Antidepressants: what to know about their uses and side effects

Antidepressants are among the most prescribed medications in the United States. This is due, in part, to the fact that the number of people diagnosed with depression and anxiety is rising and prescriptions have increased sharply in some age groups during the pandemic.

Despite the prevalence of these drugs, some patients have “significant misconceptions” about how the drugs work, said Dr. Andrew J. Gerber, a psychiatrist and president and medical director of Silver Hill Hospital in New Canaan, Connecticut.

About 80% of antidepressants are prescribed by primary care physicians who have not had extensive training in the management of mental illnesses.

Dr. Paul Nestadt, an associate professor of psychiatry at Johns Hopkins School of Medicine, said patients tell him, “'You know, doctor, I've tried everything.'” But often, he said, “they never get there to a satisfactory result.” good dose, or they only took it for a week or two.”

Here are some answers to the most frequently asked questions about antidepressants.

There are many types of antidepressants, and they all work slightly differently.

Overall, they initiate a change in how brain cells — and different regions of the brain — communicate with each other, said Dr. Gerard Sanacora, a professor of psychiatry at Yale School of Medicine.

Clinical studies have shown that antidepressants are generally more effective in moderate, severe, and chronic depression than in mild depression. Again, this is a modest effect compared to placebo.

The largest study of multiple antidepressants, dubbed the STAR*D study, found that half of participants improved after using the first or second drug they tried, and nearly 70% of people were free of symptoms on the fourth antidepressant.

Unfortunately there is no way to know in advance how an individual will respond to a particular drug, so there may be a period of trial and error.

More research is needed to better understand how antidepressants work and their effectiveness, especially when taken over the course of several years.

The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors, or SSRIs, such as Prozac or Zoloft, and serotonin-norepinephrine reuptake inhibitors, or SNRIs, such as Cymbalta and Effexor. These two types tend to have fewer side effects than tricyclic antidepressants such as clomipramine or monoamine oxidase inhibitors such as phenelzine.

In general, SSRIs and SNRIs are equally effective.

But for some people, the differences between these drugs – even those in the same class – are not subtle at all. If a medication doesn't seem right, there are other options. Experts recommend working with your doctor to find the best solution.

A common myth is that antidepressants are “quick fixes,” said Dr. Kao-Ping Chua, a pediatrician and health policy researcher at the University of Michigan Medical School. “I absolutely am not.”

In general, it can take one to two months to start seeing positive effects, experts say. And that's assuming you're taking the optimal amount.

Early on, doctors tend to do more frequent check-ins so they can monitor patients.

“It can take some time to identify the right dose,” Dr. Chua said. If the dosage is adjusted and it still doesn't work, “switching to a different antidepressant might be reasonable,” he said.

If you experience acute or debilitating symptoms of depression, including thoughts of self-harm, seek immediate help by calling the Suicide and Crisis Lifeline by dialing 988.


Unlike older antidepressants, SSRI and SNRI drugs typically don't have many short-term side effects, and if they do, they're often mild.

Some of the most common, which can occur within a few days of starting treatment, are a decrease in libido, headache, dry mouth and stomach upset. But many people don't experience any side effects, experts say.

Short-term side effects often fade as the body adjusts to the drug — you should know which ones are most likely to persist within about two to three weeks of starting treatment, Dr. Nestadt said.

The decrease in libido can be persistent, which could be a “deal-breaker,” he said. At that point, doctors may try to treat the problem with an additional medicine or switch to a different antidepressant.

Long-term use can bring other side effects, including weight gain or emotional dullness.

Finally, antidepressants can interact with other medications. An SSRI combined with ibuprofen, for example, increases the risk of gastrointestinal bleeding. It is also generally not recommended to drink alcohol while taking antidepressants.


Therapy remains one of the first recommended treatments for depression. Antidepressants don't make problems go away, but they can make them easier to deal with, Dr. Chua said.

Lifestyle changes can also help, experts say. Research has shown that exercise can reduce symptoms of depression. And eating a heart-healthy diet can be helpful, although more research is needed on how foods affect mood. Sleeping too much or too little also affects how we feel, so it's important to get adequate rest.


They can also treat chronic pain conditions such as shingles and migraines, as well as anxiety, social phobia, post-traumatic stress disorder, and obsessive-compulsive disorder.

In 2004, the Food and Drug Administration issued a “black box” warning stating that the use of some antidepressants may be linked to suicidal ideation and behavior in adolescents. Three years later, the warning was also extended to people aged between 18 and 24.

The warning was based on an analysis of drug trials in which no suicides occurred. However, investigators found a significant risk of suicidal thoughts. Other studies have found that SSRIs reduce suicide rates and suicidal behavior among young people, leading some experts to call for a reevaluation of the warning.

Psychiatrists usually recommend discussing whether to stop therapy after experiencing benefits for at least six months.

Studies show that “patients who do well on antidepressants are more likely to have relapses of depression if they stop taking antidepressants,” Dr. Chua said.

But that's not the case for everyone, he added, so consult your provider to decide whether to stop taking the medicine.

Psychotherapy can help people successfully come off antidepressants. But it is always important to gradually reduce the drug under the supervision of a doctor.

In some cases, if the tapering is not done slowly enough, patients may experience what are commonly called brain zaps, which feel like electric shocks, or other side effects such as nausea, said Dr. David J. Hellerstein, professor of medicine clinic. psychiatry at Columbia University Irving Medical Center.

Slow tapering is especially important with an antidepressant that has a short half-life such as Effexor or Paxil, he added. When patients stop medications like these, the amount of drugs in the body “builds up very quickly,” she added.

Some people with chronic, recurrent depression may need to take antidepressants indefinitely, Dr. Hellerstein said.

This is generally considered safe, he said, adding that it is significantly riskier for people to go without treatment.

If you are thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to for a list of additional resources. Go Here for resources outside the United States.

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