Antidepressants

What are antidepressants?

Antidepressants are prescription medications that can help relieve symptoms of depression and several other conditions. There are several classes, which work in different ways and have different side-effect profiles.

What they’re used for

Depending on the medication, antidepressants may be prescribed for:

• Depression
• Anxiety disorders, including generalized anxiety, panic and social anxiety
• Obsessive-compulsive disorder
• PTSD
• Some chronic pain conditions and other uses a clinician may consider

How they work

Most antidepressants affect brain chemical messengers (neurotransmitters) such as serotonin and norepinephrine. Scientists believe the benefits also involve longer-term changes in how brain circuits adapt, which may help explain why they take weeks to work.

Main types

• SSRIs (selective serotonin reuptake inhibitors): often a first choice because they are generally well tolerated.
• SNRIs (serotonin-norepinephrine reuptake inhibitors): affect both serotonin and norepinephrine.
• Atypical antidepressants: such as bupropion and mirtazapine, which work in different ways.
• Tricyclic antidepressants (TCAs): an older class, used less often because of side effects.
• MAOIs (monoamine oxidase inhibitors): an older class with important food and drug interactions.

How they’re taken

Antidepressants are usually taken by mouth once or more daily. Prescribers typically start at a lower dose and adjust gradually, based on response and side effects. Your prescriber and pharmacist will give instructions specific to your medication — this page does not provide dosing guidance.

Common side effects

Side effects vary by medication and person. Common ones include:

• Nausea or upset stomach
• Headache
• Sleep changes (drowsiness or insomnia)
• Sexual side effects, such as reduced desire or difficulty with orgasm
• Dry mouth, sweating
• Weight changes (with some medications)

Many early side effects improve within the first weeks.

Serious side effects

Seek medical advice promptly if you notice:

• Worsening depression, new or increased thoughts of suicide, or unusual changes in behavior
• Signs of serotonin syndrome — agitation, confusion, fast heart rate, high temperature, muscle stiffness or twitching — which is a medical emergency
• Signs of mania, such as unusually elevated mood, racing thoughts or reduced need for sleep
• Unusual bleeding or bruising
• Severe allergic reactions

Warnings

• Boxed warning: increased risk of suicidal thoughts and behaviors in people under 25, especially early in treatment.
• Bipolar disorder: antidepressants used alone can trigger mania in some people with bipolar disorder. Tell your prescriber about any history of elevated mood.
• Stopping treatment: stopping suddenly can cause discontinuation symptoms, such as dizziness, irritability, flu-like feelings and “brain zaps.” Changes should be planned with your prescriber.
• Pregnancy and breastfeeding: discuss risks and benefits with your healthcare team.

Interactions

Antidepressants can interact with other medications and supplements, including other antidepressants, some migraine medications (triptans), certain pain medications, blood thinners, St. John’s wort and alcohol. MAOIs have particularly important interactions. Always tell your prescriber and pharmacist about everything you take.

What to expect when starting

Antidepressants are rarely felt immediately. Some effects, such as better sleep or appetite, may appear within a couple of weeks, while improvement in mood often builds over four to eight weeks. Side effects, when they occur, often show up early and may ease as your body adjusts. This gap can be discouraging, so plan a follow-up with your prescriber and keep taking the medicine as directed unless you’ve been told otherwise. If one medicine doesn’t work well enough or causes troublesome side effects, there are others to try, and a prescriber can adjust the plan. Many people need more than one attempt to find a good fit.

Antidepressants and talk therapy

For mild to moderate depression, therapy and medication are both effective options, and for more severe or long-lasting depression, using both is often better than either alone. Therapy can teach skills that continue to help after medication stops. See therapy for depression and CBT.

Myths and facts

• Myth: Antidepressants are “happy pills” that change your personality. Fact: They are intended to ease depression or anxiety symptoms, not to create artificial happiness. Some people report feeling emotionally “flat” on certain medicines, which is worth raising with a prescriber.
• Myth: Antidepressants are addictive. Fact: They do not cause the cravings or compulsive use seen with addictive substances, but stopping suddenly can cause discontinuation symptoms.
• Myth: You’ll be on them forever. Fact: Length of treatment varies. Many people continue for months after feeling better to lower the chance of relapse, and some stay on them longer. Stopping should be planned with a prescriber.
• Myth: Medication means you’ve failed. Fact: Depression is a medical condition with biological, psychological and social contributors, and medication is one valid tool.

Safety to keep in mind

Pay attention to changes in mood, sleep, agitation or any new thoughts of self-harm, especially in the first weeks and after a change of medicine, and tell your prescriber promptly. If you or someone you care about is in crisis, call your local emergency number or see Get Help Now. Never stop or change a prescribed antidepressant without talking to your prescriber, and tell every clinician and pharmacist what you take. Our guides to online depression treatment and depression treatment explain how to access care.

Questions to ask your healthcare professional

• Why are you recommending this medication for me, and what are the alternatives?
• How long before I might notice a difference?
• What side effects should I watch for, and which ones mean I should call you?
• Does this interact with anything else I take?
• How will we know if it is working, and when will we review it?
• How long might I take it, and how would I stop safely?

Antidepressants can also be prescribed through telehealth. For example, Lemonaid Health prescribes SSRIs, SNRIs and bupropion with ongoing check-ins for $95 a month, and PlushCare and Sesame offer doctor visits for new prescriptions or refills.