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Antidepressants (Depression Medication)

What You Need to Know About Medications for Depression

Antidepressants (Depression Medication) In This Article

Antidepressant medication, used under the guidance of a mental health professional, may relieve your depression symptoms. But antidepressants also come with 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 usually isn’t enough—you also may need therapy and lifestyle changes. 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 enough to impact your ability to function in life, medication can be helpful—even lifesaving. However, research shows that antidepressants fall short for many people.

A major National Institute of Mental Health 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

Medication may be right for you if depression is interfering with your ability to function in an important part of your life—work, school, or in your relationships, for example—and you think it’s worth the common side effects of antidepressants, such as weight gain and loss of sex drive. Therapy, exercise and other lifestyle changes can work just as well or better than antidepressants—minus the side effects—but often depression can rob you of the energy and motivation to pursue these avenues.

Antidepressants can take several weeks to take effect. If possible, use that time to explore self-help strategies, such as exercise, that can provide a more immediate mood boost. Alternatively, once the medication takes effect and your energy levels improve, consider therapy and lifestyle changes that 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.

Is depression caused by a chemical imbalance in the brain?

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 the causes of depression are far more complex than a simple deficiency in serotonin or other neurotransmitters. Since there is no test that can measure the amount of serotonin in the living brain, 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 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.

What are the risk factors of antidepressants?

Anyone who takes antidepressants can experience 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/aggressiveness risk

Antidepressants can make depression worse rather than better for some people, leading to an increased risk of suicide, hostility, and even homicidal behavior. While this is particularly true of children and young adults on antidepressant medication, anyone taking antidepressants should be closely watched for suicidal and hostile thoughts and behaviors. 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, panic attacks, insomnia, hostility, restlessness, 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. The suicide risk is greatest during the first two months of antidepressant treatment.

What are the 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, such as weight gain or loss of sexual interest, are common.

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). Research suggests there is little difference in the effectiveness of 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 hostility, agitation, and anxiety.

Other side effects include:

  • 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. SSRIs can also cause serious withdrawal symptoms if you stop taking them abruptly.

How easy is it to stop taking antidepressants?

Once you’ve started taking antidepressants, stopping can be tough. Many people have severe 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."

All medications for depression can cause withdrawal symptoms.

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

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.

Is depression medication right for you?

If you’re considering antidepressants as a treatment option, the following questions may help you make your decision.

Questions to ask yourself and a mental health professional

  • Is my depression adversely affecting my life enough to require 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?

Guidelines for taking antidepressants

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.
  • Beware of drug interactions. You should avoid drinking alcohol when taking SSRIs since it can lessen the effects of the medication. Dangerous drug interactions can occur when SSRIs are taken with antihistamines, found in many over-the-counter cold and allergy medicines and sleep aids, or with prescription painkillers. Always talk to your doctor or pharmacist before combining medications.
  • 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. See your doctor on a regular basis.
  • 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.

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.

More help for depression

Resources and references

General information about depression medication

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

What causes depression? Research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals. (Harvard Health Publications)

Is Depression Just Bad Chemistry? Article about how a complex disorder has so far eluded a simple biological explanation. (Scientific America)

Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study – Information about a major study conducted to determine the effectiveness of different treatments for people with depression. (National Institute of Mental Health)

Astounding increase in antidepressant use by Americans – Blog that details how the rate of antidepressant use in the U.S. has increased among teens and adults. (Harvard Medical School)

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

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)

Common Side Effects of Antidepressants – Find out about common and not-so-common side effects of antidepressants and how to manage them (Physicians’ Desk Reference)

SSRI Antidepressant Medications: Adverse Effects and Tolerability – Explores adverse effects during long-term use of SSRIs (Journal of Clinical Psychiatry)

Side Effects of Antidepressants – Details side effects of SSRIs and other depression medications. (Clinical Depression UK)

Prescription Drugs Associated with Reports of Violence Towards Others – Research that explores how certain drugs, including antidepressants, can cause acts of violence towards others. (PLOS)

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)

Using Second-Generation Antidepressants to Treat Depressive Disorders – Guidelines for the available evidence on the pharmacologic management of major depressive disorder. (American College of Physicians)

Guidance on the use of Antidepressants – Suggested plans for the treatment of unipolar depression and anxiety in adults. (Sussex Partnership National Health Service)

Coming off Antidepressants (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)

Antidepressant Discontinuation Syndrome – Discusses symptoms that can occur after abrupt discontinuation of an antidepressant medication. (American Family Physician)

Going off antidepressants – Steps to minimize or avoid the discontinuation symptoms that can occur if medications are withdrawn too quickly. (Harvard Women’s Health Watch)

Effectiveness, safety, and side effects of antidepressants

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)