What is the main advantage of using SSRIs over TCAs?

The main advantage of using selective serotonin reuptake inhibitors (SSRIs) over tricyclic antidepressants (TCAs) lies in their profile of side effects. SSRIs tend to have a more favorable side effect profile compared to TCAs, which are associated with a wider range of adverse effects, including sedation, weight gain, anticholinergic effects (like dry mouth and constipation), and cardiovascular concerns such as arrhythmias. This reduced incidence of side effects makes SSRIs more tolerable for many patients and often leads to better adherence to treatment.

While some may argue that SSRIs have comparable efficacy to TCAs for certain individuals, the variability in patient response can vary widely, and SSRIs generally do not demonstrate stronger efficacy across the board. Additionally, SSRIs may not be significantly cheaper than TCAs, and the onset of action for SSRIs is typically similar to that of TCAs, often taking several weeks to fully realize their antidepressant effects. Ultimately, the reduced side effect burden of SSRIs is a major factor in their preference for first-line treatment in depression.