“The best prescription is knowledge.”
If you decide to take depression medication, it’s prudent to learn all you can about your prescription. The more you know about your antidepressant, the better equipped you’ll be to deal with it’s both positive and negative effects.
Here is a list of helpful information about antidepressants:
1. Symptom relief can take weeks
Antidepressants are not a quick fix and take time to work. It may take several weeks (or more) before positive results are noticed. Because everyone’s brain chemistry is different, antidepressants will affect individuals differently.
You may start to feel better within one to three weeks of taking antidepressant medicine. But it can take as many as six to eight weeks to see further improvement.
How antidepressants work is a subject of ongoing research and speculation. The prevailing theory is that they boost chemicals in the brain, especially the neurotransmitters serotonin and neuropinephrine, that make you feel better.
2. Antidepressants are not “happy pills”
Don’t expect a “high”. Antidepressants aren’t like narcotics or alcohol. They don’t make you high, or cause hangovers. Their effectiveness is gradual and the benefits are subtle.
3. Side effects
Antidepressants may cause a wide range of side effects. For many people, the side effects are more unpleasant than the depression itself, so they discontinue treatment. In fact, for every 4 people starting a Selective Serotonin Reuptake Inhibitor(SSRI), treatment is stopped in 1 due to side effects4.
There are two side-effects that people seem to find the most troubling: sexual dysfunction and weight gain.
Rather ironically, just about all medications used can also potentially cause sexual side-effects. If these problems are of great concern, trazodone3, bupropion (Wellbutrin)2 and mirtazapine (Remeron) are medications which have fewer sexual side effects.
Regarding weight gain, paroxetine (Paxil), mirtazapine (Remeron) and citalopram (Celexa) are the worst offenders1. Venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac) do not seem to cause weight gain as badly, and may even cause some people to lose a few pounds.
In general, SSRIs cause fewer types of adverse effects than do Tricyclic Antidepressants (TCAs). With many tricyclics, the most troublesome effect with ongoing use is sedation.
4. Most antidepressants are equally effective
Most of these drugs are equally effective. While drug companies have reduced medication side effects with the newer antidepressants, there’s still not much improvement with onset of action or efficacy.
However, finding the correct antidepressant can be hit and miss. With some people it can mean going to 5-6 different ones before finding the one that works best.
5. If antidepressant doesn’t work
If one antidepressant doesn’t do the trick, your doctor may consider the following options:
- Increasing the dose of the antidepressant you’re on.
- Continuing at the same dose and adding a second drug: either another antidepressant (combination therapy) or another type of drug (augmentation therapy)
- Switching, which involves gradually stopping the first drug and starting a second.
- Starting alternative therapy
6. “Poop-out” effect: It is possible that one day your antidepressant will stop working
This phenomenon affects approximately 20 percent of people who take antidepressants - the so-called “poop-out” effect. In such cases, the medications simply stop being effective. Psychiatrists don’t fully understand what causes this.
The good news is that adjusting the dosage, changing medications or adding other medications is usually effective in countering thiseffect. Alternative therapies (cognitive behavioral therapy, psychotherapy, exercise) also can help.
7. Antidepressants work only 40% to 50% of the time
Researchers agree that when depression is severe, medication can be helpful - even life saving. However, some studies show that the benefits of depression medication have been exaggerated - with some researchers concluding that, when it comes to mild to moderate depression, antidepressants are only slightly more effective than placebos.
The effectiveness of a dozen popular antidepressants has been overstated by selective publication of favorable results, according to a review of unpublished data submitted to the Food and Drug Administration. The suppression of negative studies isn’t a new concern. The tobacco industry was accused of sitting on research that showed nicotine was addictive, for instance.
For some people antidepressants become true life-savers: read comments on “Antidepressants Don’t Work, Says Study”
8. Discontinuation syndrome
Once you have started taking antidepressants, stopping can be tough. Many people get withdrawal symptoms following the interruption, reduction or discontinuation of the antidepressant. This make it difficult to get off of the medication. The most common symptom is “Brain Zaps” which are said to defy description for whoever has not experienced them, but are described as a sudden jolt likened to an electric shock originating in the brain itself, with associated disorientation. These symptoms are considered to be caused by the brain’s attempts to readjust after such a major neurochemical change in a short period of time.
People also might have trouble sleeping, have an upset stomach, have shock-like sensations in the arms and hands, feel dizzy, or feel nervous.
9. Antidepressants aren’t a cure
Medication may treat some symptoms of depression, but can’t change underlying contributions to depression in your life. Antidepressants won’t solve your problems if you’re depressed because of a dead-end job, a pessimistic outlook, or an unhealthy relationship. That’s where therapy and other lifestyle changes come in.
Studies show that therapy works just as well as antidepressants in treating depression, and it’s better at preventing relapse once treatment ends. While depression medication only helps as long as you’re taking it, the emotional insights and coping skills acquired during therapy can have a more lasting effect on depression. However, if your depression is so severe that you don’t have the energy to pursue treatment, a brief trial of antidepressants may boost your mood to a level where you can focus on therapy.
10. Antidepressant uses: “Off-label” & “On-label”
Antidepressants were initially developed to relieve depression. Although the FDA has approved these medications for treatment of a variety of conditions, they are prescribed for a number of “off-label” (unapproved) uses. Importantly, off-label drug use is legal and often beneficial. But there is growing concern that it’s on the rise, it’s not always wise, it’s getting riskier.
Some off-label uses of antidepressants include:
- Sleep aid, insomnia (trazodone, amitriptyline)
- Premature ejaculation (paroxetine)
- Migraine headaches prophylaxis (fluoxetine)
- Fibromyalgia (fluoxetine, amitriptyline)
- Pain management (tricyclic antidepressants, duloxetine, venlafaxine)
- Weight loss (bupropion)
Tip: When your doctor prescribes a drug - any drug - ask if it’s an approved use or an “off-label” use. If you get an off-label prescription, ask your doctor whether the scientific evidence really supports this use.
References
- 1. Maina G, Albert U, Salvi V, Bogetto F. Weight gain during long-term treatment of obsessive-compulsive disorder: a prospective comparison between serotonin reuptake inhibitors. J Clin Psychiatry. 2004 Oct;65(10):1365-71. PubMed
- 2. Thase ME, Haight BR, Richard N, Rockett CB, Mitton M, Modell JG, VanMeter S, Harriett AE, Wang Y. Remission rates following antidepressant therapy with bupropion or selective serotonin reuptake inhibitors: a meta-analysis of original data from 7 randomized controlled trials. J Clin Psychiatry. 2005 Aug;66(8):974-81. PubMed
- 3. Montorsi F, Strambi LF, Guazzoni G, Galli L, Barbieri L, Rigatti P, Pizzini G, Miani A. Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study. Urology. 1994 Nov;44(5):732-6.PubMed
- 4. Kroenke K, West SL, Swindle R, Gilsenan A, Eckert GJ, Dolor R, Stang P, Zhou XH, Hays R, Weinberger M. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. Journal of American Medical Association. 2001 Dec 19;286(23):2947-55.
