I don't believe antidepressants can be ranked this way.  Among the categories (SSRI, SNRI, SSNRI, Atypical Antidepressants, Tricyclics and MOAIs, one must consider multiple patient variables including comorbidities, other medications they are taking, age of the patient, which is FDA approved for which ages and conditions, specific diagnosis and target symptoms.   Also a careful family history is essential to see if others, particularly first generation relatives, have been treated with one or more antidepressants and how they responded.  The selection of antidepressants is more complex than choosing from a  favorite 5.   

Dear Atiq, 

You cannot really answer the question in this way. Sometimes ECT is the most effective treatment. There is also the doctor-patient effect.   Look at this link: 

http://www.helpguide.org/articles/depression/types-of-antidepressants-and-their-side-effects.htm

well, Atiq,

it depends of a patient! but, as the literature says they are escitalipram, citalopram, fluoxetine, tianeptin...see this article 

"Comparative efficacy and acceptability"

The SSRIs as a class, except for fluvoxamine (Luvox), which has multiple drug-drug interactions due to CYP enzyme inhibition. Nefazodone (Serzone) would have been a good candidate (minimal sexual side effects, minimal weight effects), but liver toxicity pulled it from the market in 2003. If I had to pick just one- I would go with fluoxetine (Prozac)- generic, cheap, easy to dose, and long half-life prevents inter-dose withdrawal symptoms seen with other antidepressants with shorter half-life.

Fluoxetine (Prozac) has had some very very nasty side effects in school children in Finland although it is probably the most popular and preferred SSRI drug. 

This is a question that you can not answer easly 

what you meen with effective -- therapy succeed ?   side effects?  safety ? toxity?

Check this site; I think you will find an answer.

Thinking about Antidepressants.

http://psyberspace.com.au/depression/

Im to comply with David

Unfortunately, the truth is that science and clinical practice have no room for democratic opinions. I'm sorry to disappoint you, but it is a fact that SSRI's are good anxiolytics and in patients without a clear bipolar diathesis - in manic-depressive illness the response tends to be unpredictable - the SSRI's are really very weak antidepressants. Other muck points of view are just fueled by propaganda and they are dishonestly supported by the fake trials arranged by pharmaceutical companies.

Said that, on the basis of the extensive experience of the psychiatric department of Pisa University and in my own clinical practice, the most effective antidepressants drugs - IN REAL DEPRESSION - are:

- Amitriptyline (especially in melancholic depression, but this drug have not the minimum side effects...)

- Nortriptyline (and this have few and mild sides)

- Imipramine (with an intermediate position in terms of side effects)

- Phenelzine (probably more efficacious than tricyclics and not only in atipical depression, but less manageable - were "less manageable" does not mean it has more side effects)

- Tranylcypromine ("similar" to phenelzine, but more stimulant)

- Mirtazapine (fairly powerful but the initial sedation and especially appetite and weight gain are real problems)

- Bupropione (definitely the less efficacious of these but, except for the ability to evoke anxiety and insomnia, the least burdened with adverse reactions)

- Nefazodone (the liver complications are rare)

- Pramipexole (a generally well tolerated off label drug)

- And finally... ...ECT (the more potent antidepressant treatment and probably the less burdened of sides, but... this is not a drug!)

Obviously, this list has a value only in general terms, because the determining factors are the patients type, the specific form of its disorder and the drug metabolism, which is genetically predetermined and not always predictable.

Greetings!

I agree that this is a complicated issue.  As far as effectiveness goes, the vast majority of antidepressants are equally effective--although there are some clinicians who believe that the MAOI class is more effective as may be some of the tricyclics.  Having said that, they are the most dangerous of the antidepressants--not so long ago people would die from one week's worth of tricyclics (non-treatable cardiac problems) or have hypertensive crises with MAOI + other medications.  Side effects, of course, vary.  Some patients are intensely unhappy about one that may not bother another patient at all. I usually discuss side effects with patients and also request that they call or email me if they have concerns. My experience with employers of patients is that sleepiness is a real concern that they have. (True with other classes of medications such as antipsychotics, as well).

I would place sertraline among the 5 with the least problems and greatest efficacy, even though higher dosages frequently cause relatively minor gastrointestinal side effects, such as loose stool. The tricyclic antidepressant imipramine is notorious for cardiological toxicity and would not place anywhere near the top 5.

I don't believe antidepressants can be ranked this way.  Among the categories (SSRI, SNRI, SSNRI, Atypical Antidepressants, Tricyclics and MOAIs, one must consider multiple patient variables including comorbidities, other medications they are taking, age of the patient, which is FDA approved for which ages and conditions, specific diagnosis and target symptoms.   Also a careful family history is essential to see if others, particularly first generation relatives, have been treated with one or more antidepressants and how they responded.  The selection of antidepressants is more complex than choosing from a  favorite 5.   

En la practica hemos constatado que la sertralina es un antidepresivo que es muy bien tolerado por los pacientes y su efecto es aceptable.

Effexor

Trazadone

Dear Joanne Senn , thanks for your answering.