Depression

Medication

What Are Antidepressants?

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Types of Antidepressants

There are several types of antidepressants.

  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • tricyclic antidepressants (TCAs)
  • monoamine oxidase inhibitors (MAOIs)

There are other antidepressants that don’t fall into any of these categories and are considered unique, such as Mirtazapine and Bupropion.

Learn more about the different types of antidepressants.

Taking Antidepressants

Antidepressants take time – usually 2 – 4 weeks – to work, and often symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness.

If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 – 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Side Effects

Although all antidepressants can cause side effects, some are more likely to cause certain side effects than others. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has side effects that you can manage.

Common side effects listed by the FDA for antidepressants are

  • nausea and vomiting
  • weight gain
  • diarrhea
  • sleepiness
  • sexual problems.

Other more serious but much less common side effects listed by the FDA for antidepressant medicines can include seizures, heart problems, and an imbalance of salt in your blood, liver damage, suicidal thoughts, or serotonin syndrome (a life-threatening reaction where your body makes too much serotonin). Serotonin syndrome can cause shivering, diarrhea, fever, seizures, and stiff or rigid muscles.

Most antidepressants are generally safe, but the U.S. Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. The warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

For older adults who are already taking several medications for other conditions, it is important to talk with a doctor about any adverse drug interactions that may occur while taking antidepressants.

Herbal and Natural Products

You may have heard about an herbal medicine called St. John's wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression and there are serious concerns about its safety and effectiveness.

(Watch the video to hear a short scientific discussion about how St. John's wort interacts with medications. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)

Do not use St. John’s wort before talking to your health care provider. It should never be combined with a prescription antidepressant, and you should not use it to replace conventional care or to postpone seeing a health care provider.

Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe) remain under study but have not been proven safe and effective for routine use.

Keep in mind that dietary supplements can cause medical problems if not used correctly or if used in large amounts, and some may interact with medications you take. Your health care provider can advise you. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health.