Antidepressants are among them more prescribed drugs in the United States. This is due, in part, to the number of people diagnosed depression and anxiety has been on the riseand prescriptions skyrocketed in certain age groups during the pandemic.
Despite the prevalence of these drugs, some patients have “significant misconceptions” about how the drugs work, said Dr. Andrew J. Gerber, a psychiatrist and president and medical director of Silver Hill Hospital in New Canaan, Conn.
About 80 percent Antidepressants are prescribed by primary care physicians who have not had extensive training in the management of mental illness.
Dr. Paul Nestadt, an associate professor of psychiatry at the Johns Hopkins School of Medicine, said his patients say, “You know, doctor, I’ve tried everything.” But often, he said, “they never got to a good dose, or they only took it for a week or two.”
Here are some answers to frequently asked questions about antidepressants.
How do antidepressants work?
There are many types of antidepressantsand everything works a little differently.
In general, they initiate a change in the way brain cells — and different areas of the brain — communicate with each other, said Dr. Gerard Sanacora, a professor of psychiatry at Yale School of Medicine.
Clinical trials have shown that antidepressants are general more efficient with moderate, severe and chronic depression than with mild depression. Even then, it’s a modest effect compared to placebo.
The largest study of multiple antidepressants — nicknamed the STAR*D trial — found that half of the participants had improved after using either the first or second drug they tried, and nearly 70 percent of people had become symptom-free by the fourth antidepressant.
Unfortunately, there is no way to know in advance how a person will respond to any given drug, so there may be a period of trial and error.
More research is needed to better understand how antidepressants work and how effective they are, especially when taken over many years.
How do I know which one to get?
The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors, or SSRIs, such as Prozac or Zoloft, and serotonin-norepinephrine reuptake inhibitors, or SNRIs, such as Cymbalta and Effexor. These two types tend to have fewer side effects than tricyclic antidepressants such as clomipramine or monoamine oxidase inhibitors such as phenelzine.
In general, SSRIs and SNRIs are equally effective.
But for some people, the differences between these drugs—even those in the same class—are not subtle at all. If a drug isn’t right, there are other options. Experts advise working with your doctor to find the best fit.
How long do antidepressants take to work?
A common myth is that antidepressants are “quick fixes,” said Dr. Kao-Ping Chua, a pediatrician and health policy researcher at the University of Michigan Medical School. “It certainly isn’t.”
Generally, it can take one to two months to start seeing positive results, experts say. And that’s assuming you’re getting the optimal amount.
At first, clinicians tend to check in more frequently so they can follow up with patients.
“It may take some time to determine the right dose,” said Dr. Chua. If the dose is adjusted and it still doesn’t work, “switching to a different antidepressant could be reasonable,” he said.
If you are experiencing acute or debilitating symptoms of depression, including thoughts of self-harm, seek immediate help by calling the Suicide and Crisis Helpline by dialing 988.
Are side effects inevitable?
No.
Different Earlier antidepressantsSSRI and SNRI drugs usually do not have many short-term side effects, and if they do, they are often mild.
Some of the most common, which may occur within days of starting medication, are decreased libido, headache, dry mouth, and upset stomach. But many people experience no side effects at all, experts said.
Short-term side effects often fade as your body adjusts to the medication—you should know which ones are most likely to stick around within about two to three weeks of starting the medication, Dr. Nestadt said.
Decreased libido can be persistent, which can be “disabling,” she said. At that point, doctors may try to treat the problem with an additional drug or switch to a different antidepressant.
Long-term use can cause other side effects, including weight gain or emotional dullness.
Finally, antidepressants can interact with other medications. An SSRI combined with ibuprofen, for example, increases the risk of gastrointestinal bleeding. Additionally, drinking alcohol while taking antidepressants is generally not recommended.
Should I do anything other than take the medicine?
Yes.
Therapy remains one of the first treatments recommended for depression. Antidepressants don’t make problems go away, but they can make them easier to deal with, Dr. Chua said.
Lifestyle changes may also help, experts said. Research has shown it exercising can reduce symptoms of depression. And eating a heart healthy diet may be beneficial, although more research is needed on how foods affect mood. Too much or too little sleep also affects how we feel, so it’s important to get enough rest.
Are antidepressants used for anything other than depression?
Yes.
They can also treat chronic pain conditions such as shingles and migraines as well as anxiety, social phobia, post-traumatic stress disorder and obsessive-compulsive disorder.
What about the “black box” warning?
In 2004, the Food and Drug Administration issued a “black box” warning saying that the use of certain antidepressants may be linked to suicidal ideation and behavior in teenagers. Three years later, the warning was expanded to include 18- to 24-year-olds.
The warning was based on an analysis of drug testing in which there were no suicides. However, the researchers found a significant risk of suicidal thoughts. Other studies have found that SSRIs reduce suicide rates and suicidal behavior among young people, which led to some experts request that the warning be re-evaluated.
How do I know when it’s time to stop taking antidepressants?
Psychiatrists usually recommend discussing whether to wean off the drug after you’ve experienced benefits for at least six months.
Studies show that “patients who do well on antidepressants are more likely to experience depression relapse if they stop taking antidepressants,” said Dr.
But that’s not true for everyone, he added, so check with your provider to decide whether to stop taking your medication.
Psychotherapy can help people are successfully discontinuing antidepressants. But it is always important to decrease the medication under the supervision of a doctor.
In some cases, if the taper is not done slowly enough, patients can experience what we commonly call a stroke, which feels like an electric shock, or other side effects such as nausea, said Dr. David J. Hellerstein, professor of clinical psychiatry at Irving Medical Center. of Columbia University.
The slow taper is especially important with an antidepressant that has a short half-life like Effexor or Paxil, he added. When patients stop drugs like these, the amount of drug in the body “is there very quickly,” he added.
Some people with chronic and recurrent depression may need to take antidepressants indefinitely, Dr. Hellerstein said.
That’s generally considered safe, he said, adding that it’s far more dangerous for people to go untreated.
If you are having suicidal thoughts, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources. I am going here for resources outside the United States.