This Website Could Help You Find the Right Antidepressant on Your First Try

For people taking antidepressants, it can take a lot of trial and error before they find the one that works for them. But now, researchers are proposing a different approach.

"Clinicians do not know what will work well for a specific patient. So one starts somewhere and by trial and error finds what works," Farrokh Alemi, PhD, professor and healthcare researcher at George Mason University in Virginia, told Verywell via email. "Our approach is quite different. We want to prescribe the right medication the first time so as to avoid different trials."

Alemi and colleagues recently released a study summarizing the experiences of over 3.6 million with major depression who had more than 10 million antidepressant treatments. By analyzing data, they were able to identify which drugs tended to work better for patients given their medical histories and other demographic information.

But the study doesn't stop there. They also created a website, MeAgainMeds, accessible to clinicians and patients. Alemi also partnered up with Arman Carter, an entrepreneur and former Tesla engineer based in Washington, D.C., to create the website UforU. It's the same idea as Alemi's website but designed for a wider scope—for people and healthcare organizations all over the U.S.

"My hope is that UforU will help people struggling to find the right antidepressant to finally get what they need," Carter told Verywell. "I can imagine this service becoming the status quo when prescribing antidepressants for patients."

Alemi and colleagues published their data in EClinical Medine in early October.

Finding the Right Antidepressant

Antidepressants are one of the most commonly-prescribed drugs in the United States. However, research finds that about 60% of patients don't benefit from their first antidepressant. Why some work better than others, Alemi said, is not universally agreed upon.

"There are many theories about why certain medications are better than others," he said. "The general practice in existing guidelines is to separate the medications into tier one and tier two medications and start the patient in tier one medications."

But if the first pill, which is likely to be a tier-one selective serotonin reuptake inhibitor (SSRI), proves to be ineffective or causes too many side effects, people can spend months to years trying to find the one that works best for them. All that time searching can lead to high medical bills, many side effects, lost hope, and deeper depression.

"By getting people the right medication the first time around, we can improve patient outcomes and reduce the cost of care," Carter said.

Optimizing Antidepressant Treatment

To see how they could expedite the treatment process, Alemi and colleagues gathered information on more than 3.6 million patients with major depression. They then broke down the data into almost 17,000 subgroups based on demographics, medical conditions, and prescribed medications.  

"We think of major depression as any disease in which comorbidities may complicate the treatment," Alemi said. "So we have organized the experiences of remission by patients’ comorbidities."

Now, when you answer questions about your medical history, the site will take your responses and tell you which antidepressants were most effective for people most similar to you. "These comorbidities drive the recommendation of the system," Alemi added.

For example, if you're a male aged 13-19 who has sought medical care for headaches, based on the 521 who match your profile, 141 persons tried escitalopram (Lexapro). Of those people, 19% experienced remission or a 50% reduction in depression symptoms.

That's not a super hopeful statistic, but it is compared to bupropion (Wellbutrin). Only 3% of people similar to you experienced remission on this antidepressant.

Alemi plans to advertise MeAgainMeds to residents of Virginia at the end of November. But his larger vision involves working with Carter to offer the service to everyone in the U.S. as well as partner with healthcare organizations. UforU's services are available today.

Services like MeAgainMeds and UforU are some of many that aim to speed up prescription processes via direct-to-consumer service. But they aren't meant to be used without advice from a doctor. Rather, they're just tools to optimize the standard process.

Once users answer questions and receive their data-based recommendation, Alemi said, "they can provide the report ID to their clinician who can then print the report and prescribe a new medication," using their clinical judgment in the process.

"We provide patients with a report that outlines their recommendations and the rationale behind those recommendations," Carter said. "We also engage directly with the patient’s physician to explain how our service works so they can factor that into their decision making."

At the end of the day, he adds, "we’re aiding the physician in making a decision regarding what to prescribe."

"We still have a lot of work to do," Carter added. But here's the long-term vision: A patient visits their doctor for help treating their depression, and UforU seamlessly integrates with the patient's health history to provide the doctor with recommendations.

"The doctor has everything they need to make the best possible decision," Carter said. "And the patient leaves with the best possible prescription for them."