Antidepressant Selection Workshop

Build a patient scenario and watch the reasoning, not just the ranking. Every movement on the list is explained and cited.

Educational tool. The scores here are a teaching device that makes trade-offs visible; they are not validated weights and this is not a prescribing algorithm. Tiers reflect a synthesis of FDA labeling, network meta-analyses, CPIC guidance, and major guidelines (APA 2010, CANMAT 2016/2023, NICE 2022), but many individual factors have weaker evidence than a clean number implies. Read the ledger, argue with it, and check the primary sources.

Teaching cases

Load a case, then change one factor at a time and watch what moves.

Patient scenario 0 factors

Tap factors to toggle. Orange factors are hard stops or near-hard stops for at least one agent.

Teaching points for this scenario

Select factors to surface the nuances that matter for this combination. With nothing selected, the ranking below reflects guideline "first-line by default" consensus, which is itself a teaching point: first-line status is about the average patient, and no patient is average.

Agents, ranked for this scenario

Click any agent to open its reasoning ledger. Scores are relative, not absolute; a +3 and a +2 are "both reasonable, here's the tiebreaker," not "one is 50% better."

Baseline. Each agent starts with a small baseline (−1 to +2) that encodes where it sits in the Cipriani 2018 network meta-analysis efficacy/acceptability plane and its typical guideline line of therapy. This is what you see with no factors selected.

Factors. Each selected factor contributes a delta from roughly −3 to +3 per agent, with a one-line rationale and a source. Hard contraindications (e.g., bupropion in a seizure disorder, any serotonergic agent within 14 days of an MAOI) place the agent in the Avoid tier regardless of other points.

Tiers. Favored ≥ +3 · Reasonable −2 to +2 · Caution ≤ −3 · Avoid = hard stop. Thresholds are deliberately coarse: the lesson is the direction and the reason, not the decimal.

What the engine deliberately ignores. Prior response in the patient or a first-degree relative, patient preference after shared decision-making, formulary and cost, and your own clinical gestalt. In practice those often outrank anything on this page. A tool that claims to fold them in is overclaiming.

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