Antidepressants: How They Work and When They're Used
In addition to traditional psychotherapy, antidepressant medications are a fundamental component in the treatment of depression. When typical coping skills are no longer effective, your doctor or psychiatrist may recommend antidepressant therapy to assist with your recovery.
Antidepressants have been scientifically proven to significantly improve feelings of hopelessness, despair, and suicidal ideation in persons with moderate, severe, or chronic depression.
What Are Antidepressants?
The term “antidepressant” is used to describe a classification of medications typically prescribed for the treatment of depressive disorders. Some of these disorders include:
- Major depressive disorder
- Persistent depressive disorder
- Seasonal affective disorder (SAD)
- Psychotic depression
- Premenstrual dysphoric disorder (PMDD)
- Situational depression
- Peripartum (postpartum) depression
- Atypical depression
Antidepressants are sometimes used in an off-label capacity to treat symptoms of pain or to treat other mental health conditions like anxiety disorders or post-traumatic stress disorder (PTSD).
Types of Antidepressants
There are many different antidepressants available, and most fall into the following groups:
- Tricyclic antidepressants (TCAs)
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Selective Serotonin Noradrenaline Reuptake Inhibitors (SNRIs)
- Adrenergic alpha-2 receptor antagonists
- Monoamine oxidase (MAO) inhibitors
- Selective noradrenaline reuptake inhibitors
- Selective noradrenaline/dopamine reuptake inhibitors
- Melatonin receptor agonists and serotonin 5-HT2C receptor antagonists
The majority of antidepressants prescribed today are TCAs, SSRIs, and SNRIs. Some herbal supplements have been studied in the treatment of depression like St. John’s Wort.
Who Is A Good Candidate For Antidepressant Treatment?
A doctor or psychiatrist will ask questions to gauge your depression symptoms. Many considered for antidepressant treatment frequently experience some or all of the following symptoms on a regular basis:
- Feelings of hopelessness, despair, numbness, or emptiness
- Frequent episodes of crying or tearfulness
- Difficulty sleeping or staying asleep
- Sleeping too much or during the day
- Lack of motivation
- Feelings of tiredness
- Issues with thinking clearly or concentrating
- Difficulty remembering things or making decisions
- Feeling overwhelmed with day-to-day tasks
- Moving or speaking more slowly than usual or moving so slowly that another person notices
- Feelings of guilt or shame, thinking about past failures repeatedly
- Issues with hygiene or wanting to bathe
- Lack of interest in food
- Lack of interest in hobbies or relationships that bring you joy
- Physical feelings of pain
- Thoughts of suicide or not wanting to be alive
- Feelings of irritability or impatience
It’s important to note that each individual’s symptoms of depression may vary, so a thorough evaluation by a psychiatric provider is essential to form a comprehensive treatment plan.
How Do Antidepressants Work?
Most antidepressants work by honing in on chemical signals in the brain that may have become imbalanced due to a number of environmental or genetic factors. Typically, neurotransmitters like dopamine and serotonin become imbalanced and can cause a number of psychiatric symptoms, including depression and anxiety.
Taking an antidepressant can help balance these neurotransmitters in a way that makes them more available for the brain and nervous system to use. Each class of antidepressants does this in a slightly different way; that’s why it’s important to have a psychiatrist manage your care to uncover which class of antidepressants may work best for you and how you should take antidepressants.
Typically, a person would take an antidepressant pill every day over a period of time. The duration of treatment is personalized to the individual’s unique situation, but most people take antidepressants for at least 6-12 months. However, some people with chronic, recurring depression may take antidepressants for much longer.
It’s important to be in contact with your psychiatrist if you decide that you want to stop taking antidepressants. Abruptly stopping an antidepressant can cause a relapse in depressive symptoms along with other unpleasant withdrawal symptoms.
How Effective Are Antidepressants?
How well antidepressant treatment works depends on a number of factors. Some factors include:
- Dosage of medication
- Compliance with medication regimen
- Relationship status and satisfaction with existing relationships
- Happiness with employment
- Financial stressors
- Educational stressors
- Lack of access to adequate resources
- Lack of a support system
- Family issues
- Genetic predispositions
- Vitamin deficiencies
- Thyroid Issues
- Unresolved infection/illness
- Amount and efficacy of coping skills
Because every person and every case is unique, antidepressant therapy has been proven to be significantly more effective when combined with traditional therapy. An antidepressant alone may be helpful, but overall, individuals report a larger decrease in depression symptoms when additional support structures are in place.
How Long Do Antidepressants Take To Start Working?
Typically, after starting antidepressant therapy, individuals will notice an improvement in symptoms after two to three weeks without missing any doses. Your psychiatrist may start you on a low dose of the medication to see if it is effective for you and then slowly begin increasing the dose if symptoms of depression do not improve.
Sometimes people feel worsening symptoms of depression or suicidal thoughts during the first month of therapy. This is a very concerning phenomenon and should be managed closely by a health care professional.
If you have recently started antidepressant treatment and begin having thoughts of suicide, please immediately call 911 or go to your local emergency department. Suicidal thoughts are a medical emergency and should be treated as such. This is also why combining antidepressant treatment with additional supportive structures like therapy is generally considered more effective.
Potential Side Effects Of Antidepressants
All medications have potential side effects, and antidepressants are no exception. Fortunately, for most people side effects of antidepressants are typically mild. Some common side effects are:
- Nausea
- Diarrhea
- Drowsiness
- Fatigue
- Dry mouth
- Decreased libido
Some more serious side effects do exist. If you are concerned about a possible side effect of an antidepressant medication, make sure to talk with your doctor about them. Oftentimes lowering the dose or switching to a new medication can resolve undesirable side effects so that you can continue treatment.
How Can I Maximize My Antidepressant Treatment?
The first and most important aspect to get the most out of your antidepressant medication is to stay in contact with your psychiatrist. For many antidepressants, there are additional mental health medications that may enhance treatment. For example, combining an SSRI with an insomnia medication may decrease feelings of depression.
You can also play an active role in your therapy by getting adequate nutrition, exercising as tolerated, prioritizing your sleep schedule, and making positive changes in your life to support your recovery. This may include leaving a relationship or job that is no longer healthy for you, or starting therapy.
Vitamin deficiencies are also common in individuals with depression. Up to 90% of people with diagnosed depression are deficient in vitamin D. Ask your provider about serum vitamin testing for depression symptoms. Other conditions like hypothyroidism, anemia, vitamin B deficiency, and gastrointestinal disorders can mimic symptoms of depression so it is important to have a thorough mental health evaluation to explore all possibilities.
How Can I Stop Taking Antidepressants?
If your symptoms of depression are resolved and you are considering stopping antidepressant treatment, don’t go cold turkey with your medication. There are several important factors to consider. Your psychiatrist may recommend reducing the dose of medication slowly over a period of time. If you suddenly stop taking an antidepressant, you may experience withdrawal symptoms which can be very unpleasant if not managed appropriately.
Normally when an individual stops taking antidepressants, withdrawal symptoms appear within 5-7 days. Some of these symptoms may include:
- Restlessness
- Irritability
- Flu-like symptoms
- Abdominal pain
- Nausea
- Anxiety
- Trouble sleeping
It is very normal for a person to need additional support when they stop taking depression medication. Seeking help from a therapist or mental health program is strongly encouraged to avoid relapses in depression and suicidal thoughts.
Treating Depression With Sequoia Behavioral Health
Antidepressant treatment may be an option for you if you have moderate to severe depression that is unresponsive to other methods. Call Sequoia Behavioral Health today. Our team has years of experience and can help you find relief for your depression. Reach for a free consultation about antidepressant treatment.
Written by E. Parsons, RN, BSN, CTSS
*Disclaimer: This post is not medical advice. If you are experiencing symptoms of depression or have questions about medications, talk with your physician or go to your local emergency room.