What You Should Know

Will this medicine work for me?

• The antidepressants presented in this decision aid
all work the same for treating depression.
• Most people with depression can find one that can
make them feel better.
• 6 out of 10 people will feel better with the first
antidepressant they try and the rest will have to try
other antidepressants before they find the one that
is right for them.

How long before I feel better?

• Most people need to take an antidepressant regularly
for at least 6 weeks to begin to get the full effect.

Understanding side effects

• Most people taking antidepressants have at least
one side effect.
• Many side effects go away after a few weeks,
but some only go away after you stop the medicine.

Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-36rev0717
 Weight Change
Some people may experience weight change. It is most
likely to occur over six to twelve months and depends
on your actual weight. The chart below is based on a
150 lb person.

Weight loss Weight gain

(1 to 5 lbs) None (1 to 5 lbs)

Citalopram
SSRIs

(Celexa®)

Escitalopram
(Lexapro®)

Fluoxetine
(Prozac®)

Fluvoxamine
(Luvox®)

Paroxetine
(Paxil®)

Sertraline
(Zoloft®)

Desvenlafaxine
SNRIs

(Pristiq®)

Duloxetine
(Cymbalta®)

Venlafaxine
(Effexor®)

Bupropion
Others

(Wellbutrin®)

Mirtazapine
(Remeron®)

Amitriptyline
TCAs

or Nortriptyline
(Elavil® or Aventyl HCI®)

Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-37rev0717
 Stopping Approach
Quitting your medicine all at once can make you feel
sick, as if you had the flu (e.g. headache, dizziness,
light-headedness, nausea or anxiety).

More Sick if
None
likely you skip

Citalopram
SSRIs

(Celexa®)

Escitalopram
(Lexapro®)

Fluoxetine
(Prozac®)

Fluvoxamine
(Luvox®)

Paroxetine
(Paxil®)

Sertraline
(Zoloft®)

Desvenlafaxine
SNRIs

(Pristiq®)

Duloxetine
(Cymbalta®)

Venlafaxine
(Effexor®)

Bupropion
Others

(Wellbutrin®)

Mirtazapine
(Remeron®)

Amitriptyline
TCAs

or Nortriptyline
(Elavil® or Aventyl HCI®)

Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-38rev0717
 Cost
These figures are estimates and are for comparative
reference only. Actual out-of-pocket costs vary over time,
by pharmacy, insurance plan coverage, preparation
and dosage.

Less More

$4 / month – Super-
Citalopram
SSRIs

stores drug program

(Celexa®)

Escitalopram $100 / month

(Lexapro®)
$4 / month – Super-
Fluoxetine stores drug program
(Prozac®)

Fluvoxamine $75 / month

(Luvox®)

$4 / month – Super-
Paroxetine stores drug program
(Paxil®)

Sertraline $25 / month

(Zoloft®)

$150 / month –
Desvenlafaxine
SNRIs

No generic available
(Pristiq®)

Duloxetine $150 / month

(Cymbalta®)

Venlafaxine $125 / month

(Effexor®)
Others

Bupropion $50 / month

(Wellbutrin®)

Mirtazapine $50 / month

(Remeron®)

$4 / month – Super-
Amitriptyline
TCAs

stores drug program

or Nortriptyline
(Elavil® or Aventyl HCI®)

Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-39rev0717
 Sexual Issues
Some people may experience loss of sexual desire
(libido) or loss of ability to reach orgasm because
of their antidepressant.

Less Normal More

libido libido

Citalopram
SSRIs

(Celexa®)

Escitalopram
(Lexapro®)

Fluoxetine
(Prozac®)

Fluvoxamine
(Luvox®)

Paroxetine
(Paxil®)

Sertraline
(Zoloft®)

Desvenlafaxine
SNRIs

(Pristiq®)

Duloxetine
(Cymbalta®)

Venlafaxine
(Effexor®)

Bupropion
Others

(Wellbutrin®)

Mirtazapine
(Remeron®)

Amitriptyline
TCAs

or Nortriptyline
(Elavil® or Aventyl HCI®)

Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-40rev0717
 Sleep

Some people may experience sleepiness or insomnia

because of their antidepressant.

Insomnia Sleepiness

Citalopram
SSRIs

(Celexa®)

Escitalopram
(Lexapro®)

Fluoxetine
(Prozac®)

Fluvoxamine
(Luvox®)

Paroxetine
(Paxil®)

Sertraline
(Zoloft®)

Desvenlafaxine
SNRIs

(Pristiq®)

Duloxetine
(Cymbalta®)

Venlafaxine
(Effexor®)

Bupropion
Others

(Wellbutrin®)

Mirtazapine
(Remeron®)

Amitriptyline
TCAs

or Nortriptyline
(Elavil® or Aventyl HCI®)

Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-41rev0717
 Keep in Mind
Depression medicines may cause some:
• constipation, diarrhea and nausea
• increased risk of suicidal thoughts and behaviors (18- to 24-year-olds)
• harm to an unborn child
• risk of developing serotonin syndrome, a potentially life-threatening condition
• possible drug-drug interactions

Additional considerations
Citalopram Can cause problems with your heart
SSRIs

(Celexa®)

Escitalopram Currently no other issues

(Lexapro®)

Fluoxetine More likely to interact with other drugs you are taking
(Prozac®)

Fluvoxamine More likely to cause constipation, diarrhea or nausea

(Luvox®) Not officially recognized as a treatment for Major
Depressive Disorder

Paroxetine If you are pregnant, this medicine is more likely to cause

(Paxil®) problems with your unborn child

Sertraline More likely to cause diarrhea

(Zoloft®)

Desvenlafaxine Tell your doctor if you have high blood pressure

SNRIs

(Pristiq®)

Duloxetine Can help with pain

(Cymbalta®) Tell your doctor if you have high blood pressure

Venlafaxine More likely to cause nausea and vomiting

(Effexor®) Can cause problems with your heart
Tell your doctor if you have high blood pressure
Others

Bupropion Higher risk of seizures

(Wellbutrin®)

Mirtazapine Starts to work more quickly

(Remeron®)

Amitriptyline More likely to cause constipation, diarrhea or nausea

TCAs

or Nortriptyline Can help with pain

(Elavil® or Aventyl HCI®) If you are elderly, this medication may not be
the best option

Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-42rev0717
What You Should Know Sleep Weight Change Stopping Approach
What You Should Know Sleep Stopping Approach
Approach
Weight Change Stopping
Will this medicine work for me? Some people may experience sleepiness or insomnia Some people may experience weight change. It is most Quitting your medicine all at once can make you feel
because of their antidepressant. likely to occur over six to twelve months and depends Quitting
sick, asyour medicine
if you had the all
flu at once
(e.g. can make
headache, you feel
dizziness,
• The antidepressants presented in this decision aid on your actual weight. The chart below is based on a sick, as if you had the flu (e.g.
light-headedness, nausea or anxiety).headache, dizziness,
all work the same for treating depression. 150 lb person. light-headedness, nausea or anxiety).
• Most people with depression can find one that can Insomnia Sleepiness More Sick if
make them feel better. Weight loss Weight gain None More Sickskip
if
None likely you
(1 to 5 lbs) None (1 to 5 lbs) likely you skip
• 6 out of 10 people will feel better with the first Citalopram

SSRIs
antidepressant they try and the rest will have to try Citalopram

SSRIs
(Celexa®)
Citalopram

SSRIs
Citalopram

SSRIs
other antidepressants before they find the one that (Celexa®)
is right for them. Escitalopram (Celexa®)
(Celexa®)
(Lexapro®) Escitalopram
Escitalopram Escitalopram
(Lexapro®)
Fluoxetine (Lexapro®)
(Lexapro®)
How long before I feel better? (Prozac®) Fluoxetine
Fluoxetine Fluoxetine
(Prozac®)
• Most people need to take an antidepressant regularly Fluvoxamine (Prozac®)
(Prozac®)
for at least 6 weeks to begin to get the full effect. (Luvox®) Fluvoxamine
Fluvoxamine Fluvoxamine
(Luvox®)
Paroxetine (Luvox®)
(Luvox®)

Understanding side effects (Paxil®) Paroxetine

Paroxetine Paroxetine
(Paxil®)
• Most people taking antidepressants have at least Sertraline (Paxil®)
(Paxil®)

one side effect. (Zoloft®) Sertraline

Sertraline Sertraline
(Zoloft®)
Desvenlafaxine
SNRIs

• Many side effects go away after a few weeks, (Zoloft®)

(Zoloft®)
Desvenlafaxine

SNRIs
(Pristiq®)
but some only go away after you stop the medicine.
Desvenlafaxine

SNRIs
Desvenlafaxine

SNRIs
(Pristiq®)
Duloxetine (Pristiq®)
(Pristiq®)
(Cymbalta®) Duloxetine
Duloxetine Duloxetine
(Cymbalta®)
Venlafaxine (Cymbalta®)
(Cymbalta®)
(Effexor®) Venlafaxine
Venlafaxine Venlafaxine
(Effexor®)
(Effexor®)
Bupropion
Others

(Effexor®)
Bupropion

Others
(Wellbutrin®)
Bupropion

Others
(Wellbutrin®)
Bupropion

Others
(Wellbutrin®)
Mirtazapine (Wellbutrin®)
(Remeron®) Mirtazapine
Mirtazapine
(Remeron®)
Mirtazapine (Remeron®)
(Remeron®)
Amitriptyline
TCAs

Amitriptyline

TCAs
or Nortriptyline
orAmitriptyline

TCAs
Amitriptyline Nortriptyline
(Elavil® or Aventyl HCI®) or(Elavil®
Nortriptyline

TCAs
or Aventyl HCI®)
or Nortriptyline (Elavil® or Aventyl HCI®)
(Elavil® or Aventyl HCI®)

Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-36rev0717
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-41rev0717 Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-37rev0717 © Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-38rev0717
Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-38rev0717
 Sexual Issues
Sexual Issues Cost
Cost Keep
KeepininMind
Mind
Some people may experience loss of sexual desire These figures are estimates and are for comparative Depression medicines may cause some:
(libido) or loss of ability to reach orgasm because reference only. Actual out-of-pocket costs vary over time, • constipation, diarrhea and nausea
of their antidepressant. by pharmacy, insurance plan coverage, preparation • increased risk of suicidal thoughts and behaviors (18- to 24-year-olds)
and dosage. • harm to an unborn child
• risk of developing serotonin syndrome, a potentially life-threatening condition
Less Normal More
• possible drug-drug interactions
libido libido Less More
Additional considerations
$4 / month – Super-
Citalopram Citalopram

SSRIs
Can cause problems with your heart
Citalopram
SSRIs

stores drug program

SSRIs
(Celexa®) (Celexa®)
(Celexa®)

Escitalopram $100 / month Escitalopram Currently no other issues

Escitalopram (Lexapro®)
(Lexapro®)
(Lexapro®)
Fluoxetine More likely to interact with other drugs you are taking

MAKING WISER CHOICES

$4 / month – Super-
Fluoxetine Fluoxetine stores drug program (Prozac®)
(Prozac®)
(Prozac®)
Fluvoxamine
ABOUT MEDICINES
More likely to cause constipation, diarrhea or nausea

Fluvoxamine Fluvoxamine $75 / month (Luvox®) Not officially recognized as a treatment for Major
(Luvox®) (Luvox®) Depressive Disorder

Paroxetine $4 / month – Super- Paroxetine If you are pregnant, this medicine is more likely to cause
Paroxetine (Paxil®)
stores drug program (Paxil®) problems with your unborn child A take-home guide to help patients
(Paxil®)
Sertraline More likely to cause diarrhea compare depression medicines.
Sertraline Sertraline $25 / month (Zoloft®)
(Zoloft®) (Zoloft®)

$150 / month – Desvenlafaxine Tell your doctor if you have high blood pressure

SNRIs
Desvenlafaxine Desvenlafaxine
SNRIs

SNRIs

No generic available (Pristiq®)

(Pristiq®) (Pristiq®)
Duloxetine Can help with pain
Duloxetine Duloxetine $150 / month
(Cymbalta®) Tell your doctor if you have high blood pressure
(Cymbalta®) (Cymbalta®)

Venlafaxine Venlafaxine $125 / month Venlafaxine More likely to cause nausea and vomiting
(Effexor®) (Effexor®) (Effexor®) Can cause problems with your heart
Tell your doctor if you have high blood pressure
Bupropion
Others

Others

Bupropion $50 / month

(Wellbutrin®) (Wellbutrin®)

Others
Bupropion Higher risk of seizures
Mirtazapine Mirtazapine $50 / month
(Wellbutrin®)
(Remeron®) (Remeron®)
Mirtazapine Starts to work more quickly
(Remeron®)
$4 / month – Super- This information reflects the best available
Amitriptyline Amitriptyline
TCAs

stores drug program research studies. It was prepared by

TCAs

or Nortriptyline or Nortriptyline Amitriptyline More likely to cause constipation, diarrhea or nausea

TCAs
(Elavil® or Aventyl HCI®) (Elavil® or Aventyl HCI®) or Nortriptyline Can help with pain Mayo Clinic researchers without funding
(Elavil® or Aventyl HCI®) If you are elderly, this medication may not be from makers of depression medicines.
the best option

Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-40rev0717 © Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-39rev0717 Makers of this aid have no financial relationships with pharmaceutical or device manufacturers. Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved. MC5733-42rev0717

Makers of this aid have no financial relationships with pharmaceutical or device manufacturers.
Details at shareddecisions.mayoclinic.org
© Mayo Foundation for Medical Education and Research. Updated 2017. All rights reserved.
MC5733-43rev0717