The short answer
The most common antidepressants in Australia are SSRIs such as sertraline, escitalopram, fluoxetine and citalopram. Other types include SNRIs (venlafaxine, desvenlafaxine, duloxetine), mirtazapine, tricyclics (amitriptyline, nortriptyline), MAOIs (moclobemide, phenelzine) and newer medicines such as agomelatine and vortioxetine. In large trials they all worked better than placebo on average, and the bigger differences between them are side effects, interactions and how well they suit your health and symptoms.
On this page
What are the main types of antidepressants?
Antidepressants are grouped into classes based on how they act on brain chemicals such as serotonin, noradrenaline, dopamine and melatonin [1]. Exactly how they relieve depression still isn't fully understood [1].
The table below covers the main antidepressants on the PBS in Australia, plus two newer medicines that aren't PBS-listed. Most medicines in the table are sold under several brand names, including generic brands [2].
| Type | Generic names | Often used for | Common side effects and cautions |
|---|---|---|---|
| SSRIs | Sertraline, escitalopram, citalopram, fluoxetine, paroxetine, fluvoxamine | Depression; some are also PBS-listed for OCD, panic disorder or anxiety disorders [2] | Nausea, headache, sleep changes, sexual problems [1] |
| SNRIs | Venlafaxine, desvenlafaxine, duloxetine | Depression, including more severe or persistent depression [1] | Headache, nausea, sleep changes [1]; withdrawal symptoms if stopped suddenly [1] |
| Mirtazapine and mianserin | Mirtazapine, mianserin | Depression, especially with poor sleep [3] | Sleepiness, increased appetite, weight gain [4] |
| Tricyclics (TCAs) | Amitriptyline, nortriptyline, clomipramine, dosulepin (dothiepin), imipramine | Depression; also used for pain and OCD [2][3] | Drowsiness, dizziness; dangerous in overdose [5] |
| Noradrenaline reuptake inhibitor | Reboxetine | Depression [2] | Less likely to cause drowsiness [1] |
| Reversible MAOI (RIMA) | Moclobemide | Depression; often used for anxiety [1] | Serotonin toxicity risk with some other medicines [1] |
| MAOIs | Phenelzine, tranylcypromine | Depression with atypical features, such as oversleeping and increased appetite [3] | Must not be combined with other antidepressants, because of the risk of serious reactions including serotonin toxicity [1][17]; some foods and drinks containing tyramine can cause a dangerous rise in blood pressure [16]; rarely prescribed today [1] |
| Melatonergic | Agomelatine | Depression with sleep problems [3] | Needs liver blood tests; not PBS-listed [2][6] |
| Multimodal | Vortioxetine | Depression, including with thinking and memory problems [3] | Nausea is a common side effect; not PBS-listed [2][7] |
What are the most common antidepressants in Australia?
Antidepressants are by far the most dispensed mental health medicine in Australia. In 2022–23 they made up 73% of mental health-related prescriptions, about 33.4 million scripts [8]. The dispensing rate rose from 1,099 to 1,269 prescriptions per 1,000 people between 2018–19 and 2022–23 [8].
SSRIs are the most commonly prescribed class [1]. They aren't more effective than other antidepressants, but most people tolerate them well [1]. Sertraline, escitalopram, citalopram and fluoxetine are all PBS-listed, with multiple generic brands [2].
Brand names and generics
The same medicine can be sold under several brand names. Sertraline, for example, is PBS-listed under its original brand and a range of generic brands [2]. Some original brands carry an extra brand charge at the pharmacy, on top of your PBS co-payment [2].
If you've been prescribed a medicine and your pharmacist offers a different brand, it contains the same active ingredient. Ask your pharmacist if you'd like to stay on one brand for consistency.
Do some antidepressants work better than others?
The biggest comparison to date pooled 522 trials with 116,477 adults with major depression [9]. Every one of the 21 antidepressants studied worked better than placebo. The odds of responding ranged from about 1.4 times placebo for reboxetine to about 2.1 times placebo for amitriptyline [9].
In head-to-head trials, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine came out ahead on effectiveness [9]. Agomelatine, citalopram, escitalopram, fluoxetine, sertraline and vortioxetine had fewer people dropping out [9]. The certainty of this evidence was rated moderate to very low, and many of the differences between drugs were small [9].
How big is the benefit?
A 2022 analysis of 232 placebo-controlled trials, covering 73,388 participants, found the average benefit over placebo was modest [10]. About 15% of people had a substantial response beyond the placebo effect, and the gap between medicine and placebo grew with more severe depression [10].
Put simply, antidepressants help many people but not everyone, and much of the improvement seen in trials also happens in people taking placebo [10]. Australian guidelines say combining psychological treatment with medication is the most effective strategy for acute major depression [3].
What Australian guidelines recommend first
The 2020 Australian and New Zealand mood disorders guidelines nominate seven first-choice medicines from different classes: escitalopram, vortioxetine, agomelatine, venlafaxine, mirtazapine, bupropion and amitriptyline [3]. Bupropion isn't approved for depression in Australia [3], so in practice your GP chooses from the others or from the wider range in the table above.
How does a GP choose an antidepressant?
Australian guidelines say side effects drive the choice of antidepressant as much as effectiveness does [3]. The concerns patients raise most are sexual side effects, weight gain and sedation [3].
Your main symptoms also matter. The guidelines suggest these matches [3]:
| If your main symptoms include | Medicines the guidelines prefer |
|---|---|
| Anxiety | SSRIs, SNRIs |
| Poor sleep | Agomelatine, mirtazapine |
| Pain | Duloxetine, tricyclics |
| Trouble thinking or concentrating | Duloxetine, vortioxetine |
| Oversleeping and increased appetite | MAOIs |
Your GP will also consider your age, possible side effects, other medicines, pregnancy or breastfeeding, and your preferences and lifestyle [1]. A consultation doesn't guarantee a prescription. Your GP decides what's clinically appropriate.
For a step-by-step look at the process, see how to get antidepressants in Australia.
What are the common side effects of antidepressants?
Common side effects include headaches, dizziness, nausea, weight gain, restlessness, sleep problems or sleepiness, and sexual problems such as low sex drive [1]. Several side effects are temporary and may fade within a few weeks of starting, but others can persist or appear later, including weight gain, sexual dysfunction, sleep disturbance and low blood sodium [11].
Some side effects are specific to certain medicines:
- Mirtazapine can cause sleepiness and increased appetite with weight gain [4].
- Tricyclics such as amitriptyline can cause drowsiness and dizziness, and taking too much at once is dangerous [5].
- Agomelatine needs liver blood tests before you start and at set points during treatment [6].
- Vortioxetine commonly causes nausea [7].
A few less common risks need prompt attention. Some people, especially young people, have suicidal thoughts when starting an antidepressant [1]. Serotonin toxicity is rare but serious, causing symptoms such as tremor, confusion, sweating and fever, and needs urgent medical help [1].
In people with bipolar disorder, an antidepressant can sometimes trigger a manic or hypomanic episode [3]. Signs include unusually high mood or energy and needing much less sleep than usual without feeling tired [3]. Tell your GP promptly if you notice these changes, and let them know before you start if you or a close family member has had bipolar disorder.
Which antidepressants don't cause weight gain?
No antidepressant is guaranteed to be weight-neutral for everyone, but they do differ.
- Higher risk. A meta-analysis of 116 studies found amitriptyline, mirtazapine and paroxetine were linked with the most weight gain [12].
- Lower risk. Fluoxetine and bupropion were linked with some weight loss, although fluoxetine's effect seemed limited to the early phase of treatment [12]. Most others had little short-term effect, but differences became clearer with long-term use [12].
- Small differences between common choices. A 2024 study of 183,118 people compared weight change 6 months after starting common antidepressants [13]. Compared with sertraline, escitalopram, paroxetine and duloxetine were linked with about 0.3 to 0.4 kg more weight gain, fluoxetine was similar, and bupropion was linked with slightly less [13].
Over the long term, a UK study of nearly 300,000 adults found people taking antidepressants had a 21% higher rate of gaining 5% or more of their body weight, and the raised risk lasted at least six years [14]. The authors noted this association may not be fully caused by the medicines [14].
Bupropion, the option most consistently linked with the least weight gain, is only approved in Australia as a short-term aid to stop smoking [15].
If weight is a concern, tell your GP before you start, so it can factor into the choice and you can keep an eye on changes early.
Are agomelatine and vortioxetine on the PBS?
Neither appears in the PBS antidepressant listings as at November 2026 [2], so neither is PBS-subsidised and both are dispensed at the full private price. The 2020 Australian and New Zealand guidelines list both among their seven first-choice antidepressants, alongside escitalopram, venlafaxine, mirtazapine, amitriptyline and bupropion [3].
What happens when you stop or switch antidepressants?
Up to 40% of people may get discontinuation or withdrawal symptoms when stopping an antidepressant [3]. Australian guidelines recommend lowering the dose gradually, generally in at least weekly steps, and more slowly for people at higher risk [3]. Agomelatine is the exception, as it isn't associated with these symptoms [3].
Switching to or from an MAOI such as phenelzine needs extra care. MAOIs must not be combined with other antidepressants, because the combination can cause serious reactions, including serotonin toxicity [1][17]. So when switching to or from an MAOI, there needs to be a planned gap between the two medicines, and your doctor works out how long it should be [16][17]. Some gaps are long. Fluoxetine, for example, stays in the body for a long time, so Australian guidelines advise a 5-week gap before starting an MAOI [17].
People taking an MAOI also need to avoid some foods and drinks that contain tyramine, such as many cheeses, yeast extracts, soy sauce, some beers and red wine, because they can cause a severe rise in blood pressure [16]. A headache, fast heartbeat, nausea or vomiting after eating or drinking needs urgent medical help [16].
Never stop or swap medicines on your own. Our guides on how long antidepressants take to work and antidepressants and alcohol cover related questions.
Getting help
If you're wondering whether an antidepressant could help, or your current one isn't working well, a GP is a good place to start. You can read more about depression or try our free mental health check.
If you'd like to talk to a GP about how you've been feeling, you can request an appointment. Mental Health Clinic is for adults 18 and over and isn't an emergency service.
If you're in crisis or thinking about suicide, call Lifeline on 13 11 14 or 000 in an emergency.
This page is general information, not medical advice.
Common questions
What is the most commonly prescribed antidepressant in Australia?
Which antidepressant is least likely to cause weight gain?
In a large meta-analysis, amitriptyline, mirtazapine and paroxetine carried the greatest risk of weight gain, while fluoxetine and bupropion were linked with some weight loss, although fluoxetine's effect seemed limited to early treatment [12]. Bupropion is only approved in Australia to help people stop smoking [15]. Individual responses vary, so raise weight concerns with your GP before you start.
Are generic antidepressants as good as brand names?
PBS-listed brands of the same medicine contain the same active ingredient, and several generic brands are listed for most common antidepressants [2]. Some original brands carry an extra brand charge at the pharmacy on top of the usual co-payment [2]. Your pharmacist can tell you which brands are available.
Are agomelatine and vortioxetine on the PBS?
As at November 2026, neither agomelatine nor vortioxetine appears in the PBS antidepressant listings [2]. That means they aren't PBS-subsidised and are dispensed on a private prescription at full cost. Your pharmacist can tell you what a private prescription costs.
Which antidepressant has the fewest side effects?
It varies from person to person. In the largest comparison of trials, agomelatine, citalopram, escitalopram, fluoxetine, sertraline and vortioxetine had fewer people stopping because of any reason, including side effects, than other antidepressants [9]. Your GP will match the choice to the side effects that matter most to you [3].
References
- healthdirect Australia. Antidepressants (last reviewed April 2025). Accessed November 2026. healthdirect.gov.au/antidepressant-medicines
- Pharmaceutical Benefits Scheme. Browse by body system: N06A Antidepressants, and linked item listings for brands and restrictions (last updated 1 November 2026). Accessed November 2026. pbs.gov.au/browse/body-system?depth=3&codes=n06a
- Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. 2021;55(1):7-117. doi.org/10.1177/0004867420979353
- NPS MedicineWise. Avanza (mirtazapine) consumer medicine information (updated December 2020). Accessed November 2026. nps.org.au/medicine-finder/avanza-tablets
- NPS MedicineWise. Endep (amitriptyline) consumer medicine information (prepared February 2025). Accessed November 2026. nps.org.au/medicine-finder/endep-tablets
- NPS MedicineWise. Valdoxan (agomelatine) consumer medicine information (prepared May 2022). Accessed November 2026. nps.org.au/medicine-finder/valdoxan-tablets
- NPS MedicineWise. Brintellix (vortioxetine) consumer medicine information (prepared October 2024). Accessed November 2026. nps.org.au/medicine-finder/brintellix-tablets
- Australian Institute of Health and Welfare. Mental health-related prescriptions (last updated April 2024). Accessed November 2026. aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions
- Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-1366. pubmed.ncbi.nlm.nih.gov/29477251
- Stone MB, Yaseen ZS, Miller BJ, et al. Response to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis. BMJ. 2022;378:e067606. pubmed.ncbi.nlm.nih.gov/35918097
- Carvalho AF, Sharma MS, Brunoni AR, et al. The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: a critical review of the literature. Psychother Psychosom. 2016;85(5):270-288. pubmed.ncbi.nlm.nih.gov/27508501
- Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272. pubmed.ncbi.nlm.nih.gov/21062615
- Petimar J, Young JG, Yu H, et al. Medication-induced weight change across common antidepressant treatments: a target trial emulation study. Ann Intern Med. 2024;177(8):993-1003. pubmed.ncbi.nlm.nih.gov/38950403
- Gafoor R, Booth HP, Gulliford MC. Antidepressant utilisation and incidence of weight gain during 10 years' follow-up: population based cohort study. BMJ. 2018;361:k1951. pubmed.ncbi.nlm.nih.gov/29793997
- healthdirect Australia. Zyban SR (bupropion) medicine information. Accessed November 2026. healthdirect.gov.au/medicines/brand/amt,58481000168104/zyban-sr
- NPS MedicineWise. Nardil (phenelzine) consumer medicine information (prepared December 2015). Accessed November 2026. nps.org.au/assets/medicines/aac4da87-c1a3-4dca-8dc7-a53300ff060f.pdf
- Andrews G, Bell C, Boyce P, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Aust N Z J Psychiatry. 2018;52(12):1109-1172. ranzcp.org/getmedia/5456b019-e2dd-4d7a-91d3-ca0ca8b356e3/anxiety-disor
Published by Mental Health Clinic. Last updated 6 November 2026. This page is general information only and isn’t a substitute for advice about your own situation. If you or someone else is in danger, call 000.