Antidepressants

Antidepressants are medications that treat mental health conditions like depression, anxiety, PTSD and some eating disorders. They can also help with long-term pain and trouble sleeping.

Depression is the main reason people take antidepressants. This is a mental health condition that goes beyond feeling sad. It’s lasting and can affect your mood, thoughts, energy and motivation. It can cause you to lose interest in things you used to enjoy. It can also make it hard to remember things, eat well and sleep.

These medications may reduce symptoms, like emotional changes or fatigue. But they don’t fix the root cause. That’s why providers often suggest talking with a therapist (called talk therapy), too.

Antidepressant drugs are one of the most commonly prescribed medicines in the U.S.

What conditions do antidepressants help treat?

The U.S. Food and Drug Administration (FDA) approved antidepressant drugs for the following conditions in adults:

• Bipolar disorder
• Bulimia nervosa
• Chronic pain and fibromyalgia
• Depression, major depressive disorder and seasonal affective disorder
• Diabetes-related neuropathy
• Generalized anxiety disorder and social anxiety disorder
• Obsessive-compulsive disorder
• Panic disorder
• Premenstrual dysphoric disorder
• Post-traumatic stress disorder

Providers may also prescribe antidepressants for other health concerns. This is called off-label use. It means it isn’t officially approved by the FDA for that purpose. For example, some providers use tricyclic antidepressants to help with insomnia or migraines.

What are the types of antidepressants?

There are different types or classes of antidepressant drugs, including:

• Selective serotonin reuptake inhibitors (SSRIs): These raise serotonin levels in your brain to improve mood.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): These raise both serotonin and norepinephrine levels, which help with mood, stress and alertness.
• Tricyclic antidepressants: These increase serotonin and norepinephrine, like SNRIs, but they also affect other parts of your brain and body.
• Monoamine oxidase inhibitors (MAOIs): These boost levels of brain chemicals by blocking an enzyme that breaks them down.
• NMDA receptor antagonists: These block N-methyl-D-aspartate receptors and can work quickly to improve mood. Providers usually use them when other antidepressants haven’t helped. They often give this type in a clinic.
• Atypical antidepressants: These don’t fit into the other groups. Each one works in a different way to affect brain chemicals.

There are also several kinds of medications (and brands) within each class.

What is the most common type of antidepressant?

SSRIs are the most commonly prescribed type of antidepressant. Fluoxetine (Prozac®) is probably the most well-known SSRI.

SSRIs are often the first treatment providers choose for many mental health conditions. They work well to manage symptoms and have milder side effects, so providers usually start with them before trying other options.

How do antidepressants work?

Antidepressants change the way your brain uses certain chemicals (called neurotransmitters) to better regulate your mood and behavior.

They can also rewire your brain through a process called neuroplasticity. This means your brain can form new connections between nerve cells. It improves how various parts of your brain interact. This leads to improvements in your mood over time.

How should I take antidepressants?

Antidepressants usually come as pills you swallow with water. When you first start, your provider will likely prescribe the lowest dose they think will help. Your provider will check in regularly and adjust your dose if needed.

It may take a few weeks before you start to feel better. Even after you feel better, keep taking the medication as directed. Stopping suddenly can cause uncomfortable symptoms.

Most people stay on this medication for at least six months after they start feeling better. If depression is long-term, comes back often or is very severe, your provider may recommend taking the medication longer.

How do I know which depression medicine is right for me?

With so many options, choosing a depression medication can feel overwhelming. Your healthcare provider will help you decide which one is most likely to work based on factors like:

• Your specific symptoms
• Possible side effects
• How it might interact with other medications you take
• Other conditions you have

It’s also important to talk to your doctor about your plans. For example, some antidepressants are safe to take during pregnancy. Your provider can help you choose the safest option as you start your family.

It can take time to find the right antidepressant. Be patient with the process. Tell your provider if you have side effects that bother you or if your symptoms don’t improve after a few weeks. They may adjust your dose, switch your medication or suggest taking more than one type.

Antidepressant side effects

Each type (class) of antidepressant drug has different possible side effects. Common side effects include:

• Blurred vision
• Drowsiness
• Dizziness
• Dry mouth
• Headache
• Hypomania (bipolar disorder)
• Lack of energy
• Mood changes (anxious, agitated or numb)
• Nausea
• Rash
• Problems during sex
• Sleep issues
• Tremor
• Weight gain
• Changes in sodium level

Before starting a medication, talk with your doctor or pharmacist about the possible side effects.

Most side effects are mild and may get better over time. If you notice any that bother you, let your provider know. They might change your dose or suggest a different medicine.

There’s currently a black box warning (the strongest safety warning the FDA gives for medicines) on antidepressants about an increased risk of suicidal thoughts and behaviors in people 24 years old or younger. This isn’t considered a typical side effect, but it’s a debated adverse effect with mixed evidence in the medical field.

What are the possible complications of taking antidepressants?

Most people tolerate antidepressants well. But like any medication, they can cause problems in some cases. It’s generally safe to take an antidepressant under your provider’s supervision. But there are certain complications you should be aware of. Let your provider know right away if you notice any of the following:

• Suicidal thoughts or behavior: If you’re under age 24, antidepressants may increase thoughts of self-harm, especially when starting or changing the dose.
• Discontinuation syndrome: Stopping antidepressants quickly can cause flu-like symptoms, trouble sleeping, dizziness and mood changes.
• Serotonin syndrome: This is rare but serious. It happens when there’s too much serotonin in your body. It can cause confusion, muscle stiffness, fever or seizures.
• Overdose: Taking too much can be dangerous or life-threatening, mostly with tricyclic antidepressants. Always follow your provider’s instructions.
• Stomach bleeding: SSRIs may raise the chance of bleeding in your stomach, especially when taken with pain relievers like NSAIDs.
• Hypomania: If you have bipolar disorder, this medication may cause your mood or emotions, energy level or activity level to be elevated or change.
• Sodium level changes: Antidepressants may change the sodium level in your body. Your provider will watch for this.

Are antidepressants addictive?

No, antidepressant medicines aren’t addictive.

Antidepressant benefits

Antidepressants can help you feel better by managing symptoms of depression and other conditions. Some of the benefits include:

• Reducing symptoms like low mood, worry or tiredness
• Improving daily functioning, so it’s easier to work, go to school or take care of yourself
• Working well with therapy, making other treatments more effective

Your provider can explain how this medication might help you and the specific benefits you can expect.

How long does it take for antidepressants to work?

It can take four to eight weeks for the medication to work and for your symptoms to ease. You might notice changes in appetite, energy, focus or sleep before your mood improves. The delay happens because the medication needs time to change the connections in your brain.

Be sure to follow your provider’s instructions and take the medicine for the full recommended time. If you stop too soon, you might not feel the full benefits. And it could have unwanted side effects.

When should I call my healthcare provider?

You should have regular check-ins with your provider while taking an antidepressant to see how well it’s working. Also, let your provider know if:

• You have side effects that bother you
• Your symptoms aren’t getting better or are getting worse
• You’re thinking about stopping the medication

When should I seek emergency care?

If you have symptoms of serotonin syndrome or overdose, call 911 (or your local emergency service number) or go to the nearest emergency room.

If you’re having suicidal thoughts, you can call or text 988 (U.S.). This is the Suicide and Crisis Lifeline. Someone is available to talk to you 24/7. If you’re in immediate danger, contact emergency services.