Which class of antidepressants is commonly considered first-line due to favorable side effect profiles?

• A. MAOIs
• B. SSRIs
• C. Tricyclic antidepressants
• D. Atypical antidepressants

Answer: (B)

Selective serotonin reuptake inhibitors are favored as first-line antidepressants because they offer a strong balance of efficacy and tolerability. They are generally well tolerated and have a safer safety profile in overdose compared with older classes. They also avoid the dietary restrictions and serious interaction risks associated with monoamine oxidase inhibitors and have fewer anticholinergic and cardiotoxic effects than tricyclic antidepressants. This combination—broad effectiveness across mood and anxiety disorders plus easier dosing and monitoring—makes them the typical starting option. Commonly used examples include fluoxetine, sertraline, citalopram, and escitalopram. While they can cause sexual side effects and some initial nausea or sleep disturbances for a subset of patients, they’re overall easier to tolerate than other classes, which is why they’re chosen first. In contrast, MAOIs require strict dietary control and carry hypertensive risks, tricyclics have more anticholinergic and cardiac side effects, and atypical antidepressants vary in safety and tolerability.