What antidepressants are and what they treat
Antidepressants are prescription medicines used mainly for depression. NIMH notes that providers also prescribe them for anxiety, pain and insomnia. MedlinePlus explains that researchers think they may improve the way the brain uses certain chemicals that control mood or stress.
The most commonly prescribed types are SSRIs and SNRIs. NIMH says they are widely used because they help a broad range of depressive and anxiety disorders and have fewer side effects than older medicines. Older types, such as tricyclics and MAOIs, cause more side effects but may still be the best option for some people. The NHS notes that the different types generally work about equally well for depression; the differences lie in side effects and in who can safely take them.
Before you start: what your prescriber needs to know
MedlinePlus lists the questions a prescriber weighs when choosing a first medicine. You can help by coming prepared:
- Which symptoms bother you most, such as sleep, appetite, energy or worry
- Every medicine, supplement and herbal product you take, including over-the-counter pain relievers and decongestants
- Whether a close relative did well on a particular antidepressant
- Other health conditions
- Pregnancy, plans for pregnancy, or breastfeeding
- Any past periods of unusually high mood or energy, which Cleveland Clinic notes matter because antidepressants can trigger hypomania in people with bipolar disorder
- Alcohol and recreational drug use; MedlinePlus asks you to be honest about both
Supplements count. NIMH warns that combining antidepressants with other substances that act on serotonin, such as triptans for migraine or the supplement St. John's wort, can cause a rare but life-threatening reaction called serotonin syndrome. MedlinePlus also suggests filling all prescriptions at one pharmacy so the pharmacist can spot interactions.
The first weeks
Patience is part of the plan. NIMH says antidepressants usually take four to eight weeks to work, and that sleep, appetite, energy and concentration often improve before mood lifts. The NHS notes some people notice an effect within one to two weeks. MedlinePlus adds that you may need to try two or more medicines before finding one that works. In the NHS, people starting an antidepressant are usually seen every one to two weeks at first; ask your prescriber when your follow-up visits will be, and keep them even if you feel fine.
Common side effects, according to NIMH, include upset stomach, headache and sexual problems. They are generally mild and tend to ease with time. People sensitive to side effects sometimes start at a low dose and increase slowly, or change when they take the medicine, but those are decisions for your prescriber. If sexual side effects are a concern, Antidepressants and Other Medications That Can Affect Sex explains what to raise.
The FDA boxed warning
A boxed warning is the FDA's most prominent safety warning on a medicine's label. Antidepressants carry one headed "Suicidal Thoughts and Behaviors." The FDA-approved label for sertraline (Zoloft), for example, states that antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies, and that all patients taking antidepressants should be closely monitored for worsening and for new suicidal thoughts. Its Medication Guide describes the higher-risk group as people 24 and younger, especially in the first few months or when the dose changes.
The same Medication Guide notes that depression and other serious mental illnesses are the most important causes of suicidal thoughts. The warning is a reason for close follow-up, not a reason to go without treatment. MedlinePlus also points out that there are risks to leaving depression untreated.
Call your prescriber right away if you notice new or sudden changes in mood, behavior, thoughts or feelings, especially if severe: worsening depression, agitation, panic, trouble sleeping, irritability, acting without thinking or thoughts of harming yourself. Let someone close to you know what to watch for too.
Rare but serious reactions
Cleveland Clinic lists complications to report promptly: serotonin syndrome (confusion, muscle stiffness, fever or seizures), a higher chance of stomach bleeding when SSRIs are combined with pain relievers such as NSAIDs, changes in sodium levels, and overdose risk, mostly with tricyclics. For signs of serotonin syndrome or overdose, Cleveland Clinic advises calling 911 or going to the nearest emergency room.
How long you take it, and how stopping works
MedlinePlus gives a typical treatment length of 6 to 12 months once a medicine starts working, with some people staying on longer. Stopping is a planned step, not a sudden one. Mayo Clinic explains that stopping abruptly, particularly after more than four to six weeks, can cause antidepressant discontinuation syndrome, with symptoms starting within a day or two and usually lasting a few weeks. These symptoms do not mean you were addicted. A prescriber may lower the dose gradually over several weeks or more. Mayo Clinic also notes it can be hard to tell discontinuation symptoms from returning depression, so keep your prescriber informed.
MedlinePlus is direct: never change your dose or stop an antidepressant on your own, even if you feel better. Talk with your prescriber before changing anything.
Medication and therapy together
Medication can ease symptoms; therapy works on what keeps depression going. Therapy, Medication or Both for Depression? compares the options. Dr. Lehmann does not prescribe, but depression therapy with her can run alongside your prescriber's care, and therapy is a useful place to notice and put into words how a medication is affecting you before your next appointment.