Antidepressants are medications that can help relieve symptoms of depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and dysthymia, or mild chronic depression, as well as other conditions. According to the Centers for Disease Control and Prevention (CDC), the percentage of people aged 12 years and over using antidepressant in the United States rose from 11.8 percent in 2013-2015 to 23.6 percent in 2019-2020. Around twice as many females use antidepressants as males.
Some side effects of antidepressants resolve with continued use while other side effects can be managed by dose reduction or adding other therapies. Appropriate management of side effects and avoiding drugs and alcohol that may interact with antidepressants may improve the success of depression therapy. Unlike some drugs, it is not necessary to keep raising the dose to get the same effect with antidepressants. In that sense, they are not addictive. When you stop using an antidepressant, you will not experience the same type of withdrawal symptoms that occur, for example, when giving up smoking. However, nearly 1 in 3 people who used SSRIs and SNRIs report some withdrawal symptoms after stopping treatment.
- nightmares or vivid dreams
- electric shock-like sensations in the body
- flu-like symptoms
- abdominal pain
In most cases, symptoms were mild. Severe cases are uncommon and are more likely after stopping Seroxat and Effexor. Doctors should reduce the dose gradually to minimize the risk of unpleasant withdrawal symptoms. Many people with mild to moderate depression find that therapy, exercise, and self-help strategies work just as well or even better than medication—minus the side effects. Even if you decide to take medication, it’s a good idea to also pursue therapy and lifestyle changes that can help you to address the underlying issues and beat depression for good.
It can take several weeks for a person to notice the effects of an antidepressant. Many people stop using them because they believe the medications are not working.
Reasons why people may not see an improvement include:
- the drug not being suited to the individual
- a lack of monitoring by the health provider
- a need for additional therapies, such as cognitive behavioral therapy (CBT)
- forgetting to take the medication at the right time
Serotonin and norepinephrine reuptake inhibitors or SNRIs are the newest class of antidepressants. SNRIs work by increasing the levels of serotonin and norepinephrine that are active in the brain. Serotonin and norepinephrine are produced by nerves and released into the surrounding tissues where they can attach to nearby receptors on other nerves, thereby stimulating the other nerves. The released serotonin and norepinephrine then are taken up and released again by the nerves that produce them. SNRIs block the uptake (“reuptake”) of the serotonin and norepinephrine so that more of the serotonin and norepinephrine are free in the tissues surrounding the nerves.
The U.S. Food and Drug Administration (FDA) recently approved esketamine (brand name Spravato) for patients with severe, treatment-resistant depression. Taken as a nasal spray in conjunction with an oral antidepressant, esketamine may deliver rapid improvement of symptoms for some patients with major depression. However, as a form of ketamine, it also carries some mind-altering side effects, including dissociation, changes in speech and behavior, anxiety, and suicidal thoughts. There is also the potential for abuse and misuse of this drug and, as yet, no definitive studies on its long-term effects.
There is a danger that, in some people, antidepressant treatment will cause an increase, rather than a decrease, in depression. In fact, the FDA requires that all depression medications in the U.S. include a warning label about the increased risk of suicide in children and young adults. The suicide risk is particularly great during the first month or two of treatment. Anyone taking antidepressants should be closely watched for suicidal thoughts and behaviors. Monitoring is especially important if this is the person’s first time on depression medication or if the dose has recently been changed. If you spot the warning signs in yourself or a loved one, contact your doctor or therapist immediately.