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Which Antidepressant to Choose?

There is a strange disconnect between what we psychiatrists do in daily practice and what official antidepressant treatment guidelines recommend. Treatment guidelines typically say, essentially, that all antidepressants are equal in efficacy, but real psychiatrists have strong personal preferences, based on some combination of the scientific literature, the advice of experts, our clinical experience, and perhaps even the personalities of the last drug reps we saw in the office. In this article we review a range of evidence to come up with suggestions for which antidepressants to start with, as well as adding bonus material on how to start meds that many of us may have little experience with, namely the tricyclics and the MAOIs.

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