Antidepressants: How They Work, Types, Side Effects and Safe Use

Antidepressants are prescription medicines for depression. Depression is more than feeling a little sad or "blue" for a few days: it is a very common, serious medical illness that affects mood and mental health. It can leave people tired, hopeless, worried or afraid; change how they think, sleep and eat; and lead some to think about ending their lives. Antidepressants can help many people who have it.

Researchers think antidepressants may improve the way the brain uses certain chemicals that control mood or stress. Health care providers also prescribe them for anxiety, chronic pain or insomnia, and sometimes for other conditions.

Types

There are many antidepressants, and each works differently. Providers usually start with the newer ones, which cause fewer side effects than older types and seem to help with more kinds of depression and anxiety.

The older types can cause more serious side effects, but for some people the benefits may outweigh the risks.

Finding the right one

Bodies and brains work differently, so no antidepressant works for everyone, and it may take two or more before one works. A provider will help choose the first to try, considering:

• Which symptoms bother you most. Some antidepressants may help more with particular symptoms, such as trouble sleeping.
• What else you take. Some antidepressants cause problems with certain medicines and herbs.
• What worked in your family. One that helped a parent, brother or sister could be a good choice.
• Other health conditions. Some antidepressants can make other conditions better or worse.
• Pregnancy. If you are pregnant, planning a pregnancy or breastfeeding, your provider will help find a treatment that is safe for you and your baby.

How long they take, and for how long

Antidepressants usually take 4 to 8 weeks to work, so patience is needed. Sleep and appetite may improve before mood does — a good sign that the medicine may just need more time.

Sometimes an antidepressant helps at first and then symptoms return while you are still taking it; there is usually another to try. For more relief, a provider may suggest combining two antidepressants, adding another kind of medicine, or adding talk therapy or other approaches.

Once one works, you and your provider decide how long to continue. Treatment typically lasts 6 to 12 months, though some people take antidepressants much longer.

Side effects

Not everyone gets side effects, and those who do usually find them mild and easing as the body adjusts. The most common are:

• nausea and vomiting;
• weight gain;
• diarrhea;
• sleepiness;
• sexual problems, such as lack of desire or ability to have sex.

There are risks in leaving depression untreated too, and a provider can help weigh the options. A provider may suggest ways to manage side effects while you wait to see whether the medicine works; if they are too troublesome, you may need to switch. But never change the dose or stop on your own. Call your provider right away about serious problems or worrying changes — new or worsening symptoms, unusual mood changes, or acting differently.

Children, teenagers and young adults under 25 may in some cases be more likely to think about hurting or killing themselves when they start an antidepressant or when the dose changes. Get medical help right away if this happens.

Taking them safely

Antidepressants are generally safe when used correctly:

• tell your provider everything you take — medicines, herbs, supplements and over-the-counter products such as pain relievers and decongestants — and be honest about alcohol and recreational drugs;
• try to fill all your prescriptions at one pharmacy, so the pharmacist can warn you and your provider about medicines that may not mix;
• follow the instructions for taking your medicine, and talk with your provider if side effects bother you;
• never stop without your provider's help. Stopping too fast may bring depression back or even make it worse; the body needs time to adjust, and your provider can explain the safest way to come off.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.

Sources

• MedlinePlus, U.S. National Library of Medicine, "Antidepressants," drawing on the National Institute of Mental Health. https://medlineplus.gov/antidepressants.html
• Rewritten in hubnx's own words.