The Best Antidepressants for Anxiety and Depression

Anxiety and depression are two of the most common mental health conditions. Anxiety can feel like constant worry, restlessness, or even shortness of breath during stressful situations. Depression may show up as persistent sadness, fatigue, or struggling to find the joy in things you used to enjoy.

Antidepressants are one of the most common treatment options for depression and anxiety symptoms. However, finding the right one for your symptoms can depend on your lifestyle, your medical history, and more.

We’ve laid out some common antidepressant options below, along with tips on choosing the best one.

How do antidepressants treat depression and anxiety?

Antidepressants help improve your mood by adjusting the levels of neurotransmitters in the brain. Examples of neurotransmitters include serotonin, norepinephrine and dopamine.

Most antidepressants take 6-8 weeks to build up their full effect and are better for long-term management. In some cases, however, your doctor might prescribe short-acting medications until longer-acting antidepressants start working.

What are the types of antidepressants?

There are five main types of antidepressant medications, and they all work a little differently. Here’s what you need to know about how they work, when they’re usually prescribed, and their side effects:

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are usually one of the first medications that doctors prescribe. This is because they’re very effective and aren't as likely to cause withdrawal symptoms as other antidepressants. This means that if you ever need to stop taking them, your body usually has an easier time adjusting.

SSRIs work by helping serotonin stay active in the brain for longer, which then helps improve your move. Common side effects of SSRIs include nausea, headaches, weight changes, sleep problems, and sexual dysfunction.

Some of the most common SSRIs include:

• Citalopram, also known as Celexa
• Escitalopram, also known as Lexapro
• Fluoxetine, also known as Prozac
• Sertraline, also known as Zoloft
• Paroxetine, also known as Paxil
• Vilazodone, also known as Viibryd
• Fluvoxamine, also known as Fluvox

Selective norepinephrine reuptake inhibitors (SNRIs)

Selective norepinephrine reuptake inhibitors (SNRIs) are a first-line treatment for people with anxiety, depression and chronic pain. They work by increasing levels of both serotonin and norepinephrine.

Together, serotonin and norepinephrine can help improve mood and nerve pain related to diabetes, fibromyalgia and more. Common side effects of SNRIs include dry mouth, high blood pressure, nausea, headaches, weight changes, sleep problems, and sexual dysfunction.

Some of the most common SNRIs include:

• Desvenlafaxine, also known as Pristiq
• Duloxetine DR, also known as Cymbalta
• Venlafaxine, also known as Effexor
• Venlafaxine ER, also known as Effexor ER
• Levomilnacipran, also known as Fetzima

Atypical antidepressants

Atypical antidepressants all work differently to balance neurotransmitter levels in the brain. If SSRIs or SNRIs are causing side effects like sexual dysfunction or insomnia, atypical antidepressants may be a better option for you.

For example, bupropion (Wellbutrin) is less likely to cause weight gain than other antidepressants. Trazadone (Desyrel) usually causes fewer problems with sexual desire and performance compared to other options. Your healthcare provider can help you decide on the best one for your needs.

Some of the most common atypical antidepressants include:

• Bupropion SR, also known as Wellbutrin SR
• Bupropion XL, also known as Wellbutrin XL
• Trazadone, also known as Desyrel
• Mirtazapine, also known as Remeron

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants are an older type of antidepressant. They’re not typically prescribed unless other newer antidepressants aren’t working. They may also be prescribed if you're struggling with insomnia, since they've been shown to improve sleep quality.

TCAs work by affecting many neurotransmitters, including serotonin, histamine, and acetylcholine. Because of this, they tend to have more side effects and interactions.

Common side effects of TCAs include dry mouth, heart palpitations, dizziness, increased sweating and constipation. They can also cause blurred vision, trouble urinating, sexual dysfunction, and weight gain.

Some of the most common TCAs include:

• Amitriptyline, also known as Endep
• Nortriptyline, also known as Pamelor
• Clomipramine, also known as Anafranil
• Doxepin, also known as Silenor
• Imipramine, also known as Tofranil

Monoamine oxidase inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) were the first type of antidepressant to be developed. They are rarely prescribed by healthcare providers anymore. This is because they have a much higher potential to interact with medications and foods than newer antidepressants.

These drugs work by blocking the action of monoamine oxidase, a chemical that removes neurotransmitters like serotonin and dopamine from the brain. By blocking this action, MAOI medication keeps these mood-regulating chemicals in the brain longer. This helps reduce the symptoms of depression.

Some of the most common MAOIs include:

• Selegline
• Phenelzine
• Isocarboxazid
• Tranylcypromine

Combination medications

Combination medications are not technically a type of antidepressant. However, if one antidepressant isn’t treating your symptoms, your doctor might prescribe a combination of medications. This treatment strategy involves using two or more medications together.

These combinations can include two antidepressants from different classes. Your provider might also pair an antidepressant with another type of medication, like an antipsychotic. The goal is to target multiple neurotransmitter systems at once. This can sometimes lead to better symptom relief.

Some of the most common combination medications include:

• SSRI + bupropion (Wellbutrin): a combination that’s often used to improve energy, motivation, and reduce sexual side effects from SSRIs
• SSRI or SNRI + mirtazapine (Remeron): this combination may provide stronger effects for treatment-resistant depression
• Antidepressant + antipsychotic (e.g., aripiprazole, quetiapine): a combination that’s sometimes prescribed for treatment-resistant depression
• Antidepressant + mood stabilizer (e.g., lithium, lamotrigine): a combination that’s sometimes used for people with recurrent or treatment-resistant depression.

How to choose the best antidepressant for your anxiety and depression

Given how many antidepressants are out there, choosing the right one can feel overwhelming. However, there are some practical things you and your doctor can consider to make the process smoother.

The tips below can help you think about the factors that matter most to you, so you feel more confident and prepared when talking with your provider.

• Think about how side effects fit into your daily life. Every antidepressant has the potential for side effects. These can include energy changes, sleep changes or sexual side effects. Consider how these side effects could affect your day-to-day routine.
  
  For instance, antidepressants like bupropion, venlafaxine, and TCAs are usually taken 2-3 times a day. If you’re very busy (or forgetful), you might want to discuss a “once-a-day” medication with your doctor instead. If you struggle with social anxiety, Zoloft may be better than Prozac at helping improve it. And if you struggle with sleeping, a medication that makes you more energized or activated might make it harder to get a good night’s sleep.
  
  Communicating these routines and preferences can guide your provider towards a medication with side effects that won’t be as disruptive to your lifestyle.
• Look at your personal history (and your family’s). Your past experiences matter. If you’ve tried a medication before and it helped your symptoms, that’s important to share with your doctor! And if that medication causes problems, that’s important to share, too.
  
  Family history and genetics may also play a role in how effective a medication can be. Some research suggests that if one of your parents or siblings responded well to a certain antidepressant, you may be more likely to do well on it, too.
  
  Because of this, your doctor may recommend a test to see how your body metabolizes different medications to help guide your treatment.
• Consider your other health conditions. If you have additional health concerns (like chronic pain or migraines) certain antidepressants may help with those as well. But on the other hand, some antidepressants can make those conditions worse. This is why sharing your full medical history with your prescriber is so important.
• Factor in your costs and health coverage. Some antidepressants can be pricey, especially newer ones. Ask your provider about generic medications, which are just as effective and much more affordable.
  
  You can also check your insurance company’s drug formulary to see which antidepressants are covered. That way, you don’t run into any surprise costs. And if your insurance doesn’t cover the medication you need, try using a prescription savings card. These can help you save on the price of your medication at the pharmacy checkout.

The bottom line is that the "best" antidepressant is the one that fits your symptoms, your body, your lifestyle, and your budget. However, open communication with your doctor can help you get closer to a medication that supports your well-being.

Tips for starting on an antidepressant

Starting an antidepressant can be a big step, and it’s important to go into it with patience.

These medications don’t work overnight. In fact, it’s fairly common for symptom improvements to take 6–8 weeks. As you begin treatment, keep these tips in mind:

• Stay in touch with your prescriber. Regular check-ins help your doctor know whether the medication is working. They also offer insight into how you’re feeling, and whether dose adjustments are needed. Don’t wait until things feel unbearable. Bring up concerns early, no matter how small they may seem.
• Expect some trial and error. Finding the right antidepressant isn’t always instant. You and your prescriber may need to try out dose adjustments or different medications before finding a good fit. This is a normal process, so don’t let yourself feel discouraged. Narrowing down the right choice takes time and teamwork.
• Taper with medication supervision. If you and your provider decide it’s time to switch medications or stop altogether, always taper gradually under medical supervision. Stopping suddenly can cause withdrawal-like symptoms and may worsen anxiety or depression in the short term.
• Combine medication with therapy. Research shows that antidepressants can be more effective if you pair them with psychotherapy. Talking with a mental health professional can give you tools for coping, understanding patterns, and working through challenges medication alone can’t address.
• Monitor for changes in your mood or suicidal thoughts. All antidepressants carry an increased of suicidal thoughts and behaviors, especially for those under 25. You should reach out to your provider immediately if you notice any increased agitation, restlessness, or thoughts of self-harm.
• Support your body with a healthy routine. Research shows that quality sleep, balanced nutrition, and regular physical activity are incredibly important for your brain health. Even small steps can make a noticeable difference in your mood over time. Try cutting back on screen time before bed or fitting in a short walk after work.

How Sesame can help

If you’re trying to decide on the best antidepressant for your depression or anxiety, a provider on Sesame can help through Mental Health Rx.

Mental Health Rx is a monthly service that makes it simple and affordable to connect with a licensed healthcare provider for prescriptions, dose adjustments and more. Plus, your provider is available for same-dayRx refills, messaging and ongoing care—so you'll always have your medication when you need it!