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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Ronald C. Albucher, MD, is the director of counseling and psychological services and clinical assistant professor of psychiatry, Stanford University in Palo Alto, CA.
Steve Balt, MD is a psychiatrist in private practice in the San Francisco Bay area.
Richard Gardiner, MD, is a psychiatrist in private practice in Potter Valley, CA.
Alan D. Lyman, MD, is a child and adolescent psychiatrist in private practice in New York City, NY.
James Megna, MD, PhD, is the director of inpatient psychiatry and an associate professor of psychiatry and medicine at SUNY Upstate Medical University in Syracuse, NY.
Robert L. Mick, MD, is a contract physician in addiction medicine and military psychiatry in Bloomfield, NY.
Michael Posternak, MD, is a psychiatrist in private practice in Boston, MA.
Glen Spielmans, PhD, is an assistant professor of psychology at Metropolitan State University in St. Paul, MN.
Marcia L. Zuckerman, MD is director of Psychiatric Services at Walden Behavioral Care in Waltham, MA.
All editorial content is peer reviewed by the editorial board. Dr. Albucher, Dr. Balt, Dr. Gardiner, Dr. Goldberg, Dr. Lyman, Dr. Megna, Dr. Mick, Dr. Posternak, Dr. Spielmans, and Dr. Zuckerman have disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity. Dr. Balt discloses that his spouse is employed as a sales representative for Otsuka America, Inc.