This a companion article to a blog post on Behind the Wheel with Autism: How to Remove Barriers to Driving for Autistic Teens and Adults, titled Calm, Focused, or Sleepy? How Antidepressants Can Affect Driving on the Spectrum. You can find the driving blog post here.
| Rank | Medication | Activation Level | Typical Activating Effects | Common Side Effects | Most Common Uses |
|---|---|---|---|---|---|
| 1 | Bupropion (Wellbutrin) | Extremely high | Increased energy, motivation, focus, drive; may improve fatigue and apathy | Anxiety, insomnia, jitteriness, dry mouth, increased heart rate, lowered seizure threshold | Depression with fatigue/apathy, ADHD symptoms, smoking cessation, SSRI-related sexual dysfunction |
| 2 | Selegiline (Emsam patch) | Very high | Strong increase in energy and motivation; can feel distinctly stimulating | Insomnia, agitation, blood pressure interactions at higher doses | Treatment-resistant depression |
| 3 | Levomilnacipran (Fetzima) | Very high | Strong norepinephrine activation; increased alertness and mental drive | Increased heart rate, sweating, urinary hesitation, insomnia | Major depressive disorder, especially low-energy depression |
| 4 | Fluoxetine (Prozac) | High | Most energizing common SSRI; may improve psychomotor slowing and motivation | Anxiety, insomnia, GI upset, sweating, sexual dysfunction | Depression, OCD, panic disorder, bulimia, PMDD |
| 5 | Venlafaxine (Effexor) | Moderate-high to high | Increasing activation at higher doses due to norepinephrine effects | Increased blood pressure, sweating, insomnia, withdrawal symptoms if stopped abruptly | Depression, generalized anxiety disorder, panic disorder, social anxiety |
| 6 | Desvenlafaxine (Pristiq) | Moderate-high | Similar to venlafaxine but often smoother and more even activation | Nausea, sweating, insomnia, elevated blood pressure | Major depressive disorder |
| 7 | Milnacipran (Savella) | Moderate-high | Stimulating SNRI profile with increased mental and physical energy | Sweating, nausea, insomnia, elevated heart rate | Fibromyalgia |
| 8 | Sertraline (Zoloft) | Moderate | Mentally stimulating while also reducing anxiety and intrusive thoughts | GI upset/diarrhea, sweating, insomnia, sexual dysfunction | Depression, PTSD, OCD, panic disorder, anxiety disorders |
| 9 | Duloxetine (Cymbalta) | Mild-moderate to moderate | Improved energy and concentration while reducing pain and anxiety | Nausea, sweating, dry mouth, constipation, insomnia | Depression, anxiety, fibromyalgia, chronic pain, neuropathy |
| 10 | Vortioxetine (Trintellix) | Mild-moderate | More cognitive clarity and mental sharpness than physical stimulation | Nausea, dizziness, mild sexual side effects | Depression with cognitive symptoms, “brain fog” |
| 11 | Vilazodone (Viibryd) | Mild | Mild activating effects with less emotional flattening for some people | Diarrhea, nausea, insomnia, sexual side effects | Depression with anxiety symptoms |
| 12 | Escitalopram (Lexapro) | Mild-low | Usually emotionally stabilizing more than energizing | Fatigue, nausea, sexual dysfunction, headache | Anxiety disorders, depression |
| 13 | Citalopram (Celexa) | Low | Typically neutral to mildly calming rather than stimulating | Fatigue, nausea, sexual dysfunction, QT prolongation risk at high doses | Depression, anxiety |
| 14 | Paroxetine (Paxil) | Very low | Often emotionally calming rather than activating | Weight gain, fatigue, sweating, sexual dysfunction, withdrawal symptoms | Panic disorder, generalized anxiety disorder, PTSD, depression |
| Rank | Medication | Calming Level | Typical Calming Effects | Common Side Effects | Most Common Uses |
|---|---|---|---|---|---|
| 1 | Vortioxetine (Trintellix) | Mild calming | Subtle reduction in anxiety while preserving cognition and emotional range | Nausea, dizziness, mild sexual side effects | Depression with cognitive symptoms, “brain fog” |
| 2 | Vilazodone (Viibryd) | Mild-moderate calming | Anxiety reduction with less emotional flattening for some people | Diarrhea, nausea, insomnia, sexual side effects | Depression with anxiety symptoms |
| 3 | Duloxetine (Cymbalta) | Mild-moderate calming | Reduces anxiety and physical tension while helping pain symptoms | Nausea, sweating, dry mouth, constipation | Anxiety, depression, fibromyalgia, chronic pain |
| 4 | Sertraline (Zoloft) | Moderate calming | Helps reduce intrusive thoughts and anxiety while remaining somewhat energizing | GI upset/diarrhea, sweating, insomnia, sexual dysfunction | Anxiety disorders, PTSD, OCD, panic disorder, depression |
| 5 | Citalopram (Celexa) | Moderate calming | Emotionally softening and calming without major sedation | Fatigue, sexual dysfunction, nausea, QT prolongation risk at high doses | Depression, anxiety |
| 6 | Buspirone* | Moderate calming | Reduces chronic worry and physical anxiety without major sedation | Dizziness, headache, nausea | Generalized anxiety disorder |
| 7 | Fluvoxamine (Luvox) | Moderate-high calming | Strong reduction in obsessive thoughts and mental overactivity | Nausea, sleepiness, sexual dysfunction, drug interactions | OCD, anxiety disorders |
| 8 | Escitalopram (Lexapro) | High calming | Smooth reduction in anxiety and emotional reactivity; emotionally stabilizing | Sexual dysfunction, nausea, fatigue, headache | Anxiety disorders, depression |
| 9 | Paroxetine (Paxil) | Very high calming | Strong reduction in panic, hyperarousal, rumination, and anxious distress | Weight gain, fatigue, sweating, sexual dysfunction, withdrawal symptoms | Panic disorder, generalized anxiety disorder, PTSD, depression |
| Rank | Medication | Sedation Level | Typical Sedating Effects | Common Side Effects | Most Common Uses |
|---|---|---|---|---|---|
| 1 | Trazodone | Mild-moderate | Helps initiate sleep; calming without strong next-day sedation at lower doses | Dizziness, dry mouth, grogginess, rare priapism | Insomnia, depression with sleep disturbance |
| 2 | Doxepin, low dose | Moderate | Sleep maintenance; antihistamine-type calming | Dry mouth, constipation, next-day drowsiness | Insomnia, depression, anxiety |
| 3 | Amitriptyline | Moderate-high | Strong body relaxation and sleepiness | Weight gain, dry mouth, constipation, dizziness | Depression, migraines, chronic pain, insomnia |
| 4 | Nortriptyline | Moderate-high | Calming and sleep-promoting but somewhat less sedating than amitriptyline | Dry mouth, constipation, dizziness, heart rhythm effects | Depression, neuropathic pain |
| 5 | Imipramine | Moderate-high | Relaxing and anxiolytic with noticeable drowsiness | Sweating, dry mouth, constipation, weight gain | Depression, panic disorder |
| 6 | Clomipramine | High | Heavy calming with strong anti-obsessional effects | Sedation, weight gain, sexual dysfunction, dry mouth | OCD, depression |
| 7 | Trimipramine | High | Strong sleepiness and nighttime sedation | Weight gain, dry mouth, dizziness | Depression with insomnia/anxiety |
| 8 | Mianserin* | High | Potent calming and sleep promotion | Weight gain, drowsiness, dizziness | Depression, anxiety, insomnia |
| 9 | Maprotiline | High | Deep physical calming and sedation | Weight gain, dry mouth, seizure risk | Depression with anxiety/agitation |
| 10 | Mirtazapine | Very high | Heavy sleepiness, increased appetite, physical relaxation | Weight gain, increased appetite, grogginess | Depression with insomnia, low appetite, anxiety |
| 11 | Doxepin, full antidepressant doses | Very high | Strong antihistamine sedation and calming | Anticholinergic effects, dizziness, weight gain | Depression, anxiety |
| 12 | Trimipramine, higher doses | Extremely high | Deep sedation; sometimes comparable to sleep medications | Heavy grogginess, dry mouth, weight gain | Severe insomnia with depression/anxiety |
*Transparency statement: As a non-prescriber, I cannot claim to be an expert on prescription medications. I used my AI assistant to help create the comparative tables above, and AI can make mistakes.