Best Antidepressant: Information to discuss with your doctor

Which is the best antidepressant?

There are 3 important facts to remember about our current state of knowledge:-

We do not know what is wrong in depression.
We do not know how antidepressants fix depression
Therefore, there is no way of predicting which antidepressant will be “the best”.

Any antidepressant has the same unpredictable chance of producing the following results:

So, in the inevitable sequence of trial and error, please remember a few points

This site guides you to the antidepressants with the fewest side-effects in the clinical opinion of the author
The antidepressant with fundamentally no side-effects (Valdoxan, the one I would try first if I had depression..David Horgan) has been shown in a recent Cochrane review (the most prestigious reference source in Medicine in general) to be as effective as any other antidepressant.
Start with a low dose of any antidepressant for the first 2-4 days, especially in those under 25
If no brief periods of improvement occur in the first 3 weeks, it is 90% certain that antidepressant is never going to work in that patient, and a trial of another antidepressant is indicated.
Depression is like mental cancer, and needs prolonged “chemotherapy” to prevent it recurring (which will happen in 50% of cases), so antidepressants should be taken for 12 months initially according to research!
Keep long-term side-effects in mind, not reported in initial drug trials. 30-40% of patients on SSRIs or SNRIs will gain weight (mainly due to metabolic changes), 30-40% will develop sexual side-effects, and about 30% will develop withdrawal symptoms as if they were addicted.

Disclosure: I have received lecturing fees, consultancy fees and travel grants from multiple different pharmaceutical companies…David Horgan