I was hoping you could help me choose between the different types of antidepressants.

Patient: I was hoping you could help me choose between the different types of antidepressants. I have seen 2 military MDs and one counselor but their opinion is to just try one out and keep changing if it does not work out. I would rather pick one that most closely matches what I need and stick with it. I am 34 years old and have been DX with PTSD and they are debating between Dysthymic Disorder and Atypical Depression. I have very successfully dealt with my symptoms for over 20 years without medicaton. However, I experienced several life events this summer and now need medication assistance. The symptoms that bother me the most are anger, irritability, fatigue, body aches and cravings for sweet foods leading to weight gain (approx 5-10 #).One MD prescribed Zoloft which helped a little but eliminated my libido and gave me headaches. The other MD prescribed Wellbutrin but I have not started it yet. I don’t want to start it then change because of side effects or it not working.

Optional Information
Gender: Female
Age: 34
Already Tried: Counseling has worked for 15+ years. Recently tried Zoloft for 2 months. It helped but was not enough. PLus it eliminated my libido and gave me headaches

Doctor: Hello Mam,

Sexual dysfunction is commonly reported with Zoloft which belongs to a SSRI class of drugs. Spontaneous remission occurs in approximately 10% of cases. If it does not happen the dose may be reduced or that particular drug could be changed.Usually switching of drug causing sexual side effect is done with a different drug that is less likely to cause the sexual side effect.

Wellbutrin may have the lowest risk of sexual dysfunction among the various antidepressants available. Another advantage of this drug is that weight gain is not expected with this drug although a minority patients do report it. Also it has shown good results in atypical depression specially in reduction of fatigue and hypersomnia.So Wellbutrin could be a good option in your case.

Another option if you don’t want to change Zoloft is to add another antidepressant such as Mirtazapine (generic name) in low dose to your current regime which may reverse the Zoloft induced sexual side effects as seen clinically and also it has a good antidepressant effect and the combination would work fine if tolerated. But please note that Mirtazapine is known to cause weight gain.

I hope it helps.

If you have any related query, please feel free to ask.

Regards

Patient: I already stopped the Zoloft because of the low libido, headaches and it wasn’t enough to control my anger and irritability. I want to know which antidepressants are best at treating anger, irritability, body aches and fatigue and do not cause weight gain or low libido? The MDs I’ve seen don’t know which meds are better at treating different types of symptoms. They just want to try them all sequentially until one works. That could take months of switching medications (and dealing with side effects). I’d like to know which med or class of meds work best at treating my particular symptoms.

Much Thanks

Doctor: Well in that case as I mentioned earlier, Wellbutrin meets all your requirements. It does not cause weight gain, has very low side effects related to loss of libido, show good result in treatment of symptoms of atypical depression such as fatigue, body aches, irritability etc.

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