ON ANTIDEPRESSANTS

• The antidepressants in this 

guide work for treating 

depression. Most people 

can fi nd one that makes 

them feel better.

• Six out of 10 people will 

feel better with the fi rst 

antidepressant they try. The 

rest of the people will need 

to try other antidepressants 

before they fi nd the one that 

is right for them.

• Most people taking antidepressants have at least 

one side effect.

• The most common side 

effects are constipation, 

daytime sleepiness, diarrhea, dizziness, dry mouth, 

headache, nausea, sexual 

problems, shakiness, trouble 

sleeping, and weight gain. 
1

What does this guide cover?

This guide can help you work 

with your doctor or nurse to 

choose medicines for depression. 

It covers:

• Common medicines for 

adults with depression. 

• Side effects. 

• Price.

This guide is based on a 

government-funded review of 

research about the medicines 

often used to treat adults with 

depression. The antidepressants 

are listed on page 8. 

What is not covered in this guide?

This guide does not cover:

• Treatment of depression in 

children or teens.

• Postpartum depression 

(“baby blues”).

• Depression that is part of other 

mental health conditions like 

bipolar disorder (previously 

called manic-depressive 

disorder). 

• Older antidepressant medicines 

like amitriptyline (Elavil®) 

and phenelzine (Nardil®).

• Other ways to treat depression 

such as counseling, light 

therapy, and herbal supplements 

like St. John’s Wort. 
2

What are the common 

signs or symptoms of depression?

Depression is a deep sadness that 

won’t go away. It can also be the 

loss of interest in doing things you 

usually enjoy. Common symptoms 

include:

• Sad, anxious, or “empty” mood 

that lasts more than 2 weeks.

• Trouble sleeping. 

• Appetite changes—either 

less appetite and weight loss, 

or eating more and weight gain. 

• Loss of interest in doing things 

you once enjoyed, including sex. 

• Feeling restless and cranky. 

• Nagging physical symptoms that 

don’t get better with 

treatment (like chronic pain). 

• Trouble paying attention, making 

decisions, or remembering.

• Feeling tired all the time or 

like you have no energy. 

• Feeling guilty, hopeless, 

or worthless. 

• Thoughts of suicide or death. 

Depression is treatable. You can 

get better. The most common 

treatments for depression are 

antidepressant drugs, counseling, 

or a combination of the two. 

What should I tell my doctor or nurse?

• Tell your doctor or nurse 

how you feel.

• Describe any symptoms you 

have, like no appetite, feeling 

tired all the time, trouble getting 

to sleep or staying asleep, 

no interest in sex, or feeling 

worried a lot. 

• Tell them which symptoms 

bother you the most. 

• Let them know about any 

other health or mental 

health conditions you have.

• Bring a list of all your prescription and nonprescription drugs. 

Be sure to tell them if you are 

taking herbal products, like 

St. John’s Wort, or any other 

supplements.

• Tell your doctor or nurse 

whether you have taken an 

antidepressant before and how 

it worked for you.
3

Benefi ts of antidepressants

Understanding side effects

Will this medicine work 

for me?

• Most people can fi nd an 

antidepressant that works 

for them.

• Six out of every 10 people 

feel better with the fi rst 

antidepressant they try. The 

rest will need to try different 

antidepressants to fi nd the 

one that is right for them.

How long before I feel better?

• Most people need to take an 

antidepressant regularly for at 

least 6 weeks to begin to get the 

full effect.

• If you still don’t feel better, your 

doctor or nurse may give you a 

different antidepressant or add 

a second one. 

• Most people need to keep on 

taking these medicines for 6 to 

9 months. Some people will need 

to take them longer. 

All of the antidepressants in this 

guide can cause side effects. If 

side effects become a problem, 

your doctor or nurse may be able 

to help you fi nd another medicine.

• Most people taking these medicines will get at least one side 

effect. It is hard to predict which 

drug will cause which side effect 

for any one person.

• The most common side effects 

are constipation, daytime 

sleepiness, diarrhea, dizziness, 

dry mouth, headache, nausea, 

sexual problems, shakiness, 

trouble sleeping, and weight gain. 

• Many side effects go away 

after a few weeks. But some 

only go away after you stop 

the medicine.
4

RESEARCH COMPARING SIDE EFFECTS

Some of the medicines in this guide have been compared with each other 

in research studies. Here’s what we know from these studies: 

 Weight gain more likely

• More weight is gained by people 

taking mirtazapine (Remeron®)

than by people taking: 

 - citalopram (Celexa®)

- fl uoxetine (Prozac®) 

- paroxetine (Paxil®) 

- sertraline (Zoloft®) 

 The weight gain with mirtazapine

(Remeron®) is around 2 to 

7 pounds. Some people can gain 

much more. 

• More weight is gained by people 

taking paroxetine (Paxil®) than 

by people taking: 

 - fl uoxetine (Prozac®) 

- sertraline (Zoloft®) 

 The average weight gain with 

paroxetine (Paxil®) for someone 

who weighs 150 pounds is about 

5 pounds. Some people can gain 

much more. 

 Weight loss more likely

• People who take bupropion 

(Wellbutrin®) tend to lose 

a little weight, about 2 to 

3 pounds.

 Nausea & vomiting more likely

• More people (10 percent more) 

have nausea and vomiting with 

venlafaxine (Effexor®) than with:

 - citalopram (Celexa®)

- escitalopram (Lexapro®) 

- fl uoxetine (Prozac®) 

- fl uvoxamine 

- paroxetine (Paxil®) 

- sertraline (Zoloft®)

 Sexual problems less likely

• Fewer people taking bupropion 

(Wellbutrin®) have sexual 

problems (loss of sexual desire or 

loss of ability to reach orgasm) 

than people taking:

 - fl uoxetine (Prozac®) 

- paroxetine (Paxil®) 

- sertraline (Zoloft®)

 Sexual problems more likely 

• More people taking paroxetine 

(Paxil®) have sexual problems 

than people taking: 

 - fl uoxetine (Prozac®)

- fl uvoxamine 

- nefazadone 

- sertraline (Zoloft®)

 Diarrhea more likely

• More people (8 percent more) 

have diarrhea with sertraline 

(Zoloft®) than with: 

 - bupropion (Wellbutrin®) 

- citalopram (Celexa®)

- fl uoxetine (Prozac®) 

- fl uvoxamine 

- paroxetine (Paxil®) 

- mirtazapine (Remeron®)

- nefazadone 

- venlafaxine (Effexor®)
5

DON’T STOP YOUR MEDICINE SUDDENLY

Never stop taking an antidepressant medicine suddenly. If you 

quit your medicine all at once, it can make you feel sick, as if you 

have the fl u. You may get headaches, dizziness, and nausea. 

Work with your doctor or nurse to decrease your dose a little 

at a time before you stop. 

• Paroxetine (Paxil®) and venlafaxine (Effexor®) are more likely 

than the other antidepressants in this guide to cause these fl u-like 

symptoms when you stop suddenly. 

• Fluoxetine (Prozac®) is less 

likely than the others to 

cause these symptoms.
6

What is still not known?

• We do not know very much 

about using these drugs for a 

long time because research 

studies generally only last 

3 months to 1 year.

• We don’t know if any of these 

antidepressants are better than 

the others for symptoms that 

sometimes come along with 

depression, like trouble sleeping 

and pain. 

Serious risks

Serotonin syndrome

Serotonin syndrome is a rare, but serious, drug reaction. Serotonin is 

a chemical produced by nerve cells. The antidepressants in this guide 

raise the amount of serotonin in the brain. Up to a point, this can be 

good. But too much serotonin can cause serotonin syndrome. Common 

symptoms include confusion, hallucinations, loss of coordination, fever, 

rapid heart rate, and vomiting.

What causes it?

Serotonin syndrome happens most often when two drugs that raise 

serotonin in the brain are taken at the same time. Some other drugs 

that raise serotonin include:

• Migraine headache medicines called triptans (Amerge®, Imitrex®).

• The supplement L-tryptophan.

• Herbal products like St. John’s Wort.

• Over-the-counter cough medicines that contain dextromethorphan. 

• Prescription pain killers like meperidine (Demerol®).

How can I avoid it?

Check with your doctor or pharmacist before taking other prescription 

or over-the-counter medicines, supplements, or herbal products. 

Suicide

Antidepressants can increase the risk of suicide for people younger than 

25. No matter what your age, if your depression gets worse or you are 

thinking about hurting yourself, please talk with your doctor.

• We don’t know if any antidepressant works better for men 

versus women or in people of 

different races. 

• We don’t know if any one of 

these antidepressants is more 

likely than another to raise the 

risk of suicide.
7

How can I use the information in this guide?

When talking with your doctor 

or nurse about antidepressants, 

think about:

What side effects are 

most important to you? 

• Are you most worried about 

sexual issues like loss of 

sexual desire or loss of ability 

to reach orgasm? 

 You might ask your 

doctor or nurse about 

bupropion (Wellbutrin®).

• Are you concerned about 

weight gain? 

You might ask your doctor 

or nurse about taking bupropion 

(Wellbutrin®). You might want 

to avoid paroxetine (Paxil®) 

and mirtazapine (Remeron®).

• Are you most worried about 

nausea and vomiting?

 Nausea and vomiting are the 

most common side effects that 

cause people to stop taking 

their antidepressant medicine 

during the fi rst 30 days. 

 If your medicine causes nausea 

or vomiting, or any other side 

effect, let your doctor or nurse 

know. There may be a solution.

How often will you need to 

take the medicine?

Some antidepressants are taken 

once a day. Others need to be 

taken more often. Page 8 has a list 

of antidepressants and how often 

they need to be taken.

Is cost important?

Use the chart on page 8 to 

compare the prices of different 

drugs. If prescriptions are part 

of your health insurance plan, 

check with your plan about the 

cost to you.
8

 Generic Brand Price for 1-Month Supply3

 Name1 Name Dose2 Generic Brand

Bupropion Wellbutrin® 75 mg three times a day $ 65 $ 160

150 mg three times a day $ 175 $ 210

 Wellbutrin SR® 150 mg once a day $ 60 $ 85

150 mg twice a day $ 115 $ 175

200 mg twice a day $ 230 $ 320

 Wellbutrin XL® 150 mg once a day Not available $ 125

 300 mg once a day as generic $ 165

 450 mg once a day $ 290

Citalopram Celexa® 10 mg once a day $ 75 $ 90

20 mg once a day $ 75 $ 95

40 mg once a day $ 80 $ 100

60 mg once a day $ 155 $ 195

Duloxetine Cymbalta® 20 mg twice a day Not available $ 215

 30 mg twice a day as generic $ 240

 60 mg twice a day $ 240

Escitalopram Lexapro® 10 mg once a day Not available $ 80

 20 mg once a day as generic $ 85

Fluoxetine Prozac® 10 mg once a day $ 80 $ 145

20 mg once a day $ 80 $ 150

40 mg once a day $ 160 $ 295

40 mg twice a day $ 320 $ 595

 Prozac Weekly® 90 mg once a week Not available $ 110

 as generic

Fluvoxamine Only available 50 mg once a day $ 75 Only available

as generic 100 mg once a day $ 80 as generic

 150 mg once a day $ 160 

Mirtazapine Remeron® 15 mg once a day $ 80 $ 105

30 mg once a day $ 85 $ 110

45 mg once a day $ 85 $ 110

Nefazodone Only available 50 mg twice a day $ 90 Only available

as generic 100 mg twice a day $ 90 as generic

300 mg twice a day $ 200 

Paroxetine Paxil® 10 mg once a day $ 80 $ 95

20 mg once a day $ 80 $ 100

40 mg once a day $ 85 $ 110

60 mg once a day $ 165 $ 210

Sertraline Zoloft® 50 mg once a day $ 85 $ 90

100 mg once a day $ 85 $ 90

200 mg once a day $ 170 $ 180

Trazodone Desyrel® 50 mg once a day $ 15 $ 70

100 mg three times a day $ 65 $ 355

150 mg three times a day $ 130 $ 305

Venlafaxine Effexor® 37.5 mg twice a day Not available $ 135

 50 mg twice a day as generic $ 140

 75 mg three times a day $ 220

 Effexor XR® 75 mg once a day Not available $ 110

 150 mg once a day as generic $ 120

 225 mg once a day $ 230

DOSE AND PRICE OF ANTIDEPRESSANTS

1 These drugs were included in the research studies. 2 Doses are similar to those used in the research studies.

3 Average Wholesale Price from Drug Topics Redbook, 2007. SR = sustained release, XL/XR = extended release.
9

What is the source of this guide?

The information in this guide comes from a detailed review of 293 

research reports. The detailed review is called Comparative Effectiveness 

of Second-Generation Antidepressants in the Pharmacologic Treatment 

of Adult Depression (2007) and was written by RTI InternationalUniversity of North Carolina Evidence-based Practice Center.

The Agency for Healthcare Research and Quality (AHRQ) created 

the Eisenberg Center at Oregon Health & Science University to make 

research useful for consumers. This guide was prepared by Sandra 

Robinson, M.S.P.H., Valerie King, M.D., Martha Schechtel, R.N., Theresa 

Bianco, Pharm.D., and David Hickam, M.D., of the Eisenberg Center. 

People with depression helped them write this guide.

For more information

For an electronic copy of this guide and materials about choosing 

treatments and medicines for other medical conditions, visit this 

Web site: www.effectivehealthcare.ahrq.gov

For a free print copy, call the AHRQ Publications Clearinghouse

(800) 358-9295 

Ask for AHRQ Publication Number 07-EHC007-2A

For more information about depression, visit the Medline Plus 

Web site: www.nlm.nih.gov/medlineplus/depression.html

For information about mental health services and resources in 

your state, try the Mental Health Services Locator at this Web site: 

mentalhealth.samhsa.gov/databases
AHRQ Publication Number 07-EHC007-2A

August 2007

The photos in this guide are of models and are used for illustrative purposes only.