"If a patient has insomnia, you would pick something more immediately sedating," said Schlager, who is also a psychiatrist with Lone Star Circle of Care in Austin. "If the patient has decreased appetite and weight loss, you would pick something more likely to cause weight gain like mirtazapine."
Cost, of course, is another consideration.
"If one drug costs $200 a month and another costs $20, I don't see any reason why not to go with the latter," said Dr. Radu Saveanu, a professor of psychiatry at the University of Miami Miller School of Medicine.
Dosing is also important, he said, "because studies have shown that if patients have to take the drug less frequently, compliance is higher, which will make a big difference in terms of efficacy."
But given the similarity in effectiveness, prescribing antidepressants is still largely a trial-and-error process.
It's hoped that the next series of studies will provide guidance on which medications to try first.
"The real heart of the matter is, if they don't respond to one type of antidepressant, is there any guidelines about what you should try next?" Schlager said.
The U.S. National Library of Medicine has more on antidepressants.
SOURCES: Radu V. Saveanu, M.D., professor, psychiatry, University of Miami Miller School of Medicine; David Schlager, M.D., clinical assistant professor, psychiatry and behavioral science, Texas A&M Health Science Center College of Medicine, and psychiatrist, Lone Star Circle of Care, Austin; Dec. 6, 2011, Annals of Internal Medicine
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