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Antidepressants (Depression Medication)

What You Need to Know About Medications for Depression

Antidepressants (Depression Medication)

Antidepressant medication, used under the guidance of a mental health professional, may relieve some of your depression symptoms. But antidepressants also come with significant side effects and dangers. What’s more, recent studies have raised questions about their effectiveness. At the very least, it’s clear that medication alone isn’t enough—you also need to make changes in your lifestyle. Learning the facts about antidepressants and weighing the benefits against the risks can help you make an informed and personal decision about what’s right for you.

How effective are antidepressants?

Important

This information is not intended to be a substitute for medical advice. If you are taking an antidepressant, do not change your dosage without consulting your physician!

Most mental health experts agree that when depression is severe, medication can be helpful—even life saving. However, research shows that antidepressants fall short for many people.

A major 2006 U.S. government study showed that fewer than 50 percent of people become symptom-free on antidepressants, even after trying two different medications. Furthermore, many who do respond to medication soon slip back into depression, despite sticking with drug treatment.

Other studies show that the benefits of depression medication have been exaggerated, with some researchers concluding that—when it comes to mild to moderate depression—antidepressants are only slightly more effective than placebos.

The bottom line

If you have severe depression that’s interfering with your ability to function, medication may be right for you. However, it's important you first try therapy, exercise, or self-help strategies that work just as well or better—minus the side effects—as antidepressants.

Therapy and self-help strategies can help you get to the bottom of your underlying issues and develop the tools to beat depression for good. So while drug treatment can be beneficial, it’s by no means the only answer. There are other effective treatment approaches that can be taken in addition to, or instead of, medication. It's up to you to evaluate your options and decide what's best for you.

Is depression caused by a chemical imbalance in the brain?

When it comes to depression, serotonin doesn’t tell the whole story

Experts agree that depression involves much more than just “bad” brain chemistry. Serotonin is just one of many factors that may play a role in the disorder.

New research points to other biological contributors to depression, including inflammation, elevated stress hormones, immune system suppression, abnormal activity in certain parts of the brain, nutritional deficiencies, and shrinking brain cells. And these are just the biological causes of depression.

Social and psychological factors—such as loneliness, lack of exercise, poor diet, and low self-esteem—also play an enormous role in depression.

You’ve seen it in television ads, read it in newspaper articles, maybe even heard it from your doctor: depression is caused by a chemical imbalance in the brain that medication can correct. According to the theory of chemical imbalance, low levels of the brain chemical serotonin lead to depression and depression medication works by bringing serotonin levels back to normal.

The truth is that researchers know very little about how antidepressants work, as there is no test that can measure the amount of serotonin in the living brain. This means there is no way to even know what a low or normal level of serotonin is, or how depression medication can fix these levels.

While antidepressant drugs such as Prozac increase serotonin levels in the brain, this doesn’t mean that depression is caused by a serotonin shortage. After all, aspirin may cure a headache, but that doesn’t mean headaches are caused by an aspirin deficiency. Furthermore, many studies contradict the chemical imbalance theory of depression.

Experiments have shown that lowering people’s serotonin levels doesn’t always lower mood, nor does it worsen symptoms in people who are already depressed. And while antidepressants raise serotonin levels within hours, it takes weeks before medication is able to relieve depression. If low serotonin caused depression, there wouldn’t be this antidepressant medication lag.

Side effects of antidepressant medication

There are many different types of drugs used in the treatment of depression, including selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs).

Side effects are common in all antidepressants, and for many people, these effects are serious enough to make them stop taking the medication.

Side effects of SSRIs (selective serotonin reuptake inhibitors)

The most widely prescribed antidepressants come from a class of medications known as selective serotonin reuptake inhibitors (SSRIs). The SSRIs include well-known antidepressants such as Prozac, Zoloft, and Paxil. Research suggests there is little difference in the effectiveness of these newer antidepressants, but there may be differences in side effects, cost, and how long the medication takes to work.

The SSRIs act on serotonin, a chemical in the brain that helps regulate mood. Serotonin also plays a role in digestion, pain, sleep, mental clarity, and other bodily functions, which is why SSRI antidepressants cause a wide range of side effects, including:

  • Nausea
  • Insomnia
  • Anxiety
  • Restlessness
  • Decreased sex drive
  • Dizziness
  • Weight gain
  • Tremors
  • Sweating
  • Sleepiness or fatigue
  • Dry mouth
  • Diarrhea
  • Constipation
  • Headaches

While some side effects go away after the first few weeks of drug treatment, others persist and may even get worse.

Studies show that in adults over the age of 65, SSRIs may increase the risk for falls, fractures, and bone loss. The SSRIs can also cause serious withdrawal symptoms if you stop taking them abruptly.

Generic vs. Brand-Name Drugs

Generic drugs have the same use, dosage, side effects, risks, safety profile, and potency as the original brand-name drug. The main reason why generic drugs are cheaper than brand-name drugs is that the generic drug manufacturer does not need to recoup huge expenses for developing and marketing a drug. Once the patent for the original drug has expired, other manufacturers can produce the same drug with the same ingredients at a markedly lower cost.

Occasionally, brand-name drugs have different coatings or color dyes to change their appearance. In rare cases, these extra ingredients will make the generic form of the drug less tolerable, so if your condition worsens after switching from a brand-name to a generic drug, consult your doctor. In most cases, however, generic drugs are just as safe and effective as brand-name drugs, and a lot easier on your wallet.

Antidepressant risk factors

Anyone who takes antidepressants can experience unpleasant or dangerous side effects, but certain individuals are at a higher risk:

  • People over 65. Studies show that SSRI medications may increase the risk for falls, fractures, and bone loss in older adults.
  • Pregnant women. The use of SSRI's late in pregnancy may lead to short-term withdrawal symptoms in newborns after delivery. Typical symptoms include tremor, restlessness, mild respiratory problems, and weak cry.
  • Teens and young adults. The U.S. Food and Drug Administration requires all depression medications to include a warning label about the increased risk of suicide in children and young adults.
  • People who may have bipolar disorder. Antidepressants can actually make bipolar disorder worse or trigger a manic episode; there are other treatments available for those with bipolar disorder.

Antidepressant medication and suicide risk

For some people, antidepressant treatment causes an increase, rather than a decrease, in depression—and with it, an increased risk of suicide. While this is particularly true of children and young adults on antidepressant medication, anyone taking antidepressants should be closely watched for suicidal thoughts and behaviors. The suicide risk is greatest during the first one to two months of antidepressant treatment.

Monitoring is especially important if this is the person’s first time on depression medication or if the dose has recently been changed. Signs that medication is making things worse include anxiety, insomnia, hostility, and extreme agitation—particularly if the symptoms appear suddenly or rapidly deteriorate. If you spot the warning signs in yourself or a loved one, contact a doctor or therapist immediately.

If you are concerned that a friend or family member is contemplating suicide, see Suicide Prevention.

Deciding if depression medication is right for you

If you’re considering antidepressants as a treatment option, make sure you carefully consider all of your treatment options. The following questions may help you make your decision.

Questions to ask yourself and a mental health professional

  • Is my depression severe enough to justify drug treatment?
  • Is medication the best option for treating my depression?
  • Am I willing to tolerate unwanted side effects?
  • What non-drug treatments might help my depression?
  • Do I have the time and motivation to pursue other treatments such as therapy and exercise?
  • What self-help strategies might reduce my depression?
  • If I decide to take medication, should I pursue therapy as well?

Questions to ask your doctor

  • How much mental health care training have you had?
  • Are there any medical conditions that could be causing my depression?
  • What are the side effects and risks of the antidepressant you are recommending?
  • Are there any foods or other substances I will need to avoid?
  • How will this drug interact with other prescriptions I’m taking?
  • How long will I have to take this medication?
  • Will withdrawing from the drug be difficult?
  • Will my depression return when I stop taking medication?

Medication alone is not enough

Medication may treat some symptoms of depression, but can’t change underlying contributions to depression in your life. Antidepressants are not a cure and won’t solve your problems if you’re depressed because of a dead-end job, a pessimistic outlook, or an unhealthy relationship. That’s where therapy and other lifestyle changes come in.

Exploring your depression treatment options

It sometimes takes time to find the depression treatment that’s right for you. Don’t be fooled into thinking that antidepressants are the best choice, just because they may be the easiest one.

Studies show that therapy works just as well as antidepressants in treating depression, and it’s better at preventing relapse once treatment ends. While depression medication only helps as long as you’re taking it, the emotional insights and coping skills acquired during therapy can have a more lasting effect on depression. However, if your depression is so severe that you don't have the energy to pursue treatment, a brief trial of antidepressants may boost your mood to a level where you can focus on therapy.

In addition to therapy, other effective treatments for depression include exercise, meditation, relaxation techniques, stress management, support groups, and self-help steps. While these treatments require more time and effort initially, their advantage over depression medication is that they boost mood without any adverse effects.

Guidelines for taking antidepressants

If you decide to take depression medication, it’s wise to learn all you can about your prescription. The more you know about your antidepressant, the better equipped you’ll be to deal with side effects, avoid dangerous drug interactions, and minimize other safety concerns.

Some suggestions:

  • See a psychiatrist, not a family physician. Your family physician might help you or your loved one first realize that you may need depression treatment. But although any medical doctor can prescribe medications, psychiatrists are doctors who specialize in mental health treatment. They are more likely to be familiar with the newest research on antidepressants and any safety concerns. Your health depends on your doctor's expertise, so it's important to choose the most qualified physician.
  • Follow instructions. Be sure to take your antidepressant according to the doctor's instructions. Don't skip or alter your dose, and don't stop taking your pills as soon as you begin to feel better. Stopping treatment prematurely is associated with high relapse rates and can cause serious withdrawal symptoms.
  • Monitor side effects. Keep track of any physical and emotional changes you’re experiencing and talk to your doctor about them. Contact your doctor or therapist immediately if your depression worsens or you experience an increase in suicidal thoughts.
  • Be patient. Finding the right drug and dosage is a trial and error process. It takes approximately four to six weeks for antidepressant medications to reach their full therapeutic effect. Many people try several medications before finding one that helps.
  • Go to therapy. Medication can reduce the symptoms of depression, but it doesn’t treat the underlying problem. Psychotherapy can help you get to the root of your depression, change negative thinking patterns, and learn new ways of coping.

Antidepressant withdrawal

Antidepressant withdrawal symptoms

  • Anxiety, agitation
  • Depression, mood swings
  • Flu-like symptoms
  • Irritability and aggression
  • Insomnia, nightmares
  • Nausea and vomiting
  • Dizziness, loss of coordination
  • Stomach cramping and pain
  • Electric shock sensations
  • Tremor, muscle spasms

Once you’ve started taking antidepressants, stopping can be tough. Many people have withdrawal symptoms that make it difficult to get off of the medication.

If you decide to stop taking antidepressants, it’s essential to consult a doctor and taper off slowly.

If you stop abruptly, you may experience a number of unpleasant withdrawal symptoms such as crying spells, extreme restlessness, dizziness, fatigue, and aches and pains. These withdrawal symptoms are known as “antidepressant discontinuation syndrome."

Antidepressant discontinuation syndrome is especially common when you stop taking Paxil or Zoloft. Prozac, which has a longer half-life in the body, is the least likely to lead to withdrawal. However, all medications for depression can cause withdrawal symptoms.

Depression and anxiety can be symptoms of antidepressant withdrawal

Depression and anxiety are common symptoms when withdrawing from antidepressants. When depression is a withdrawal symptom, it’s often worse than the original depression that led to drug treatment in the first place. Unfortunately, many people mistake this withdrawal symptom for a return of their depressive illness and resume medication, creating a vicious circle.

Tips for stopping your antidepressants safely

  • Reduce your dose gradually. In order to avoid antidepressant withdrawal symptoms, never stop your medication “cold turkey.” Instead, gradually step down your dose, allowing for at least one to two weeks between each dosage reduction.
  • Don’t rush the process. The antidepressant tapering process may take up to several months, and should only be attempted under a doctor's supervision. Be patient. If, at any time, you experience difficulties, consider spending more time at your current dose before attempting any further reductions.
  • Choose a time to stop that isn’t too stressful. Withdrawing from antidepressants can be difficult, so it’s best to start when you’re not under a lot of stress. If you’re currently going through any major life changes or significantly stressful circumstances, you may want to wait until you’re in a more stable place.

More help for antidepressants

Resources and references

General information about depression medication

Antidepressants: Comparing Effectiveness, Safety, Side Effects, and Price (PDF) – Report helps consumers assess whether antidepressants are right for them, and if so, which one. (Consumer Reports)

Psychiatry by Prescription – Article on the growing use of psychotropic medications, including antidepressants, for relatively mild conditions. (Harvard Magazine)

Understanding Antidepressant Medications – Covers types of antidepressants and their effectiveness, side effects, and serious risks. (U.S. Food and Drug Administration)

How antidepressants work

Head Fake – Article on the misguided theory that low serotonin is responsible for depression, and new research that points to the real way antidepressants work. (Boston Globe)

The Anatomy of Mood: Biology and the Brain – Covers new evidence that antidepressants help depression by promoting neurogenesis and brain growth. (The Johns Hopkins Depression and Anxiety Bulletin)

Some Drugs Work to Treat Depression, But It Isn't Clear How – Reviews the lack of evidence for the chemical imbalance theory of depression. Includes new theories on how antidepressants work. (Wall Street Journal)

Antidepressant side effects and risks

Questions and Answers on Antidepressant Use in Children, Adolescents, and Adults – FDA Public Health Advisory on the increased suicide risk in children and adolescents taking antidepressants. (U.S. Food and Drug Administration)

Sexual Problems and Depression – Learn about the sexual side effects of antidepressants and how to treat the problem. (Cleveland Clinic)

Antidepressant Use Linked to Bone Loss – Covers two Archives of Internal Medicine studies on the connection between SSRI use in adults over 65 and abnormal bone loss. (National Institutes of Health)

Antidepressant treatment guidelines

Antidepressants: Selecting One That's Right for You – Introduction to the various types of antidepressants and how to find the right one for you. (Mayo Clinic)

Antidepressant withdrawal

Coming Off Antidepressants Can Be Tricky Business – Includes information on how to decide if stopping is the right move and a doctor’s advice on coming off antidepressant medication. (NPR)

Dependence on Antidepressants & Halting SSRIs – Advice from a doctor on how to withdraw from SSRI medication without experiencing adverse symptoms. (Benzodiazepine Addiction, Withdrawal & Recovery)