From the Guidelines
Selective Serotonin Reuptake Inhibitors (SSRIs) are generally considered antidepressants with more manageable side effect profiles compared to older medications. Common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa), and paroxetine (Paxil), typically started at low doses and gradually increased as needed. Other antidepressants with relatively favorable side effect profiles include SNRIs like duloxetine (Cymbalta) and venlafaxine (Effexor), as well as bupropion (Wellbutrin), mirtazapine (Remeron), and vortioxetine (Trintellix) 1. These medications work by increasing levels of neurotransmitters like serotonin and norepinephrine in the brain, though they may still cause side effects such as nausea, headaches, sleep disturbances, and sexual dysfunction.
Some key points to consider when selecting an antidepressant with fewer side effects include:
- Bupropion has a significantly lower rate of sexual adverse events than fluoxetine or sertraline 1.
- Paroxetine has higher rates of sexual dysfunction than fluoxetine, fluvoxamine, nefazodone, or sertraline 1.
- SSRIs are associated with an increased risk for nonfatal suicide attempts compared with placebo 1.
- Most antidepressants take 2-6 weeks to reach full effectiveness, and patients should never stop taking them abruptly without medical supervision.
Finding the right medication often requires trial and error, as individual responses vary based on genetics, specific symptoms, and other health factors. It is essential to discuss the potential benefits and risks of each medication with a healthcare provider to determine the best course of treatment.
From the FDA Drug Label
12.1 Mechanism of Action The mechanism of antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT).
- 2 Pharmacodynamics In vitro and in vivo studies in animals suggest that escitalopram is a highly selective serotonin reuptake inhibitor (SSRI) with minimal effects on norepinephrine and dopamine neuronal reuptake.
Antidepressants with fewer side effects:
- Escitalopram: is a highly selective serotonin reuptake inhibitor (SSRI) with minimal effects on norepinephrine and dopamine neuronal reuptake, which may result in fewer side effects compared to other antidepressants.
- Sertraline: is another SSRI that may have fewer side effects, although its interaction with other drugs should be carefully considered.
Key points:
- SSRIs like escitalopram and sertraline may have fewer side effects due to their selective mechanism of action.
- However, careful consideration of potential interactions with other drugs is necessary when prescribing these medications.
- The FDA drug label for escitalopram 2 and sertraline 3 provides information on their mechanism of action, pharmacodynamics, and potential interactions.
From the Research
Antidepressants with Fewer Side Effects
Some antidepressants are known to have fewer side effects compared to others. These include:
- Selective Serotonin Reuptake Inhibitors (SSRIs) such as sertraline, paroxetine, and fluoxetine 4
- Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) like duloxetine and milnacipran, which appear to be better tolerated than venlafaxine 5
SSRIs and Their Efficacy
SSRIs have been found to be effective in treating a broad range of psychiatric illnesses, including:
- Major depression
- Anxiety disorders
- Bulimia
- Dysthymia 6 They have a favorable adverse effect profile, making them a first-line treatment for many of these conditions 4
SNRIs and Their Benefits
SNRIs have been shown to be helpful in relieving chronic pain associated with and independent of depression 5. They also have a broader spectrum of efficacy beyond major depression, including anxiety disorders and other conditions 6
Comparison of Antidepressants
While SSRIs and SNRIs are generally well-tolerated, some antidepressants like tricyclic antidepressants and monoamine oxidase inhibitors have significant adverse effects and safety issues 4. Newer antidepressants like vilazodone have also been introduced, with comparable clinical efficacy and good tolerability 7
Treatment of Chronic Pain with SSRIs
SSRIs have been suggested as an alternative treatment for chronic pain due to their better tolerability and fewer side effects compared to other antidepressants 8. However, the effectiveness of SSRIs as a treatment for chronic pain conditions is still inconclusive and requires further clinical trials 8