Antidepressants are just one of a number of treatments that are effective for depression.
- For mild depression, lifestyle changes such as regular exercise, relaxation, and sleep can be very effective.
- For moderate depression, various psychotherapies are effective. While medication works faster, psychotherapy can have a more enduring benefit. Many people with moderate depression choose to use both therapy and antidepressants.
- For severe depression, it is essential to combine medication with psychotherapy because neither approach alone is likely to be effective in a timely way.
Research shows that people who take antidepressants experience improvements in their depression, as well as subtle, but significant, improvements in quality of life. They report feeling less reactive to difficult life events, having fewer negative obsessive thoughts, and they can pause and consider their feelings and actions in a more balanced way. They also report they can let go of negative thought patterns more easily and they feel less haunted by past traumatic events.
People taking antidepressants may have more energy, may sleep better and may concentrate better. Antidepressants are also effective for reducing panic attacks, general worries, and anxiety.
Individuals starting antidepressant therapy may experience several types of side effects:
- Increase in suicidal thoughts occurs in up to 18 percent of people who begin taking antidepressants and is more likely in people younger than 25. It usually lasts only for a few days, and eventually improves in 91 percent of people who experience this side effect. If you start to have persistent thoughts of suicide, contact your doctor immediately, and be sure that you are around people who can support you.
- Physical restlessness, also known as akathisia, causes a feeling of being unable to sit still and a need to keep moving. Many clinicians believe that this intense inner restlessness may drive the increase in suicidal thoughts. If you experience akathisia, you may need to switch to a different antidepressant.
- Sexual side effects, including decreased libido or delayed or less-intense orgasm, occur up to 56 percent of the time with a class of antidepressants called serotonin reuptake inhibitors (SRIs). Clinicians often treat such side effects by lowering the dose, changing the medication, or adding another medication (such as the antidepressant bupropion) that reverses the sexual side effects. It is very common for young people who are on antidepressants to take both an SRI and a low dose of bupropion.
- Drowsiness and weight gain occur around 50 percent of the time.
- Dry mouth, insomnia, fatigue, nausea, dizziness, and tremors occur less than 20 percent of the time.
Most initial side effects disappear in less than a week. If you experience lasting side effects, tell the clinician who prescribed the antidepressant. There are many medication options, and your clinician can help you find the one that works best for you.
It is better for people who are depressed not to drink alcohol. Although alcohol can provide some short-term relief, it usually worsens depression in the long run. Most people find that they get more intoxicated on less alcohol while taking an antidepressant, so if you choose to drink, it is important to do so carefully.
Alcohol can also reduce inhibitions, including inhibitions against suicide and self-destructive behavior. More than 50 percent of people who commit suicide are found to have been drinking.
If you drink while taking an antidepressant and find that you are very depressed or thinking of suicide, you should immediately call the clinician who prescribed your antidepressant or go to an emergency room.
Many clinicians believe that marijuana use interferes with the benefits of antidepressant medication. There is an association between marijuana use and depression, but it is not clear if this is a cause-and-effect relationship. If you stop using marijuana for a while, this can help determine if it is contributing to your depression.
There are potential interactions between any two medications. To avoid problems, it is important that you inform the clinician who prescribed the antidepressants—and pharmacist who filled the prescription—of all the medications you are taking.
Clinicians usually recommend that people continue taking antidepressants for about six months after they begin feeling better. Although it is tempting to stop taking the medication as soon as you feel better, abruptly stopping will greatly increase your risk of relapse.
Like other medications, antidepressants can produce withdrawal symptoms if stopped suddenly. The most common symptoms are dizziness, vertigo, nausea, gait instability, fatigue, and headache. You may also have a brief reoccurrence of the symptoms you had before starting the medication (such as depression, anxiety, irritability, or oversensitivity). Other symptoms can be quite unusual and have been described as feeling as if “the brain is sloshing around in the head” or feeling “electrical zaps” in the brain or arms and legs. In general, the symptoms of withdrawal last one or two weeks.
It’s important to realize that the symptoms you experience when stopping an antidepressant abruptly are not necessarily the way you would feel if you were taken off the medication gradually.
Clinicians began hearing this question from patients after news articles reported on a 2002 analysis of published and unpublished studies submitted to the U.S. Food and Drug Administration (FDA) as part of the approval process for several new types of antidepressant medication. This analysis concluded that the newer types of antidepressants are only marginally more effective than placebo.
However, these analyses do not reflect how antidepressants are used in actual practice. Drug trials measure only how a person responds to a single medication taken at a specific dose for a limited time. In clinical practice, however, the patient and clinician work together to find the dose and the medication or combination of medications most effective for you. Most clinicians believe that this process results in much better results than these analyses imply.
Antidepressants work by affecting neurotransmitter systems in the brain. Neurotransmitters and receptors are the way nerve cells in the brain communicate. A neurotransmitter represents a message sent from one nerve cell to another, and the receptor on the adjacent cell is like the mailbox. Antidepressants increase available levels of some neurotransmitters (messages), which, in turn, improve mood and anxiety. This happens over a period of several weeks.
People commonly refer to antidepressants as “correcting a chemical imbalance,” but this is incorrect. It is more accurate to say the medications create a new equilibrium that results in beneficial brain changes.
We don’t know the exact cause of depression, though it may be the result of a natural response that goes awry at times. But we do know that changing the levels of certain neurotransmitters has a proven, clinically significant impact, and that antidepressants can have therapeutic benefits for patients.