Antidepressants: What Are They For? How Are They Used? What To Expect?

WHAT ARE ANTIDEPRESSANTS TAKEN FOR?

  • Antidepressants can restore your mood, energy, sleep and other symptoms of depression that affect your personal and professional life. However, not everyone responds to every antidepressant in the same way.   For instance, sometimes people may have to try few different antidepressants to find the best one for their individual situation.  Since finding the right medication and the right dose for you can take time, it is very important to collaborate with your care provider and maintain regular communication about your symptoms and the medication’s effects.
  • The antidepressants that have been approved for use have been studied rigorously and proven to reduce the symptoms of depression. Together, you and your medical provider are best suited to determine if the benefits of antidepressant medication(s) outweigh the risks of treatment as well as the risks of not treating the depression.
How do antidepressants work to increase mood?
  • There are a wide variety of antidepressant agents, all organized into several classes based on how they work (see the chart below).  Despite the subtleties of their individual differences, each of these medications affects your neurons (brain cells) and neurotransmitters (important chemicals your brain normally produces) in basically similar ways. These medications regulate mood by recalibrating the ways that some of the neurons in your brain communicate with each other.  This recalibration process can take several weeks to have its full effect on your mood symptoms, so it is important to consistently communicate with your mental healthcare provider(s) and be patient.

Drug Class

Generic name (Brand name)

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Selective Serotonin Receptor Inhibitors (SSRIs)

  • Citalopram (Celexa®)
  • Escitalopram (Lexapro®)
  • Fluoxetine (Prozac®)
  • Paroxetine (Paxil®, Pexeva®)
  • Sertraline (Zoloft®)

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

  • Duloxetine (Cymbalta®)
  • Venlafaxine (Effexor XR®)
  • Desvenlafaxine (Pristiq®)

Tricyclic Antidepressants (TCAs)

  • Amitriptyline
  • Amoxapine
  • Desipramine (Norpramin®)
  • Doxepin
  • Imipramine (Tofranil®)
  • Nortriptyline (Pamelor®)
  • Protriptyline (Vivactil®)
  • Trimipramine (Surmontil®)

Monoamine oxidase inhibitors (MAOIs) 

  • Isocarboxazid (Marplan®)
  • Phenelzine (Nardil®)
  • Selegiline (Emsam®)
  • Tranylcypromine (Parnate®)

Atypical antidepressants

  • Bupropion (Wellbutrin®, others)
  • Mirtazapine (Remeron®)
  • Nefazodone
  • Trazodone (Oleptro®)

There are variety of antidepressants available. For more information, check out these resources:

CAUTION: Dietary supplements may interact with other medications. Talk to your health provider before taking any dietary supplement.           

  • St. John's Wort may be effective in treating mild symptoms of depression, but has not been proven to work in moderate or severe forms of depression. St. John's Wort can interact with antidepressants, leading to potentially dangerous side effects. St. John’s Wort can also interact with birth control pills, reducing their contraceptive effects. Talk to your health care provider if you are taking or considering taking St. John's Wort.1,2
  • SAMe (s-adenosylmethionine), a dietary supplement, has NOT yet been proven as a safe or effective treatment for depression. Do not use SAMe to replace conventional care or to postpone seeing a health care provider about a medical problem. SAMe can interact with many other medications, including some common over-the-counter cold medicines, to cause side effects such as nausea, upset stomach, and other side effects that could be potentially dangerous. Talk to your health care provider if you are taking or considering taking SAMe.3,4
  • The link between low levels of B vitamins (B12, B6, folate) and depression is unclear. Supplements are good for correcting vitamin deficiencies but no supplement can replace proven depression treatments such as antidepressants and psychological therapies.5
  • Folate (or folic acid) is a B vitamin that may augment the ability of antidepressants to improve mood. Preliminary research appears to suggest that folate may be effective when added to a person’s regular psychiatric medications, but more definitive research needs to be done. Folate may interact with your other medications. Talk to your health care provider to see if it is right for you.6 

 

HOW SHOULD ANTIDEPRESSANT MEDICATIONS BE USED?

  • Take your antidepressant as directed by your healthcare provider.  To be effective, these medications need to be taken at a consistent dose on a regular, daily basis.  Once started, do not stop taking your antidepressant abruptly.  Stopping antidepressants abruptly may lead to unwanted side effects.  More importantly, you may be at risk of worsening symptoms of depression and even feelings of suicide. Talk to your healthcare provider first if you are considering stopping your antidepressant.7 

 

WHAT SHOULD I EXPECT WHEN TAKING ANTIDEPRESSANT MEDICATIONS?

  • Will antidepressants work immediately to increase my mood?
    • Most antidepressants take 1-4 weeks to begin improving depressive symptoms. Antidepressants can sometimes unexpectedly increase suicidal thoughts when first started. Contact your health care provider right away if your depression symptoms worsen.8
  • How long do I have to take my antidepressant?
    • You should plan to take your antidepressant daily for the first 12 months after it is originally prescribed.  The duration of ongoing antidepressant treatment beyond the first 12 months is patient-specific and best determined collaboratively with your mental healthcare provider. Some people may begin tapering off their antidepressant at the end of the 12-month period, though others may require a longer duration of treatment.  Talk to your health care provider about the most appropriate duration of treatment for your specific situation.9,10
  • Is it OK to drink alcohol with my antidepressant?
    • No.  It is best to avoid drinking alcohol while taking antidepressants.  Alcohol inhibits the effectiveness of your antidepressant and can increase your symptoms of depression. Some antidepressants even have dangerous side effects when combined with alcohol.  Drinking alcohol while taking antidepressants can impact your ability to drive safely even more than alcohol alone and must be avoided altogether.11
  • Can antidepressants affect my other medications?
    • Yes.  Antidepressants can interact with other drugs and medications.  Let your healthcare providers know all the medications you are taking (prescription and over-the-counter) and avoid starting new over-the-counter medications without first discussing with your healthcare provider.  Similarly, let your mental healthcare providers know if there are any other drugs you take (including occasional recreational drugs) that are not prescribed for you.12
  • What are possible side effects of antidepressants?
    • When first starting an antidepressant, it is possible that thoughts of suicide may unexpectedly emerge. Contact your health care provider right away if this happens or if any of your depression symptoms worsen.13
    • Common side effects include dry mouth, headache, stomach upset, jitters, dizziness, or drowsiness. These symptoms typically go away within the first few weeks of starting an antidepressant.  If your antidepressant makes you drowsy, ask your health care provider if it is safe to drive while taking your medication.
    • Sexual side effects are less common, but quite bothersome to many people.  Luckily, they are fairly easy to manage and resolve once identified.  Be sure to discuss any changes in your sex drive or performance with your mental healthcare provider.
    • Antidepressants can induce manic symptoms in some people, though this is not common.  Be sure to let your mental healthcare provider know if you experience (or your loved ones observe) insomnia, boundless energy, poor judgment, or other uncharacteristic patterns of behavior after beginning antidepressant treatment.
    • Weight gain is a possible side effect of antidepressants, but some are more likely than others to cause weight gain. Some people lose weight after starting an antidepressant. Each person responds differently to each antidepressant.14
    • Since many medications can cause drowsiness that interferes with the ability to drive safely, always ask your health care provider if it is safe to drive while taking your medication(s). Roadwise RX is a tool to help you understand how medications may affect you and your driving.
    • Bottom line: antidepressants affect each person differently. There are many ways to cope with side effects related to antidepressants. Talk to your health care provider about any side effects you have, but do not stop taking your medication on your own unless you have life-threatening side effects. 

Possible side effect

Tips on how to manage15,16

Increased suicidal Ideation

  • Notify a healthcare professional urgently without delay and seek assistance immediately.
  • You may need to change to a different antidepressant regimen.

 

Sexual side effects (reduced sex drive, erection or lubrication issues, difficulty or delay in achieving orgasms)

  • Notify your healthcare provider as soon as this becomes a nuisance.  The sooner, the better.
  • Your healthcare provider can help you select the most suitable option from among several effective management strategies.

 

Hypomania/Mania (abruptly reduced need for sleep; unusual levels of energy, excitement or socializing; irritability; poor judgment; copious or loud speech; erratic behavior or decision-making)

  • Notify your healthcare provider immediately so you can review these symptoms together and review the most appropriate management options.
  • You may need to change to a different antidepressant regimen.

 

Nausea

  • Take your antidepressant with food, unless directed otherwise
  • Eat smaller meals more frequently
  • Drink plenty of water

 

Weight gain

  • Eat foods low in calories and high in nutrients (i.e. vegetables, fruit)
  • Reduce sweets, sugary drinks, saturated and trans fats
  • Eat smaller meals more frequently and slowly
  • Exercise regularly at least 30 min each day most days a week

 

Drowsiness/Fatigue

  • Take your antidepressant 1-2 hours before bedtime
  • Exercise regularly at least 30 min each day most days a week

 

Insomnia

  • Take your antidepressant in the morning
  • Avoid caffeine 
  • Complete exercise routine several hours before bedtime

 

 

DID YOU KNOW? 

Diet and exercise tips:

  • A healthy diet may help with boosting your energy levels and mood. Foods rich in vitamin B12 (poultry, fish and dairy), folate (i.e. beans and leafy greens), fruits and vegetables are all part of a healthy diet.17
  • Exercise has been shown to increase various chemicals in the brain, including endorphins, which may help improve mood. Recommendation: at least 30 minutes per day three to five times per week.18

Facts and statistics:

  • Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005–2008 and the most frequently used by persons aged 18–44 years. About one in 16 Americans aged 18–39 take antidepressant medication.
  • Between 2008–2010, 28.1% full-time college students received prescription medication for their depression.19,20

 

References

  1. http://nccam.nih.gov/health/tips/depression
  2. http://www.medicinenet.com/oral_contraceptives/page3.htm
  3. http://www.nlm.nih.gov/medlineplus/druginfo/natural/786.html
  4. https://nccih.nih.gov/health/supplements/SAMe?nav=gsa
  5. http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/vitamin-b12-and-depression/faq-20058077
  6. http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/About_Treatments_and_Supports/Folate.htm
  7. http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000570.htm
  8. http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1142&pageaction=displayproduct
  9. http://www.webmd.com/depression/features/antidepressants?page=3
  10. http://www.who.int/mental_health/mhgap/evidence/depression/q2/en/
  11. http://www.mayoclinic.com/health/antidepressants-and-alcohol/AN01653
  12. http://www.medicinenet.com/antidepressants/article.htm
  13. http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/ucm100211.pdf
  14. http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants-and-weight-gain/faq-20058127
  15. http://www.webmd.com/depression/features/coping-with-side-effects-of-depression-treatment?page=3
  16. http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20049305
  17. http://www.webmd.com/depression/features/foods-feel-better
  18. http://www.nami.org/Template.cfm?Section=Depression&Template=/ContentManagement/ContentDisplay.cfm&ContentID=88858
  19. http://www.cdc.gov/nchs/data/databriefs/db76.htm
  20. http://www.samhsa.gov/data/2k12/NSDUH060/SR060CollegeStudentsMDE2012.htm