Category:Antidepressants

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Contents

Chemical Differences

Click here for a diagram illustrating the structural relationship between the various antidepressant drugs

Clinical Differences

A guide for choosing between the drugs is given in the article on depression.

Efficacy versus acceptability

This has been studied and the clinical trial evidence suggests some first choice agents. Amitriptyline might be a resource effective choice as of 2018. This is because of its likely relative cost and that amongst 21 drugs amitriptyline has the most efficacy against placebo. The order was

  1. Amitriptyline
  2. Mirtazapine
  3. Duloxetine
  4. Venlafaxine
  5. Paroxetine
  6. Milnacipran
  7. Fluvoxamine
  8. Escitalopram
  9. Nefazodone
  10. Sertraline
  11. Vortioxetine
  12. Agomelatine
  13. Vilazodone
  14. Levomilnacipran
  15. Bupropion
  16. Fluoxetine
  17. Citalopram
  18. Trazodone
  19. Clomipramine
  20. Desvenlafaxine
  21. Reboxetine

Patient tolerability is in the following order:

  1. Agomelatine (significantly more tolerable than placebo)
  2. Fluoxetine (significantly more tolerable than placebo)
  3. Escitalopram
  4. Nefazodone
  5. Citalopram
  6. Amitriptyline
  7. Paroxetine
  8. Milnacipran
  9. Sertraline
  10. Bupropion
  11. Mirtazapine
  12. Vortioxetine
  13. Venlafaxine
  14. Desvenlafaxine
  15. Duloxetine
  16. Fluvoxamine
  17. Vilazodone
  18. Trazodone
  19. Reboxetine
  20. Levomilnacipran
  21. Clomipramine(significantly less tolerable than placebo)

In head to head comparison vortioxetine, escitalopram, bupropion, mirtazapine, amitriptyline and agomelatine have the best efficacy and tolerability relative to reboxetine. [1]

References