What do you recommend as a first-line antidepressant in patients with major depressive disorder and migraines?

In my clinical practice, I have found SNRI medication, particularly extended-release venlafaxine (dosed from 37.5 mg to 225 mg), to be helpful for patients with both comorbidities. Other medication classes I have seen used to good effect include TCAs (amitriptyline, nortriptyline) and some SSRIs (se...

Nortriptyline

Because TCAs with both 5-HT and NE effects in low doses were a mainstay of treatment by neurologists in the past for migraines, I would favor dual-action agents such as Cymbalta or Pristiq for this combination of conditions. These are cleaner than the TCAs and would offer full antidepressant respons...