Antidepressants: Types, Uses, and Mental Health

What Are Antidepressants?

Antidepressant medication is a treatment for major depression and some other psychiatric and medical conditions. Antidepressants are a psychotropic medication, which means that it impacts mood and behavior.

Antidepressants work by affecting chemicals that are naturally present in the body. These chemicals are called neurotransmitters because they help send signals and information from the brain to other parts of the body. Examples of neurotransmitters that impact mood are serotonin and norepinephrine.

While these medications are called antidepressants and are used to treat depression, clinicians also prescribe them for managing symptoms of anxiety disorders, other mental health conditions and sometimes medical conditions like chronic pain.

Conditions Treated with Antidepressants

Antidepressants are used to treat a wide range of mental health conditions. These include:

Major depressive disorder (MDD). MDD is characterized by depressed mood or lack of interest along with other potential symptoms like problems with sleep, self-esteem, appetite, concentration, motivation and thoughts of suicide. These symptoms last daily for at least two weeks.
Anxiety disorders. One anxiety disorder that antidepressants can treat is generalized anxiety disorder (GAD), which is when a person constantly worries over multiple things and has a hard time controlling the worry. Another condition treated with antidepressants is panic disorder, which involves sudden periods of intense fear, called panic attacks.
Obsessive-compulsive disorder (OCD). OCD involves obsessions, compulsions or both. Obsessions are intrusive, often disturbing, thoughts, and compulsions are repetitive behaviors. While the person may know that their obsessions or compulsions are unreasonable, they are not able to control them.
Post traumatic stress disorder (PTSD). PTSD may develop after someone experiences an event that threatens their life or causes or threatens serious injury. This can also include witnessing such an event happening to others or hearing that it happened to a loved one. Symptoms that develop are related to changes in cognition, emotion, mood, reactiveness and memories of the event. PTSD also involves avoiding things that trigger reminders of the event.
Chronic pain. In some cases, antidepressants can treat chronic pain, which is pain that lasts for three months or longer.

The most effective mental health treatment starts with an accurate diagnosis, and treatment of mental health conditions should be individualized to meet a person’s unique needs. Only credentialed health providers trained in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) can diagnose mental health disorders.

Some of these health providers include medical doctors (MD), nurse practitioners (NP), psychologists (PhD or PsyD) and licensed mental health counselors (LMHC).

FAQs

How Long Does it Take for Antidepressants to Work?

This can depend on the person and the specific medication. Often, you might see some improvement in your mood two weeks after starting the antidepressant. The full effects can often be felt after four weeks.

The important thing is to take the medication as prescribed by your provider. Do not stop the medication or change your dose without communicating with your provider.

Are Antidepressants Addictive?

Generally, antidepressants are not addictive.

Depending on the specific medication, withdrawal symptoms can occur after the medication is stopped, but that alone does not constitute addiction. Given that the effects of antidepressants depend on the person and the specific medication, it is important to consult with your prescribing provider before stopping the medication or changing the dose.

Will I Have to Take Antidepressants Forever?

This depends on the specific antidepressant and the type of depression and symptoms you are experiencing. Some people need to take them indefinitely while others may be able to discontinue them. However, stopping the mediation too early can cause symptoms to return.

Therefore, it’s best to follow your provider’s instructions. Your provider may also recommend gradually reducing your dosage over time to help minimize withdrawal.

Can I Take Antidepressants With Other Medications?

Yes, you can take antidepressants with other medications, but it is important to be aware of drug interactions. Therefore, before starting an antidepressant, talk with your provider about other medications you are taking.

What Should I Do if I Miss a Dose?

If you miss a dose, take your next dose at the usual time. Do not take twice the medication to make up for the dose you missed.

Types of Antidepressants

Most antidepressant medications can be placed into one of four classes. These classes differ in terms of how they work, what they are used to treat and their side effects.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs work by releasing more serotonin in the space between nerve cells. In addition to mood, serotonin is also involved in other processes like sleep and libido. Examples of SSRIs include fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine.

The benefits of SSRIs are that they are generally well-tolerated, have a low potential for overdose and are used for a wide range of conditions in addition to major depression. These include panic disorder, GAD, OCD and the eating disorder bulimia nervosa.

Side effects of SSRIs can be more disturbing than other types of antidepressants. SSRIs can lead to anxiety, sleep disturbance, gastrointestinal problems and sexual dysfunction.

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs include venlafaxine, duloxetine, desvenlafaxine and levomilnacipran.

These antidepressants can impact levels of two neurotransmitters, norepinephrine and serotonin. At low doses, they act like SSRIs in that they release more serotonin in the body, and in medium doses, they also release more norepinephrine in the body. In addition to mood, norepinephrine is involved in regulating arousal, attention and stress reactions.

Providers may prescribe SNRIs for an even wider range of conditions, including major depression, GAD, pain disorders like fibromyalgia and neuropathies, urinary incontinence and some symptoms of menopause. The most common potential side effects include dry mouth, dizziness, headache and upset stomach.

Tricyclic Antidepressants (TCAs)

TCAs are named as such because they have a tricyclic core, or at least three rings in their chemical structure.

Tricyclics are an older class of antidepressants mainly used before SSRIs became more available in the 1980s and 1990s. Currently, TCAs are mostly used when SSRIs or SNRIs don’t work, because TCAs have a poorer tolerability and higher overdose potential.

Like SSRIs and SNRIs, tricyclics work by releasing more serotonin and norepinephrine in the body. In addition to depression, they are used to treat neuropathy, chronic pain, insomnia and urinary incontinence. Potential side effects include dry mouth, constipation, dizziness and blurred vision.

The TCAs that providers prescribe include amitriptyline, imipramine, desipramine, nortriptyline, clomipramine, trimipramine, protriptyline, amoxapine and doxepin.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs work by releasing a set of neurotransmitters with a shared chemical structure into the body.

A few of these are serotonin, norepinephrine, epinephrine, melatonin and dopamine. Epinephrine is involved in inattention, excitement and the body’s metabolism. Abnormal levels of epinephrine have been linked to sleep problems, anxiety, high blood pressure and lowered immunity.

Melatonin is a chemical involved in regulating the sleep-wake cycle. Some of the processes dopamine is involved in include movement, motivation, mood, cognition and feelings of pleasure.

MAOIs have been found effective in treating atypical depression, which includes the ability of mood to uplift during a positive experience. In typical major depression, mood generally remains constant. MAOIs can also effectively treat Parkinson’s disease. Potential side effects of MAOIs include drowsiness, dizziness and weight gain.

MAOIs are used less commonly due to the dietary restrictions associated with them. While taking an MAOI, a person needs to avoid foods that are high in tyramine. These include fermented foods and aged cheeses and meats. It’s best to avoid these foods or consume them in small amounts with the approval from the prescribing provider.

Some MAOIs include selegiline, isocarboxazid, phenelzine and tranylcypromine.

Benefits and Risks of Antidepressant Medication

A doctor explains something to her patient

People with depression can experience various benefits with antidepressant medication. These include:

Mood stabilization
Reduced anxiety
Improved sleep
Improved focus and attention
Improved mood and motivation

As with any medication, there are potential side effects associated with antidepressants such as weight changes, sexual dysfunction or decreased libido and nausea. Your provider can help you weigh the pros and cons when deciding on a medication.

It is important to communicate regularly with your provider about any side effects you experience and how well the medication is working for you. Monitoring how the medication is affecting you allows for changes to your treatment plan, such as a change in dosage or a different medication, that may be more effective.

Lastly, in many cases, you will stop the medication by gradually reducing the dose. Do not stop taking the medication without consulting your provider.

Antidepressants and Therapy: A Combined Approach

Combining antidepressant medication with psychotherapy is often more effective than either of these methods on their own.

This is because medication can address the parts of depression that are physiological in nature, and evidence-based therapy, like cognitive behavioral therapy (CBT), can help strengthen healthy coping strategies and address issues such as interpersonal concerns or trauma.

At the same time, treatment plans are most effective when they are individualized. It is important to address the person’s needs by taking into account factors like the severity of their depression, their coping style and any social or occupational concerns.

These factors can help mental health providers recommend a specific antidepressant medication combined with the best-suited therapy strategy.

Reach Out Today

Sometimes, psychotropic medication is viewed as a quick fix or a lazy option compared to psychotherapy. However, that is not the case. Since the brain is also an organ, medication is a valid treatment for mental health conditions just as it is for conditions like diabetes or seizures. Antidepressant medication as part of an overall treatment plan can significantly improve depression.

It is never too late to seek help. Reach out today to find a qualified clinician and start your journey to an improved quality of life.