Depression is more than just a low mood, or occasional feelings of sadness.
It’s a serious illness, and it impacts millions of people each year: More than 264 million people across the world suffer from depression. In the U.S., more than 6.5% of adults have a major depressive episode each year.
If you’re suffering from depression, antidepressants may be able to help.
These medications are used to help regulate mood for people who are dealing with clinical depression.
In one study, about 40-60% of people who took an antidepressant reported improved symptoms within two months.
If you are wondering whether antidepressants are right for you, I’ll teach you more about them in this article.
I’ll talk about different types of antidepressants, how they’re used, and how they work.
I’ll explain when you might want to consider an antidepressant, and how to work with your healthcare provider to find the right medication for you.
I’ll also outline some risks, warnings, alternative treatments, and how to know when you should see your doctor.
What Are Antidepressants?
There are many types of antidepressants.
Most work with substances in your body called neurotransmitters, chemicals that transmit messages between nerve cells.
Most antidepressants work with these chemicals in one of two ways:
- Prevent neurotransmitters from being cleared too quickly
- Help neurotransmitters work in balance with each other
Antidepressants balance brain chemistry—and alleviate depression symptoms—as they adjust neurotransmitters.
They may not be effective for everyone, but as many as 60% of people report improved symptoms after 6-8 weeks of treatment.
There are many different classes of antidepressants.
All of them work to lessen the symptoms of depression, though they do so through slightly different mechanisms.
Some people do better with one type over others, and it may take some trial and error before finding the best fit for you.
If you are prescribed an antidepressant, stay in touch with your doctor to let them know how you are feeling, and to report any symptoms you experience, especially if they are concerning or you are having thoughts of suicide.
Antidepressants come with a “Black Box warning” because in some cases, they can increase the risk for suicide.
However, if your doctor has prescribed an antidepressant, they believe the benefits outweigh the risks.
By reporting symptoms to your doctor, you can decrease the risk of adverse outcomes.
The main types of antidepressants are:
- Selective serotonin reuptake inhibitors (SSRIs): When a neurotransmitter has finished carrying a neurological message, it is usually reabsorbed by your body, a process called “reuptake.” SSRIs block the reabsorption of serotonin, a mood-lifting neurotransmitter. This increases the amount of serotonin available in the brain. SSRIs are the most commonly prescribed class of antidepressants.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): These help the brain retain both serotonin and norepinephrine, a neurotransmitter that improves mood and how brain cells communicate with each other.
- Monoamine oxidase inhibitors (MAOIs):These are one of the oldest available classes of antidepressants. MAOIs work to block an enzyme in the brain that breaks down serotonin and other neurotransmitters. By decreasing the breakdown, higher levels of mood-balancing chemicals remain accessible to the brain. MAOIs have the strongest interactions with other medications, foods, and alcohol, so they are not a first-line treatment.
- Tricyclic antidepressants (TCAs): These work to block the removal of both serotonin and norepinephrine, which cause higher levels to be accessible in the brain. They are referred to as tricyclic because the chemical structure contains three rings.
- Atypical antidepressants: These medications don’t fit into one of the other categories. There are many different atypical antidepressants, and each one works in its own way. While they help to support balanced neurotransmitters, the mechanisms are not the same. Bupropion (Wellbutrin) is one of the most commonly used types of atypical antidepressants.
Antidepressants are used for treating depression, but they may also be used to treat other conditions associated with neurotransmitter imbalances, such as:
- Seasonal affective disorder (SAD)
- Generalized anxiety disorder (GAD)
- Post-traumatic stress disorder (PTSD)
- Social anxiety disorder
- Bipolar disorder
Nearly 30% of antidepressant prescriptions are for off-label use, which means a doctor prescribes them for non-FDA-approved reasons.
However, just because the FDA has not approved them for that purpose does not mean it is unethical or inappropriate to prescribe them.
It is a common practice for doctors to prescribe medication for off-label reasons.
They do so by taking your symptoms, medical condition, and other prescriptions into consideration.
How they work
Each class of antidepressant works slightly differently, but they all have the same goal: to balance neurotransmitters in the brain.
By supporting optimal levels of these brain chemicals, symptoms associated with depression can be decreased and, in some cases, eliminated.
The neurotransmitters affected by antidepressants include:
- Serotonin: This neurotransmitter has an important impact on mood, perception, memory, stress response, appetite, addiction, and sexuality. It also helps to regulate involuntary body processes like the circadian rhythm, motor control, body temperature, and several other organ systems.
- Dopamine: This neurotransmitter is important for motor functions, motivation, and reward-related interactions. People who are low in dopamine may engage in more behaviors that mimic the reward-type feeling that dopamine is supposed to regulate.
- Norepinephrine: This neurotransmitter helps modulate the nervous system in several ways, including energy metabolism, neuroplasticity, inflammation, and more. Norepinephrine helps enable the rapid-type response that is important for functioning, such as decision-making, thought processes, and other adaptive behaviors.
When To Consider Using Antidepressants
Reasons to consider antidepressants may include, but are not limited to:
- Feelings of persistent sadness
- Decreased interest in things you previously enjoyed
- Appetite changes
- Sleep problems
- Lack of energy
- Feeling hopeless
- Deep feelings of sadness that do not let up
- Increasing irritability or anger
- Poor ability to make decisions or think clearly
- Thoughts of suicide or self-harm
While everyone experiences depression somewhat differently, you may benefit from antidepressant treatment if your symptoms have lasted for a long time, or if they are affecting your ability to function normally.
If you have thoughts or suicide or have thought about harming yourself, do not delay treatment.
Call the National Suicide Prevention Lifeline for immediate assistance: 988.
Tell your doctor how you are feeling. They may prescribe an antidepressant to help you feel better.
Finding the Right Antidepressant For You
If you and your doctor have agreed that an antidepressant may help, do not be discouraged if it takes a few attempts to find the best one for you.
These medications all work slightly differently, and your body chemistry, genetics, and other health factors will determine if one works better for you.
It is not always easy to know this before trying one out.
Keep your doctor informed about how you feel as you start an antidepressant, and always tell them if you feel worse or notice new or concerning symptoms.
Your doctor will suggest an antidepressant for you based on the following factors:
- Your current health
- Other medications you take
- Cost of the prescription and insurance coverage
- Timing and frequency of dose, and how that fits into your lifestyle
- Potential side effects
You will typically be able to tell if an antidepressant is helping within 6-8 weeks.
If you start feeling worse or notice significant side effects, your doctor can change your medication sooner.
Do not stop taking an antidepressant suddenly, as this can lead to serious side effects.
Risks and Warnings for Antidepressants
Your doctor will discuss risks or warnings associated with your antidepressant medication.
Alcohol interacts with all types of antidepressants and should not be consumed at the same time.
Antidepressants may interact with other medications, so it is important to tell your doctor anything else that you take, including supplements, herbs, illicit drugs, and over-the-counter medications.
Possible side effects
Antidepressants, like other medications, have commonly reported side effects.
The type of side effects you experience will differ based on medication type, as well as individual aspects of your own biology, health, and sensitivity.
Some common side effects that may occur with antidepressant medication may include:
- Nausea, diarrhea, or constipation
- Appetite changes
- Dizziness or blurry vision
- Nervous or agitated feelings
- Heart palpitations or rapid pulse
- Weight changes
- Decrease in libido
There are some serious health risks that may occur when taking antidepressants.
These could include suicidal thoughts, low blood sodium levels (hyponatremia), or serotonin syndrome, all of which can be medical emergencies.
If you notice symptoms like confusion, thoughts of self-harm, seizures, or severe headache, seek emergency medical care.
Other Treatment Options
If you are concerned about side effects or have previously had a bad experience with an antidepressant, you may want to know about other treatment options.
Your doctor can help you understand what options may be available for you, and the evidence and effectiveness of them.
Some alternative treatment options include:
- St. John’s wort, an herb that has antidepressant effects
- S-adenosylmethionine (SAMe), is a chemical derived from an amino acid, that may influence how certain neurotransmitters work in the brain
Just because these are alternative treatment options does not mean they are safe for everyone.
Supplements have drug interactions and should be used with caution. Supplements are not regulated by the Food and Drug Administration (FDA) and so may have their own safety concerns.
Talk to your doctor before trying these treatments, and tell your doctor about anything else that you take, including prescription medications, supplements, herbs, illicit drugs, and over-the-counter medications.
When to See a Doctor
See your doctor if you experience symptoms of depression or wonder if antidepressants could be right for you.
Even if you are sure that you do not want to take an antidepressant, your doctor can help you identify positive ways to support your well-being if you have signs of depression or feel like your quality of life, mood, or general outlook on life are not where they used to be.
How K Health Can Help
Did you know you can get affordable primary care with the K Health app?
If you are feeling depressed and want to explore options for treatment, you can chat with a primary care provider on the K Health platform.
Your provider can help you decide what care is right for you, answer questions, and, if needed, send a prescription to your pharmacy.
Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a provider in minutes. K Health’s AI-powered app is based on 20 years of clinical data.
Frequently Asked Questions
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
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Off-label Indications for Antidepressants in Primary Care: Descriptive Study of Prescriptions from an Indication Based Electronic Prescribing System. (2017).
Off-label uses of drugs for depression. (2019).
The Expanded Biology of Serotonin. (2018).
Mechanisms and regulation of dopamine release. (2020).
Norepinephrine: A Neuromodulator That Boosts the Function of Multiple Cell Types to Optimize CNS Performance. (2012).
Choosing an antidepressant. (2021).
St. John’s Wort. (2020).
S-Adenosyl-L-Methionine (SAMe): In Depth. (2017).
Vitamin D and Depression: A Critical Appraisal of the Evidence and Future Directions. (2020).