Top 10 Things You Should Know About Antidepressants

Antidepressants are prescription drugs used to treat depression and a variety of other psychological conditions such as anxiety, panic, posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). Some depression drugs are also used to treat medical conditions (e.g. some tricyclic antidepressants are given for chronic pain).

Here is a list of helpful information about antidepressants (not in order of importance).

  • Antidepressants help correct chemical imbalances in your brain by affecting certain brain chemicals called neurotransmitters, which are responsible for sending messages between nerve cells. Neurotransmitters are responsible for different functions in the body. For example, some antidepressants help alleviate depression by increasing the neurotransmitter, Serotonin which plays a role in a variety of functions such as mood, appetite, sleep, memory and sexual behavior. Other antidepressants increase the neurotransmitters, Norepinephrine and Dopamine. Norepinephrine manages functions in the sympathetic nervous system (e.g. fight or flight response, blood pressure, heart rate and concentration) while Dopamine plays a part in emotion, learning, motivation, pleasure, memory, movement and other roles.
  • There are basically three major types of antidepressants. The different categories of antidepressants differ in terms of the neurotransmitters affected and the process involved in increasing these neurotransmitters.Selective Serotonin Reuptake Inhibitors (SSRI) - SSRIs (e.g. Zoloft, Lexapro, Prozac, Paxil, Celexa) are the most commonly prescribed antidepressants. SSRIs increase the amount of Serotonin by hindering the process involved in eliminating Serotonin (which is called Reuptake). After Serotonin is released from a nerve cell, the Reuptake process removes any Serotonin that is not used. Since the re-absorption of Serotonin is blocked, the level of Serotonin is increased.

    Tricyclic Antidepressants (TCA) - TCAs (e.g. Elavil, Nortriptyline) increase Seratonin, Norepinephrine and Dopamine by also blocking the Reuptake process (the removal of these neurotransmitters). Because of more adverse side effects, TCAs are prescribed less often than SSRIs.

    Monoamine Oxidase Inhibitors (MAOI) - MAOIs (e.g. Nardil, Marplan) inhibit the action of an enzyme called monoamine oxidase, which breaks down certain neurotransmitters. As a result, the amounts of Serotonin and Norepinephrine are increased. MAOIs are less prescribed than SSRIs and TCAs because of possible severe side effects and drug interactions. They are often used to treat depression that has not responded to other depression medications.

    There are other antidepressants that don't fall in any of the above categories, which affect a different combination of neurotransmitters. For example, Wellbutrin is a Dopamine and Norepinephrine Reuptake Inhibitors (DNRI), which increases both Dopamine and Norepinephrine by blocking the removal of these two neurotransmitters.

  • Be patient when working with your doctor. It often takes several tries to find the right antidepressant. A doctor will select the most appropriate antidepressant based on your symptoms, the antidepressant's potential side effects, your medical conditions and any medications you're taking. Because of the many antidepressants on the market today, doctors have many options to choose from. So don't worry if the first antidepressant is not working well for you.
  • Antidepressants are not a quick fix and take time to work. They often take several weeks (or more) before positive results are noticed. Because everyone's brain chemistry is different, antidepressants will affect individuals differently.
  • Each antidepressant will have its own particular side effects. Many side effects are temporary and will go away once your body adjusts to the medication. Ask your doctor about the typical side effects, how long they may last, and when you should contact your doctor.
  • Don't stop antidepressants too early. If you do, the chances of re-experiencing depression are increased. For most people, it is not necessary to take antidepressants for the rest of your life. Many individuals take antidepressants for six months to a year or more.
  • The beliefs that antidepressants will change your personality or not allow you to feel are myths. If you truly need antidepressants, they should make you feel better and not worse. If you feel any of these concerns, talk to your doctor. You may be on the wrong medication or dose.
  • Antidepressants are not habit forming (addictive). Often people cope with depression and other problems in less healthy ways such as using alcohol or illicit drugs. Taking depression medication is a healthier alternative with less negative consequences.
  • Don't stop taking antidepressants without talking to your doctor first. For example, some SSRIs (e.g. Paxil) which are short-acting (stays in the body for a short period of time) may cause withdrawal like symptoms if they are stopped suddenly or dosage is reduced too quickly. If you stop or reduce certain SSRIs suddenly, you may experience SSRI Discontinuation Syndrome which is characterized by flu like symptoms such as nausea, chills, diarrhea, fatigue, headache, vomiting and dizziness. See a doctor if you start to experience these symptoms.
  • There has been recent concern about using antidepressants with children. Short-term studies have shown that children using antidepressants have an increased risk of suicidal thinking and behavior in the first few months of treatment. Children should be closely monitored when beginning antidepressants or changing dosage. Likewise, adults who have depression (or other psychiatric conditions) and a history of suicidal behavior should also be closely watched.

Dr. Joanne Chao is a psychologist practicing in California and is the editor of Depression Help Resource, a website providing information about antidepressants, treatment options and depression related articles and resources.

Reviewed by athealth on February 8, 2014.