Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
⚠ Cross-class comparison (SSRI vs azapirone vs NaSSA) — class floors may not apply uniformly.
4 drugs selected — Sertraline, Escitalopram, Buspirone, Mirtazapine(click to collapse)
4/4 selected
Sertraline
Zoloft
Selective Serotonin Reuptake Inhibitor
FDA-approved indications
- Major depressive disorder (adults)
- Obsessive-compulsive disorder (adults; pediatric 6–17 years)
- Panic disorder, with or without agoraphobia (adults)
- Posttraumatic stress disorder (adults)
Off-label uses
- Generalized anxiety disorder
- Binge eating disorder
- Body dysmorphic disorder
Half-life26 hours
Escitalopram
Lexapro
Selective Serotonin Reuptake Inhibitor
FDA-approved indications
- Major depressive disorder — acute and maintenance (adults; adolescents 12–17 years)
- Generalized anxiety disorder — acute treatment (adults)
Off-label uses
- Panic disorder
- OCD
- PTSD
Half-life27 to 32 hours
Buspirone
Buspar · Bucapsol
Azapirone (5-HT1A Partial Agonist)
FDA-approved indications
- Generalized anxiety disorder — short-term relief (adults)
Off-label uses
- MDD augmentation
- Social anxiety disorder
- PTSD
Half-life2 to 3 hours
Mirtazapine
Remeron · Mirataz
Noradrenergic and Specific Serotonergic Antidepressant
FDA-approved indications
- Major depressive disorder (adults)
Off-label uses
- Insomnia
- Appetite stimulation/weight gain
- Nausea (chemotherapy or other)
Half-life20 to 40 hours
Decision GuideWhen to pick each / when to consider an alternative
Sertraline
Consider when
- Cardiac comorbidity or post-ACS depression — only SSRI with prospective trial evidence for cardiac safety (SADHART, ENRICHD)
- Postpartum depression or breastfeeding — lowest infant relative dose among SSRIs; specifically recommended first-line in lactation
- Polypharmacy with CYP2D6 substrates — mild 2D6 inhibition (~30% desipramine AUC increase) vs 300–400% with fluoxetine/paroxetine
- PMDD requiring dosing flexibility — only SSRI with FDA label supporting both continuous and luteal-phase dosing strategies
- +1 more
Consider an alternative when
- Diarrhea-prone or IBS patient — class-top labeled diarrhea 20% vs 10% placebo; OR 2.10 vs escitalopram in Cochrane NMA
- Sexual dysfunction is treatment-limiting — class-top orgasm dysfunction 45.6% (Serretti 2009); higher than escitalopram or fluvoxamine
- Top-tier MDD efficacy is the priority — mid-tier in Cipriani 2018 NMA; below escitalopram, paroxetine, and vortioxetine
- QTc risk factors present — FDA TQT showed mean ΔQTc 10 ms at 2× max dose; pimozide contraindicated
- +1 more
Escitalopram
Consider when
- First-line MDD where efficacy and tolerability both matter — only SSRI ranking top-tier on both axes in Cipriani 2018 NMA
- Generalized anxiety disorder — FDA-approved for both MDD and GAD; citalopram is MDD-only
- Adolescent depression (age 12+) — one of only two SSRIs with FDA-approved pediatric MDD indication (with fluoxetine)
- Polypharmacy with CYP2D6 or CYP3A4 substrates — minimal CYP inhibition; safest SSRI for drug interactions alongside citalopram
- +1 more
Consider an alternative when
- Sexual dysfunction is treatment-limiting — highest-SD SSRI in Reichenpfader 2014 NMA; significant vs bupropion, fluoxetine, mirtazapine
- QTc prolongation risk — dose-dependent QTc increase; max 10 mg in elderly, hepatic impairment, or CYP2C19 PM
- CYP2C19 poor metabolizer — 2× plasma levels in PMs; max 10 mg may limit therapeutic dose optimization
- Cost is primary constraint — marginally more expensive than citalopram or sertraline generics in some formularies
- +1 more
Buspirone
Consider when
- GAD when benzodiazepine avoidance desired — FDA-approved for GAD; non-sedating anxiolytic without abuse potential or dependence
- SSRI-induced sexual dysfunction augmentation — 5-HT1A partial agonism may reduce SSRI-induced SD; off-label but evidence-supported
- Elderly anxious patient — no cognitive impairment, no respiratory depression, no fall risk; preferable to benzodiazepines in geriatric population
- SUD comorbidity with anxiety — no abuse potential, not scheduled; safe in substance use disorder populations
- +1 more
Consider an alternative when
- Rapid anxiolytic effect needed — takes 2–4 weeks for onset; cannot be used PRN for acute anxiety episodes
- Prior benzodiazepine use — patients with benzodiazepine experience often report buspirone as ineffective (expectation mismatch)
- Panic disorder — not effective for panic attacks; SSRIs or benzodiazepines preferred for panic
- TID dosing is an adherence barrier — short t½ requires TID dosing; adherence may suffer compared to QD SSRIs
- +1 more
Mirtazapine
Consider when
- Insomnia-predominant depression — improves total sleep time, slow-wave sleep (N3), and efficiency without REM suppression
- Underweight, cachectic, or anorectic patient — weight gain (+0.87 kg/8 wk) and appetite stimulation (17% vs 2%) are therapeutic goals
- Sexual dysfunction on SSRIs/SNRIs — ~24% SD vs 58–73% with SSRIs; no serotonin reuptake inhibition mechanism
- Comorbid nausea or GI distress — 5-HT3 antagonism (antiemetic mechanism) causes significantly less nausea than SSRIs/SNRIs
- +1 more
Consider an alternative when
- Daytime sedation cannot be tolerated — somnolence 54% vs 18% placebo; leading discontinuation cause at 10.4%
- Weight gain is unacceptable — Pillinger 2025 +0.87 kg; FDA label weight gain 12% vs 2%, appetite increase 17% vs 2%
- Metabolic syndrome, diabetes, or obesity — sustained appetite/weight signal; bupropion or vortioxetine preferred metabolically
- Prior DRESS, SJS, TEN, or bullous reaction — contraindicated for re-exposure per FDA label
- +1 more
Drug-Drug Interactions1 contraindicated3 major2 moderate
Educational reference only. Interactions are extracted from FDA prescribing information and DDInter 2.0. Always verify with institutional pharmacy systems before clinical decisions.
Efficacy & Acceptability (7 axes)— NMA efficacy & discontinuation data (not side effects)
| Axis | Sertraline | Escitalopram | Buspirone | Mirtazapine |
|---|---|---|---|---|
| 📊 Efficacy (response rates) | ||||
MDDEfficacy | — | — | ||
GADEfficacy | — | — | ||
OCDEfficacy | — | — | ||
Panic DisorderEfficacy | — | — | ||
| 🛡️ Acceptability (all-cause discontinuation) | ||||
MDDAcceptability | — | — | ||
GADAcceptability | — | — | ||
Panic DisorderAcceptability | — | — | ||
| Axis | Sertraline SSRI | Escitalopram SSRI | Buspirone azapirone | Mirtazapine NaSSA |
|---|---|---|---|---|
| Boxed Warnings | ||||
Suicidality (boxed warning) | — | |||
Mania / hypomania induction | — | — | ||
Agranulocytosis / severe neutropenia | — | — | — | |
DRESS / multiorgan hypersensitivity | — | — | — | |
| CNS | ||||
Sedation / somnolence | — | |||
Activation / insomnia | — | |||
Emotional blunting | — | |||
Seizure risk | — | |||
| Metabolic | ||||
Weight gain | — | — | ||
Weight loss | — | — | — | |
| Autonomic | ||||
Anticholinergic burden | — | |||
Orthostatic hypotension | — | — | — | |
Sweating | — | — | ||
Angle-closure glaucoma | — | |||
| Cardiac | ||||
QTc prolongation | — | |||
| GI | ||||
Nausea / GI (general) | — | — | ||
| Electrolytes | ||||
Hyponatremia / SIADH | — | |||
| Sexual | ||||
Sexual dysfunction | — | |||
| Discontinuation | ||||
Withdrawal / discontinuation | — | |||
| Interactions | ||||
Serotonin syndrome risk | — | — | ||
CYP interactions / DDI profile | — | |||
| Safety | ||||
Bleeding risk | — | — | ||
Overdose toxicity | — | — | — | |
| Pregnancy | ||||
Teratogenicity | — | — | — | |
Lactation / breastfeeding safety | — | |||