Medications for Depression and Anxiety

First-Line Medications

The American Academy of Internal Medicine recommends selective serotonin reuptake inhibitors (SSRIs) as first-line treatment for depression and anxiety, with sertraline being a good option due to its efficacy and favorable side effect profile 1, 2, 3
Sertraline is effective for both depression and anxiety, with better efficacy for melancholia and psychomotor agitation compared to other SSRIs 3, 4
Fluoxetine has a longer half-life, which can be beneficial for patients who occasionally miss doses, and is FDA approved for depression in children/adolescents aged 8 years or older 5
Paroxetine is effective for multiple anxiety disorders but has a higher risk of discontinuation syndrome 6, 2
Citalopram/Escitalopram may have fewer drug-drug interactions than other SSRIs, but citalopram requires caution with doses exceeding 40 mg/day due to QT prolongation risk 6, 5

Mirtazapine has a faster onset of action than SSRIs and may be more effective than fluoxetine, with beneficial effects on insomnia due to its sedative effects 8, 4
Bupropion is an option for patients with depression and minimal anxiety, with less sexual side effects than SSRIs 9
Trazodone is often used at lower doses for insomnia in depressed patients and shows improvement in sleep scores compared to fluoxetine and venlafaxine 2, 3

The American Academy of Child and Adolescent Psychiatry suggests starting with lower doses for anxiety disorders as SSRIs can initially increase anxiety symptoms, and increasing dose in small increments at 1-2 week intervals for shorter half-life SSRIs and 3-4 week intervals for longer half-life SSRIs 6
Higher doses may be needed for certain anxiety disorders like OCD compared to depression 5
Combination treatment (CBT plus SSRI) is suggested over monotherapy for children and adolescents with anxiety disorders 6, 10
No significant differences in efficacy of second-generation antidepressants based on age, sex, or race/ethnicity have been found 2
Switching to a different antidepressant (bupropion, sertraline, or venlafaxine) results in about 25% of patients with treatment-resistant depression becoming symptom-free 8

Most second-generation antidepressants show similar efficacy for depression with anxiety symptoms, but venlafaxine may be superior to fluoxetine for patients with significant anxiety 1, 2, 3
Mirtazapine, trazodone, or nefazodone may improve sleep in patients with depression and insomnia 2, 3
Duloxetine and paroxetine have demonstrated efficacy for patients with depression and pain 2, 3