Here is my personal view of the different personalities of depression, and possible treatments for each of them. The most prescribed antidepressants today belong to a group of medications called the SSRIs. To this group belongs Prozac, Effexor, Zoloft, Celexa, Lexapro, Paxil and others.
Depression (excluding psychotic depression) seems to come in two flavors: low energy depression or its anxious cousin. The type of depression you are experiencing should dictate your choice of medication. In addition to recommending psychotherapy, which is a crucial treatment component for sufferers of depression, when you come to me as a patient, I may decide to prescribe one of the SSRIs. In my view, it is important to match the pharmacologic effect of a particular medication with the type of depression being experienced.
The SSRIs each have their specific spectrum of effects. Prozac and Effexor tend to energize patients. Paxil, on the other hand, often has a calming effect. Zoloft, Celexa and Lexapro produce a more neutral effect. They may energize or calm, depending on a patient’s own biochemistry and sensitivity. Therefore, if you come to me with an anxious depression, I would probably prescribe one of the middle-of-the-road antidepressants or I might prescxribe Paxil to calm your anxiety.
Taking a more calming antidepressant may also keep you from having to take a sedating medication such as Ativan, Xanax, Buspar or Valium, as the calming effect you are looking for is already built into those particular SSRIs.
For the low energy depression, on the other hand, Prozac and Effexor might work better. Usually, I try to avoid giving an anxious patient an energizing SSRI because they may experience the energizing effect as an increase in anxiety. Obviously, this is something we will try to avoid.
Despite the science involved, prescribing psychiatric medications is still an art where intuition and experience play an important role in making the right choice.
Every physician will approach this task differently and each patient’s body and mind will respond differently. It is important to keep this in mind as you and your physician search for the correct medication that will relieve your unwanted symptoms of depression. In the end, your body and mind will make the best decision.