Bupropion (Wellbutrin) works in a manner different from other families of medication, modulating both norepinephrine and dopamine, and is often able to help individuals who have not benefited from other treatments.  It does not cause weight gain.  It has less sexual difficult and even helps some individuals in this area.  It has been available for many years now and a generic is moderately priced ($35-$40/month).  It is definitely worth trying, but I don't use it as my first choice.  Click the button above for many studies.

Trazodone is an older anti-depressant which causes no weight gain and often has a strong sleep effect.  Although studies suggest it works about as well as other anti-depressants, it is no longer used very much except for its sleep effect.  Still, in view of its low cost ($15/month) and somewhat different manner of action, it is worth a try.  Click the button above for many studies.

Amisulpride is an atypical anti-psychotic which is currently unavailable in the U.S.

Amisulpride: Low Dose did as well as Paroxetine: DB 272 MDD 8 weeks 50mg vs. paroxetine 20mg. No difference. Efficacy and safety of amisulpride 50 mg versus paroxetine 20 mg in major depression: a randomized, double-blind, parallel group study. Cassano GB, Jori MC; AMIMAJOR Group. Int Clin Psychopharmacol. 2002 Jan;17(1):27-32

Amisulpride: Low Dose better than Sertraline: DB 12 weeks 50mg vs sertraline 50-100mg/d 313 outpatients with dysthymia (DSM-IV +/- episode of major depression). Full response rate on HAM-D was higher with amisulpride after 4 weeks (63% versus 50%, P < 0.02) and 8 weeks (82% versus 69%, P < 0.009). Italy. Faster response on amisulpride 50 mg versus sertraline 50-100 mg in patients with dysthymia or double depression: a randomized, double-blind, parallel group study. Amore M, Jori MC; AMISERT Investigators. Int Clin Psychopharmacol. 2001 Nov;16(6):317-24

Amisulpride Low Dose did as well as Low Dose Amitriptyline in 6 month DB: 250 dysthymic patients. amisulpride 50mg vs amitriptyline 25-75mg/d. 68% responders. Side-effects similar in degree tho differ in type. Amisulpride in medium-term treatment of dysthymia: a six-month, double-blind safety study versus amitriptyline. AMILONG investigators. Ravizza L. J Psychopharmacol. 1999;13(3):248-54

Maprotiline (Ludiomil) is a perfectly good older anti-depressant which never became very popular.  It is still available but is rarely used, even by me.

Maprotiline did as well as Paroxetine for Minor Depression: Szejedi of the University of Mainz in J Aff Disorder 9/97 45:167 studied 267 patients in a DB trial without a placebo control and found considerable improvement in both treatment groups.

Maprotiline did as well as Fluoxetine: In DB of 544 depressed out-patients studied by Szejedi of the University of Mainz in Pharmacopsychiatry 5/97;30:97, there was no difference in improvement or side-effects although the side-effects were different with more anti-cholinergic ones with maprotiline and more SSRI type with fluoxetine.