The Odyssey

In clinical studies, the most common side effects with a particular antidepressant (reported in at least 10% of patients and at least twice as often as with placebo) were constipation, dizziness, dry mouth, insomnia, loss of appetite, nausea, nervousness, sexual side effects, sleepiness, sweating, and weakness.
Well, if those don't make you feel better, what will?
The above-mentioned drug happens to be Effexor, or venlafaxine, an antidepressant that falls under the SNRI class, for serotonin norepinephrine reuptake inhibitors. This class of medication succeeded the SSRIs, or selective serotonin reuptake inhibitors, like Prozac. Selective is probably misleading, since these medication work with the subtlety of a sledgehammer. Which is why, in conjunction with some remedial activity, there is all the collateral damage. In other words, you might start to feel better after a month or a month and a half or two (please allow 6 to 8 weeks for delivery), but you sweat your ass off, can't ejaculate, become irritable, gain weight, have dry mouth and difficulty defecating, urinate frequently, can hardly urinate, can't sleep, sleep too much, and have outlandish dreams. Asthenia, also. That basically means you feel like you have the flu. Let the good times roll.
Then, if that particular medication doesn't work, you go through a "washout" period, during which you wait a few weeks for the drug to leave your system before you can start the next one (please allow another 6 to 8 weeks for delivery...if you haven't already killed yourself). Some instances aren't so extreme, and patients can start the new medicine without a prolonged washout period. You also have to build these drugs up gradually in your system, so it's not like taking an Advil and getting prompt relief.
Then there are things called myoclonic jerks, which aren't necessarily unpleasant, just sometimes inconvenient. Myoclonic jerks essentially are involuntary movements, sort of like twitches on steroids. Not too disruptive if you're alone in bed, but perhaps unseemly when seated next to a stranger on a plane. Imagine yourself dozing and then convulsing and the startled reactions.
Not all antidepressants are created equal. Wellbutrin, or bupropion, can be helpful in losing weight and can serve as an aphrodisiac of sorts. It can also simultaneously induce insomnia and anxiety. Apparently there are some people who separate anxiety from depression, but that seems to me to be parsing it too finely. For me, they go hand in hand, and anything that induces what it's supposed to alleviate seems counterproductive. Bupropion, marketed as Zyban, also is used as part of smoking-cessation plans.
Older antidepressants are another breed, but I don't consider them nearly as crude as modern-day drug-marketing powerhouses would. The idea was that Prozac would do all the good stuff that the other antidepressants did without the collateral effects, but I don't think the argument is valid. Tricyclics, like desipramine, have roughly the same side-effect profile as the modern-day happy pills, but they're supposed to be more toxic. So when you want to kill yourself, which some antidepressants in and of themselves inspire you to do, the desipramine is a handy way. That's a funny thing about some antidepressants: you start out wanting to kill yourself, the pills reinforce the notion that it's a capital idea and, since you have them, you can gobble some handfuls to accomplish the task.
MAO (monoamine oxidase) inhibtors, like Nardil and Parnate, are a class unto themselves. To say that they can inhibit urination and ejaculation is like saying Tom Cruise is a little annoying. You can literally stand at a urinal and try, to no avail, to go to the bathroom for 15 minutes. Ejaculation is out of the question, so take heed, sperm donors: avoid the MAOIs. Oh, and you can't have beer. Or Parmesan cheese. Or some kinds of chocolate. And you run the risk of your blood pressure rising to dangerously high levels. And they can make you feel spacey, but that's preferable to depressed. The real ballbuster, though, about these drugs is that they can help. They help you not want to kill yourself until you gain 30 pounds, can't piss and can't have an orgasm. Then you may as well kill yourself. So much for MAOIs.
Remeron, or mirtazapine, is another kind of medication. It's called a tetracyclic, as opposed to tricyclic. Whether a drug is a tetracyclic or a tricyclic apparently depends upon its chemical structure. That's about as much as I know about the technical aspects. What I do know, however, is that Remeron can make you sleep the sleep of the dead, and that's a good thing. Go to Starbucks, get whatever big, fancy, caffeinated bullshit drink you want right before bed, then take some Remeron and fall asleep. Alas, Remeron will make you fat. If you're already fat, it will make you fatter. And it's probably not a great idea to drink.
There are "natural" alternatives, such as St. John's wort, 5-HTP, SAM-e and some kind of extract I don't even recall the name of from a holistic practitioner. You'll try anything, attempting to be optimistic and to maintain an open mind.
So, your choices pretty much boil down to these. Of course, you can try all kinds of mix and match, such as Remeron with Effexor, Wellbutrin with whatever, lithium with something. In case the side effects from one medicine aren't substantial enough for you, try a cocktail. Don't fret, though, because the drug companies are striving to come up with something new and improved. They care about whether you're suffering from side effects, sonce you might stop taking the drug, and thjey would lose money. They really care about coming up with something new and better when patents are about to expire. They care so much that they repackage the existing drug, call it something different and tell you how much better it is. That's easier than actually having to come up with a novel approach.
They'll say that it costs a lot of money to develop new treatments and the regulatory requirements are onerous. There's some validity to that argument. On the other hand, when you have to satisfy shareholders, it's also important squeeze what you can out of what you've got.

It's a dirty business, and patients' options involve gravitating toward the lesser of many evils. Those are, however, better than no evils at all.