Background

If your doctor or mental health professional has diagnosed you with depression, you may need to take an antidepressant. Antidepressants can improve the symptoms of depression. But they can also cause serious side effects, so you don’t want to take one if you don’t have to.

The information in this report can help you decide—with your doctor or mental health professional—whether an antidepressant might be right for you, and if so, which one. To help you and your doctor choose the right one for you, Consumer Reports Best Buy Drugs has evaluated 12 of the most commonly prescribed antidepressant drugs based on their effectiveness, safety, and cost. This brief is a summary of a free 30-page report you can access on the Internet at CRBestBuyDrugs.org.

Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need an Antidepressant?

Here’s a thumbnail guide to help you decide if you should consider medication:

  • It is normal to feel "down" or "blue" in the wake of a stressful life event, such as the death of someone close, a divorce, or a job loss. If you are still able to function and have no history of depression, your symptoms will usually ease on their own within a few months, aided, if necessary, by family support and professional counseling, without the use of an antidepressant.
  • If you are not functioning well and your symptoms have lasted for a few weeks, you are more likely to be a candidate for an antidepressant. That is especially true if there is no apparent reason for you to be depressed or if you have had repeated episodes of depression.

Symptoms of Depression

People experience depression symptoms differently. But generally, if you have five or more of the following symptoms persistently for several weeks or longer, you may have serious or so-called "major" depression that could warrant treatment with medication. That is especially likely if you have a history of depression and there has been no "triggering" event or trauma in your life, such as a death in the family, a job loss, a divorce, or marital problems.

  • Decreased energy, fatigue, feeling "slowed down"
  • Depressed mood
  • Difficulty concentrating or making decisions
  • Feeling restless or fidgety
  • Feelings of worthlessness or inappropriate guilt
  • Insomnia, early-morning awakening, or oversleeping
  • Loss of interest or pleasure in hobbies, work, and activities you usually enjoy, including sex
  • Recurrent thoughts of death or suicide; suicide attempts
  • Substantial weight loss or gain or appetite changes (eating significantly less or more)

The bottom line is this:

  • If you have some of the symptoms listed above but they are not particularly severe and you are functioning OK in life, you may have mild depression. If your "blues" seem to be triggered by a specific event, trauma, or transition in your life but you have no history of depression, you may also have mild "situational" depression. In both cases, you should think twice before taking an antidepressant. Experts believe that too many people whose temporary depression can resolve on its own in a few weeks are prescribed an antidepressant.
  • If you have five or more of the symptoms listed above, for most of the time almost everyday for two weeks or longer—and you are not functioning well in life—you are likely a candidate for an antidepressant. This is true even if your depression was triggered by a life event or trauma, and is especially true if you have had previous episodes of depression. Millions of people who have such symptoms are not getting the treatment they need.
  • If you have experienced several of the symptoms listed above at a low-grade level for months, you should see a doctor or therapist. You may want to try psychotherapy or other counseling first, especially if your symptoms can be linked to a definable stressor (such as problems with your marriage, an unhappy work situation, or the illness of someone you care about). If that doesn’t help, consider an antidepressant.


Some studies have found—and many experts believe—that antidepressants often work best in combination with psychotherapy lasting at least several months. But antidepressants on their own play an important role in our culture. That’s because not everyone has access to, can afford, or accepts that psychotherapy can help. On the other hand, many people prefer to try psychotherapy alone, or they are afraid of the side effects and skeptical of the benefits of antidepressant drugs. We would encourage you to seek out whichever type of treatment or combination of treatments you are most comfortable with.

Possible Side Effects

Relatively minor side effects that usually go away in time or are short-lived:

  • Diarrhea
  • Dizziness
  • Dry mouth
  • Headaches
  • Nausea
  • Sweating
  • Tremors

More serious side effects that can be annoying or dangerous. If they persist, you may need to switch drugs:

  • Drowsiness or confusion
  • Feeling of panic or dread
  • Increased thoughts of suicide
  • Insomnia
  • Loss of libido, difficulty achieving erections, inability to reach orgasm
  • Nervousness and agitation
  • Weight gain

Our Recommendations

Second-generation antidepressants have been proven to help relieve the symptoms of depression in 55 to 70 percent of the people who take them. None have clearly been shown to be any more effective in relieving symptoms or bringing about a full recovery than any other when taken in comparable doses. But they do cause different side effects, so your choice may be based on the particular side effects a drug causes and costs. You should also know that people respond to antidepressants differently, so it’s not uncommon to try two or three before finding one that works.

Taking effectiveness, safety, side effects, and cost into account, we have chosen five Consumer Reports Best Buy Drugs as initial options to consider for depression:

These medicines are substantially less expensive than brand-name antidepressants and are equally as effective. Both bupropion and escitalopram are more expensive than the others, so if cost is a concern, that may be something to consider when choosing an antidepressant for the first time. If you have drug coverage, talk with your doctor about finding the antidepressant that has the lowest out-of-pocket cost under your insurance plan.


Other important considerations:

  • Start with the lowest therapeutic dose. If it doesn’t help within six to eight weeks or causes side effects, talk with your doctor about changing the dose or switching to another antidepressant.
  • If you took an antidepressant before and it worked, you may want to stick with that one.
  • Tell your doctor whether the differences in side effects among the antidepressants are important to you.
  • If you already take an antidepressant and it is working for you, we don’t recommend that you switch to another one.

This report was published in September 2013.

Cost Comparison

Note: If the price box contains a

, that indicates the dose of that drug may be available for a low monthly cost through programs offered by large chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

Generic Name and Strength

Brand NameA

Frequency of UseB

Average Monthly CostC

Bupropion 75 mg tablet

Wellbutrin

Three a day

$289

Bupropion 75 mg tablet

Generic

Three a day

$64

Bupropion 100 mg tablet

Wellbutrin

Three a day

$357

Bupropion 100 mg tablet

Generic

Three a day

$80

Bupropion 100 mg sustained-release tablet

Wellbutrin SR

Two a day

$280

Bupropion 100 mg sustained-release tablet

Budeprion SR

Two a day

$104

Bupropion 100 mg sustained-release tablet

Generic

Two a day

$62

Bupropion 150 mg extended-release tablet

Wellbutrin XL

One a day

$276

Bupropion 150 mg extended-release tablet

Budeprion XL

One a day

$158

Bupropion 150 mg extended-release tablet

Generic

One a day

$80

Bupropion 150 mg sustained-release tablet

Wellbutrin SR

Two a day

$294

Bupropion 150 mg sustained-release tablet

Budeprion SR

Two a day

$99

Bupropion 150 mg sustained-release tablet

Generic

Two a day

$63

Bupropion 200 mg sustained-release tablet

Wellbutrin SR

Two a day

$541

Bupropion 200 mg sustained-release tablet

Generic

Two a day

$140

Bupropion 300 mg extended-release tablet

Wellbutrin XL

One a day

$406

Bupropion 300 mg extended-release tablet

Budeprion XL

One a day

$141

Bupropion 300 mg extended-release tablet

Generic

One a day

$81

Bupropion 174 mg extended-release tablet

Aplenzin

One a day

$339

Bupropion 348 mg extended-release tablet

Aplenzin

One a day

$468

Bupropion 522 mg extended-release tablet

Aplenzin

One a day

$1,053

Citalopram 10 mg tablet

Celexa

One a day

$179

Citalopram 10 mg tablet

Generic

One a day

$32

Citalopram 20 mg tablet

Celexa

One a day

$192

Citalopram 20 mg tablet

Generic

One a day

$25

Citalopram 40 mg tablet

Celexa

One a day

$195

Citalopram 40 mg tablet

Generic

One a day

$33

Citalopram 10 mg/ 5 mL oral solution

Generic

One dose per day

$61

Desvenlafaxine 50 mg sustained-release tablet

Pristiq

One a day

$196

Desvenlafaxine 100 mg sustained-release tabletD

Pristiq

One a day

$203

Duloxetine 20 mg capsule

Cymbalta

One a day

$226

Duloxetine 30 mg capsule

Cymbalta

One a day

$244

Duloxetine 60 mg capsule

Cymbalta

One a day

$247

Escitalopram 5 mg tablet

Lexapro

One a day

$193

Escitalopram 5 mg tablet

Generic

One a day

$86

Escitalopram 10 mg tablet

Lexapro

One a day

$171

Escitalopram 10 mg tablet

Generic

One a day

$87

Escitalopram 20 mg tablet

Lexapro

One a day

$183

Escitalopram 20 mg tablet

Generic

One a day

$88

Escitalopram 5 mg/ 5 mL oral solution

Generic

One dose per day

$121

Fluoxetine 10 mg capsule

Prozac

One a day

$257

Fluoxetine 10 mg capsule

Generic

One a day

$28

Fluoxetine 10 mg tablet

Generic

One a day

$49

Fluoxetine 20 mg capsule

Prozac

One a day

$260

Fluoxetine 20 mg capsule

Generic

One a day

$31

Fluoxetine 20 mg tablet

Generic

One a day

$31

Fluoxetine 40 mg capsule

Prozac

One a day

$535

Fluoxetine 40 mg capsule

Generic

One a day

$99

Fluoxetine 60 mg tablet

Generic

One a day

$94

Fluoxetine 90 mg delayed-release capsule

Prozac Weekly

One per week

$199

Fluoxetine 90 mg delayed-release capsule

Generic

One per week

$145

Fluoxetine 20 mg/5 mL oral solution

Generic

One dose per day

$80

Fluvoxamine 100 mg tablet

Generic

One a day

$45

Fluvoxamine 100 mg continuous-delivery capsule

Luvox CR

One a day

$463

Fluvoxamine 100 mg continuous-delivery capsule

Generic

One a day

$302

Fluvoxamine 150 mg continuous-delivery capsule

Luvox CR

One a day

$417

Fluvoxamine 150 mg continuous-delivery capsule

Generic

One a day

$316

Mirtazapine 7.5 mg tablet

Generic

One at bedtime

$69

Mirtazapine 15 mg tablet

Remeron

One at bedtime

$169

Mirtazapine 15 mg tablet

Generic

One at bedtime

$44

Mirtazapine 15 mg dissolvable tablet

Generic

One at bedtime

$63

Mirtazapine 30 mg tablet

Remeron

One at bedtime

$170

Mirtazapine 30 mg tablet

Generic

One at bedtime

$42

Mirtazapine 30 mg dissolvable tablet

Remeron

One at bedtime

$150

Mirtazapine 30 mg dissolvable tablet

Generic

One at bedtime

$70

Mirtazapine 45 mg tablet

Generic

One at bedtime

$42

Mirtazapine 45 mg dissolvable tablet

Generic

One at bedtime

$72

Paroxetine 10 mg tablet

Paxil

One a day

$144

Paroxetine 10 mg tablet

Pexeva

One a day

$260

Paroxetine 10 mg tablet

Generic

One a day

$21

Paroxetine 20 mg tablet

Paxil

One a day

$160

Paroxetine 20 mg tablet

Pexeva

One a day

$253

Paroxetine 20 mg tablet

Generic

One a day

$21

Paroxetine 30 mg tablet

Paxil

One a day

$171

Paroxetine 30 mg tablet

Pexeva

One a day

$263

Paroxetine 30 mg tablet

Generic

One a day

$38

Paroxetine 40 mg tablet

Paxil

One a day

$170

Paroxetine 40 mg tablet

Pexeva

One a day

$331

Paroxetine 40 mg tablet

Generic

One a day

$37

Paroxetine 12.5 mg sustained-release tablet

Paxil CR

One a day

$153

Paroxetine 12.5 mg sustained-release tablet

Generic

One a day

$94

Paroxetine 25 mg sustained-release tablet

Paxil CR

One a day

$168

Paroxetine 25 mg sustained-release tablet

Generic

One a day

$103

Paroxetine 37.5 mg sustained-release tablet

Paxil CR

One a day

$177

Paroxetine 37.5 mg sustained-release tablet

Generic

One a day

$110

Paroxetine 10 mg/5 mL oral suspension

Paxil

One dose per day

$151

Sertraline 25 mg tablet

Zoloft

One a day

$185

Sertraline 25 mg tablet

Generic

One a day

$33

Sertraline 50 mg tablet

Zoloft

One a day

$174

Sertraline 50 mg tablet

Generic

One a day

$29

Sertraline 100 mg tablet

Zoloft

One a day

$181

Sertraline 100 mg tablet

Generic

One a day

$33

Sertraline 20 mg/mL oral suspension

Generic

One a day

$159

Venlafaxine 25 mg tablet

Generic

Two a day

$89

Venlafaxine 37.5 mg tablet

Generic

Two a day

$83

Venlafaxine 50 mg tablet

Generic

Two a day

$93

Venlafaxine 75 mg tablet

Generic

Two a day

$78

Venlafaxine 100 mg tablet

Generic

Two a day

$99

Venlafaxine 37.5 mg sustained-release tablet

Generic

One a day

$119

Venlafaxine 75 mg sustained-release tablet

Generic

One a day

$108

Venlafaxine 150 mg sustained-release tablet

Generic

One a day

$120

Venlafaxine 225 mg sustained-release tablet

Generic

One a day

$270

Venlafaxine 37.5 mg continuous-delivery capsule

Effexor XR

One a day

$209

Venlafaxine 37.5 mg continuous-delivery capsule

Generic

One a day

$70

Venlafaxine 75 mg continuous-delivery capsule

Effexor XR

One a day

$223

Venlafaxine 75 mg continuous-delivery capsule

Generic

One a day

$100

Venlafaxine 150 mg continuous-delivery capsule

Effexor XR

One a day

$218

Venlafaxine 150 mg continuous-delivery capsule

Generic

One a day

$105

Selected doses are listed due to space limitations. For a more complete listing, see our full report at: CRBestBuyDrugs.org.

A. “Generic” indicates drug sold by generic name.

B. As typically prescribed.

C. Prices reflect nationwide retail average for May 2013, rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.
D. According to Pristiq’s drug label, "in clinical studies doses of 50-400 mg/day were shown to be effective although no additional benefit was demonstrated at doses greater than 50 mg/day and adverse events and discontinuations were more frequent at higher doses."

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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