Which of the 8 SSRIs might be the best choice for treatment of my depression?
Since all the SSRIs have about the same effectiveness (about 50% or more if you are early in the course of your depression, lower if you have already had a number of medications without success), usually the most important variable initially is tolerability, how likely are you to tolerate this particular medication and not have to stop it prematurely due to side effects. Possibly the best tolerated SSRIs are Lexapro and Zoloft. Zoloft are Lexapro are well tolerated with a general expectation that 85% of patients can be expected to tolerate it.
Another important variable is that some of the SSRIs have several FDA approvals for various anxiety disorders as well as major depression. Since at least 50% of patients have a concomitant anxiety disorder along with depression it is very helpful to have these additional approvals. An FDA approval is a guarantor that the medication has been adequately tested scientifically in this disorder and found to be both safe and effective. Lexapro has an FDA approval for generalized anxiety disorder (GAD) as well as major depression. GAD is in fact the most common co-occurring anxiety disorder with major depression, present in 50% of cases. In this way then, if Lexapro works there will be a two-for-one benefit with both GAD and major depression (MDD) responding to Lexapro.
Some SSRIs have multiple indications, in fact Zoloft has all of 6 FDA approvals: MDD, OCD, Panic Disorder, PTSD, Social Phobia and PMDD. Therefore, when you are prescribing Zoloft you are covering a wide turn indeed. Prozac was the first ever SSRI to become available in the US way back in 1987 (33 years ago) and has approvals for the following disorders in addition to MDD: OCD, Bulimia Nervosa, Panic Disorder and Cataplexy.
The two newest SSRIs that have come out in the last few years are Viibryd and Trintellix. In practice I haven’t these two very effective so I don’t particularly use them. Overall you can whittle the 8 down to three: Lexapro as first line, then Zoloft followed by Prozac. If there is OCD as well as MDD then Luvox is a good choice.
