Antidepressants are among the most commonly prescribed medications in the United States. That's partly because the number of people being diagnosed with depression and anxiety is on the rise, and prescriptions for some age groups have skyrocketed during the pandemic.
Despite the widespread use of these drugs, some patients have “serious misconceptions” about how they work, says the president and medical director of Silver Hill Hospital in New Canaan, Conn. said psychiatrist Dr. Andrew J. Garber.
Approximately 80% of antidepressants are prescribed by primary care physicians who are not adequately trained in the management of mental illness.
Dr. Paul Nestadt, associate professor of psychiatry at Johns Hopkins University School of Medicine, says patients “say, 'Doctor, you know, I've tried everything,' but often they… “We did not reach a final conclusion.” Either I was taking a sufficient dose or I was only taking it for a week or two. ”
Here are answers to some frequently asked questions about antidepressants.
How do antidepressants work?
There are many types of antidepressants, each with slightly different effects.
Generally, they cause changes in brain cells and the way different areas of the brain communicate with each other, said Dr. Gerardo Sanacola, professor of psychiatry at Yale School of Medicine.
Clinical trials have shown that antidepressants are generally more effective for moderate, severe, and chronic depression than for mild depression. Still, the effects are modest compared to placebo.
In the largest study of multiple antidepressants, called the STAR*D trial, half of the participants experienced improvement after their first or second dose of the drug, and nearly 70 percent experienced improvement after their fourth dose. It turned out that her symptoms disappeared by the time she started taking antidepressants.
Unfortunately, there is no way to know in advance how an individual will react to a particular drug, so there can be a period of trial and error.
Further research is needed to better understand how antidepressants work and their effectiveness, especially when taken over several years.
How do I know which one to take?
The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, and serotonin norepinephrine reuptake inhibitors (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 are not subtle at all, even if they are in the same class. If one drug doesn't suit you, there are other options. Experts advise working with your doctor to find what's best for you.
How long does it take for antidepressants to take effect?
Dr. Kao-Ping Chua, a pediatrician and health policy researcher at the University of Michigan Medical School, said the conventional wisdom is that antidepressants are a “quick-fix treatment.” “They definitely aren't.”
Experts say it generally takes one to two months to start seeing positive effects. And that's assuming you're consuming the optimal amount.
Initially, clinicians tend to check in more frequently so they can monitor patients.
“It can take time to identify the right dose,” Dr. Chua says. If adjusting the dose doesn't help, “it may make sense to switch to a different antidepressant,” he says.
If you are experiencing acute or debilitating symptoms of depression, including thoughts of self-harm, seek immediate help by calling the Suicide and Crisis Lifeline by dialing 988.
Are side effects inevitable?
no.
Unlike traditional antidepressants, SSRI and SNRI drugs usually do not have many short-term side effects, and if they do, they are usually mild.
The most common symptoms that occur within a few days of starting the drug include decreased sex drive, headache, dry mouth, and upset stomach. But experts say many people experience no side effects at all.
Short-term side effects often fade as your body gets used to the drug, but you need to know which side effects are more likely to persist within about two to three weeks of starting the drug, Dr. Nestadt said.
Low sex drive can persist, he says, and can be a “deal breaker.” At that point, your doctor may try to treat the problem with additional medications or switch you to a different antidepressant.
Long-term use can cause side effects such as weight gain and emotional blunting.
Finally, antidepressants can interact with other medications. For example, taking SSRIs and ibuprofen together increases the risk of gastrointestinal bleeding. Additionally, drinking alcohol while taking antidepressants is generally not recommended.
Should I do anything other than take medicine?
yes.
Therapy remains one of the first recommended treatments for depression. Antidepressants won't solve the problem, but they can make it easier to deal with it, Dr. Chua said.
Experts say lifestyle changes may also help. Research shows that exercise reduces symptoms of depression. And while eating a heart-healthy diet may be beneficial, more research is needed into how food affects mood. Getting an adequate amount of rest is important, as too much or too little sleep can affect your mood.
Are antidepressants used for things other than depression?
yes.
It is also used to treat chronic pain conditions such as shingles and migraines, anxiety, social phobia, post-traumatic stress disorder, and obsessive-compulsive disorder.
What about “black box” warnings?
In 2004, the Food and Drug Administration issued a “black box” warning that the use of certain antidepressants may be associated with suicidal thoughts and behavior in adolescents. Three years later, the warning was extended from those aged 18 to those aged 24.
This warning is based on an analysis of drug trials in which there were no suicides. However, researchers found a significant risk for suicidal ideation. Other studies have found that SSRIs reduce suicide rates and behavior in young people, leading some experts to call for a reassessment of warnings.
How do I know when to stop taking antidepressants?
Psychiatrists usually recommend discussing whether to stop taking the medication after it has been effective for at least six months.
Studies have shown that “patients who do well on antidepressants are more likely to experience depression relapse when they stop taking the antidepressant,” Dr. Chua said.
But that doesn't apply to everyone, so check with your health care provider about whether to stop taking the medication, he added.
Psychotherapy may help successfully discontinue antidepressants. However, it is always important to taper off the medication gradually under your doctor's supervision.
In some cases, if the taper is not done slowly enough, patients can experience a so-called brain zap, which feels like an electric shock, or experience side effects such as nausea, said David, a professor of clinical medicine. said Dr. J. Hellerstein. Department of Psychiatry, Columbia University Irving Medical Center.
She added that tapering slowly is especially important for antidepressants with short half-lives, such as Effexor and Paxil. When patients stop taking such drugs, the amount of the drug in their body “depletes very quickly,” he added.
Some people with chronic, recurrent depression may have to take antidepressants indefinitely, Dr. Hellerstein said.
This is generally considered safe, he said, adding that going without treatment is very risky for patients.
If you are thinking of suicide, contact the 988 Suicide and Crisis Lifeline by calling or texting 988 or visit the link below. SpeakerOfSuicide.com/Resources For a list of additional resources, go here For resources outside the United States.