Harvard Mental Health Letter

Advice about which antidepressant to choose first

Relative risk of side effects may help influence treatment decisions.

Major depression is one of the most common psychiatric disorders in the United States, affecting more than 16% of adults at some point in their lives. Several antidepressants and other types of drugs are available to treat depression. The conventional wisdom, based on the large Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study and smaller studies, is that all antidepressants are about equal in terms of efficacy.

Because the side effects of first-generation antidepressants such as tricyclics or monoamine oxidase inhibitors have been tolerated less well than those of the second-generation agents such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), the newer drugs tend to be prescribed first. Researchers have evaluated 12 second-generation drugs for use in treating major depression.

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