Antidepressant Side Effect Comparison Tool
Find antidepressants that best match your needs
This tool helps you understand how new antidepressants compare across important factors like speed of relief, side effects, and convenience. Select your priorities to see which options might work best for you.
1. How important is speed of relief?
2. How important is minimizing sexual side effects?
3. How important is minimizing weight gain?
4. How important is cost and accessibility?
Your Results
Compare Options
This table shows how each antidepressant performs based on your selected priorities.
| Antidepressant | Speed of Action | Sexual Side Effects | Weight Gain | Cost & Accessibility | Overall Score |
|---|---|---|---|---|---|
| Exxua (gepirone) | 2-4 weeks | 2-3% | Minimal | $$ (Moderate cost) | 0% |
| Zuranolone (Zurzuvae) | 2-5 days | 5-8% | Minimal | $$$$ (High cost) | 0% |
| Auvelity | 1-2 weeks | 15-20% | 15-20% lower than duloxetine | $$$ (High cost) | 0% |
| SPRAVATO (esketamine) | 24-48 hours | 10-15% | Neutral or slight loss | $$$$ (Very high cost) | 0% |
For decades, if you were prescribed an antidepressant, you knew what you were getting: weeks of waiting for relief, followed by possible weight gain, sexual problems, or constant nausea. Many people stopped taking their meds not because they didn’t work, but because the side effects made life feel worse than the depression. That’s changing. In 2026, a new wave of antidepressants is hitting the market-ones that work faster and don’t wreck your sex life, your appetite, or your energy levels. These aren’t just tweaks of old drugs. They’re built on entirely new science.
What’s Different About These New Antidepressants?
Traditional antidepressants like sertraline or escitalopram (SSRIs) work by slowly boosting serotonin levels. It takes 4 to 8 weeks for them to kick in, and up to 70% of people on them report sexual side effects. Weight gain is common too-10 to 15 pounds over six months isn’t unusual. These aren’t minor complaints. They’re reasons why nearly half of people quit their meds within the first year.
The new generation doesn’t just tweak serotonin. It targets entirely different brain pathways. Some block glutamate receptors. Others boost neurosteroids. A few combine two drugs to get a faster, cleaner effect. The result? Relief in days, not weeks. And side effects? They’re dramatically lower.
Exxua (Gepirone): The First New Chemical Entity in Over a Decade
Exxua got FDA approval in September 2023-the first completely new antidepressant chemical since vortioxetine in 2013. Unlike SSRIs, it works on serotonin 1A receptors, which helps regulate mood without flooding the system. In clinical trials, 2 to 3% of users reported sexual dysfunction. Compare that to 30 to 50% with SSRIs. Weight gain? Nearly zero. Sleep disruption? Much less than older drugs.
One Reddit user, u/AnxietyWarrior2023, wrote: “After 15 years on SSRIs with terrible sexual side effects, switching to Exxua in January 2025 was life-changing-no ED issues and noticeable improvement in mood within 10 days.” That’s not an outlier. Multiple studies show Exxua works just as well as SSRIs but with far fewer complaints. It’s taken off fast among patients who’ve tried everything else.
Zuranolone (Zurzuvae): A 14-Day Course That Resets Mood
Zuranolone, approved in August 2023 for postpartum depression and expanded to major depression in October 2025, is unlike anything before. It’s a neurosteroid that calms overactive brain circuits by boosting GABA, the brain’s natural calming chemical. You take it once a day for just 14 days. No daily pills for months. No gradual titration.
Response rates hit 70% in postpartum patients and 53% in general major depression trials by day 15. That’s faster than any other oral antidepressant. But it’s not perfect. About 25% of users get dizzy. 20% feel sleepy. And it must be taken with food-skip the meal, and absorption drops by half.
On Healthgrades, Zuranolone has a 3.8 out of 5 rating. Most users praise the speed. “I felt like myself again by day 5,” wrote one mother of a newborn. But cost is a barrier: a full 14-day course runs about $9,450. Insurance coverage is spotty. Many still need prior authorization.
Auvelity: A Two-Drug Combo That Works in Days
Auvelity combines dextromethorphan (a cough suppressant) and bupropion (an antidepressant). The bupropion slows down how fast your body breaks down dextromethorphan, letting it build up to block NMDA receptors-same target as ketamine. The result? Mood improvement in 1 to 2 weeks, not 6.
Studies show Auvelity causes 15 to 20% less weight gain than duloxetine. Sexual side effects are lower than SSRIs too. It’s taken orally, no clinic visits needed. But it’s not for everyone. People with uncontrolled high blood pressure or seizure disorders should avoid it. The prescribing guide runs 32 pages. Doctors need to check for drug interactions-especially with other antidepressants or stimulants.
SPRAVATO (Esketamine): Fast, But Not Simple
SPRAVATO, the nasal spray version of ketamine, was approved in 2019. It’s the fastest-acting option-some patients feel better within 24 hours. It’s reserved for treatment-resistant depression: when at least two other antidepressants failed.
But it comes with big caveats. About half of users feel dissociated-like they’re floating, disconnected from their body. Some get dizzy or nauseous. Because of this, you must take it in a certified clinic and stay for two hours after each dose. There are only 1,243 of these clinics in the U.S. as of late 2025. Rural patients often can’t access it.
Cost is another hurdle. Each 56mg dose costs $880. Medicare covers it, but private insurers often deny claims without multiple layers of paperwork. One user on Reddit wrote: “SPRAVATO gave me terrifying dissociation episodes despite working well for depression-I had to quit after three treatments.”
How Do They Compare to the Old Standbys?
Here’s how the new drugs stack up against traditional ones:
| Antidepressant | Onset of Action | Sexual Side Effects | Weight Gain | Key Risks |
|---|---|---|---|---|
| SSRIs (e.g., sertraline, fluoxetine) | 4-8 weeks | 30-70% | 10-15 lbs over 6 months | GI upset, insomnia, QT prolongation |
| Exxua (gepirone) | 2-4 weeks | 2-3% | Minimal | Headache, dizziness |
| Zuranolone (zurzuvae) | 2-5 days | 5-8% | Minimal | Dizziness (25%), sleepiness (20%) |
| Auvelity (dextromethorphan/bupropion) | 1-2 weeks | 15-20% | 15-20% lower than duloxetine | Blood pressure spikes, seizure risk |
| SPRAVATO (esketamine) | 24-48 hours | 10-15% | Neutral or slight loss | Dissociation (45-55%), sedation, abuse potential |
| Amitriptyline (TCA) | 4-6 weeks | 40-60% | Up to 4.2 kg (9 lbs) | Heart rhythm issues, dry mouth, constipation |
Notice the pattern? The newer drugs cut sexual side effects by 70-90%. Weight gain is rare. Onset is faster. But they’re not magic. Each has its own trade-offs.
Who Benefits Most?
These new drugs aren’t for everyone. They’re best for:
- People who’ve tried at least two SSRIs or SNRIs with no success
- Those who can’t tolerate sexual side effects or weight gain
- Patients needing fast relief-like new mothers with postpartum depression
- People with treatment-resistant depression
But they’re not ideal for:
- Those with uncontrolled high blood pressure or heart rhythm problems
- People who can’t travel to a certified clinic for SPRAVATO
- Those on a tight budget without good insurance coverage
- People with a history of substance abuse (ketamine-based drugs carry abuse risk)
What’s Next? The Future of Personalized Depression Treatment
The biggest shift isn’t just about new drugs-it’s about matching the right drug to the right person. Dr. Alison Cave, former FDA Deputy Center Director, says: “The most significant advancement is in personalized treatment selection based on individual risk factors.”
Right now, doctors pick antidepressants mostly by trial and error. But that’s changing. The NIH has awarded $2.4 million to develop a genetic test that predicts which antidepressant will cause which side effects-with 85% accuracy. Imagine getting a blood test that tells you: “You’re likely to gain weight on fluoxetine, but Exxua will work well for you.” That’s coming by 2027.
Another drug in Phase 3 trials, Aticaprant, targets a different brain receptor entirely. Early results show 60% response in treatment-resistant cases-with almost no weight gain. It could be approved by mid-2026.
Real-World Challenges
Even with better drugs, access is uneven. Only 38% of primary care doctors feel confident prescribing Zuranolone. Insurance companies fight coverage. SPRAVATO requires prior authorization in 92% of commercial plans. And many patients still don’t know these options exist.
Also, nearly all studies last only 8 to 12 weeks. We still don’t know what happens after a year. Will Zuranolone’s effects last? Will Exxua cause liver damage over time? These are open questions.
Dr. Prasad Nishtala warns: “All of these findings are based on short-term studies. There’s a major lack of long-term research.” That’s true. But for someone drowning in depression, waiting for perfect data isn’t an option.
Bottom Line: Hope Is Here, But It’s Not Simple
For the first time in decades, people with depression have real alternatives that don’t come with the same old baggage. You can now get relief without sacrificing your sex life, your body, or your dignity. These drugs aren’t perfect. They’re expensive. They’re not always covered. And they’re not for everyone.
But they’re proof that science is finally catching up to what patients have been saying for years: depression treatment shouldn’t feel like trading one problem for another. The future isn’t about one miracle drug. It’s about matching the right tool to the right person. And that’s a revolution worth waiting for.
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