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Antidepressant Medications

Antidepressant medications successfully elevate mood in 60 to 80 percent of people who use them as directed for several months.

Different people respond best to different medications. Fortunately, there are many to try. The different drugs also cause different side effects. Make sure you discuss the various drugs' side effects fully with your physician before opting for any particular medication.

While drug therapies have been very effective in many people for treating depression, there's more to beating depression than just antidepressant medications. There's the rest of your life. How you think, eat, live, work, and play can either send you farther down into the abyss--or help you overcome depression and rediscover the happiness of life. For some people, these non-drug therapies are enough. But if you take antidepressant medication, they can also help significantly.

An Introduction to Antidepressant Medications

All antidepressant medications are equally effective. They elevate mood in 60 to 80 percent of people who use them as directed. It usually takes two to four weeks to feel any benefit.

The first antidepressants, monoamine oxidase (MAO) inhibitors, were discovered accidentally during the 1960's by researchers who were trying to develop new drugs to treat tuberculosis. MAO inhibitors didn't help TB, but they elevated mood. Since then, many other types of antidepressants have been developed. The newer drugs are safer and for most people, have fewer side effects. 

While all these medications are equally effective, some work better for different combinations of symptoms than others. It's important to tell your doctor about your symptoms in detail so that your symptom cluster can be matched to the medication that works best for it.

But if the first antidepressant you try does not provide sufficient relief, don't despair. Another probably will. Many depression sufferers must try several different medications before they find the one that works best for them.

Antidepressants are usually prescribed by themselves, but some psychiatrists combine them with other drugs to increase their effectiveness. 

What's it like to take an antidepressant?  

 In What You Need to Know About Psychiatric Drugs, Stuart Yudofsky, M.D., Robert Hales, M.D., and Tom Ferguson, M.D. say, "We tell our patients that it's just the opposite of drinking alcohol.  With alcohol, you get the enjoyable effects right away.  The hangover doesn't appear until the next morning.  With antidepressants, most people experience the unpleasant side effects first, while the benefits may take four to six weeks to appear."

Having to wait a month or six weeks to feel better can be very frustrating.  Be patient.  You'll feel better soon.

Are there side effects?

 As for the side effects, most subside after a few weeks of using the medication.

The first side effect most people notice is a dry mouth. It helps to drink more water and juice, eat more juicy fruits (oranges, etc.), and suck on hard candies. By about the third week, dry mouth and some other initial side effects (e.g. constipation and headache) typically subside.

The different antidepressants have different effective dosages. It's important to note that the dose you take has nothing to do with the severity of your depression or your hopes for recovery. The number of milligrams (mg) is irrelevant. Some antidepressants work at 15 mg a day, others at 200 mg a day. That's just the way these drugs are formulated.

It often takes a while to get used to taking antidepressants. Most physicians start people on a low dose, and slowly increase it over a few weeks or months. Again, having your dosage increase has nothing to do with the severity of your depression or your prognosis.   Antidepressants are not addictive. But overdosing on some antidepressants (notably, the tricyclic and tetracyclic compounds) can be fatal. Because any depressed individual is potentially at risk for suicide, the possibility of fatal overdose is a major disadvantage of the tricyclic and tetracyclic drugs.

How long will you take antidepressants? 

That depends on how many depressive episodes you've had.

• First episode. For a first episode of clinical depression, drug treatment typically lasts six to nine months. But it's important to understand that a first episode increases your risk of a second. You face about a 50 percent chance of becoming seriously depressed again within five years.
• Second episode. A recurring depressive episode usually requires one to two years of medication, and the chance of another episode within five years increases to 70 percent.
• Third episode. A third serious depression virtually guarantees more recurrences (95 percent chance). As a result, people in this situation typically take antidepressants for life. There is nothing hazardous about taking antidepressants long-term. Think of your medication as a diabetic thinks of insulin. You need it to function.

Do not drink alcohol while taking antidepressants. Alcohol is a powerfully depressant drug.

Don't stop taking antidepressants abruptly. If you do, you may experience a variety of flu-like withdrawal effects. When you're ready to stop taking your medication, you physician can help you taper off.

Will antidepressants affect your sex life? 

Possibly. Depression typically changes sexuality. Some people lose their libidos. Others become hyper-sexual. Once the depression clears up, sexuality usually returns to normal.

Some antidepressants have been associated with sex problems. Among people taking the Prozac family of medications (SSRI's), some 40 to 50 percent report sexual impairment: loss of libido in both sexes, difficulty ejaculating in men, and loss of orgasm in women. If you believe that your medication is causing sex problems, don't suffer in silence. Call your doctor. Wellbutrin and Serzone cause very few sex problems.

How do antidepressants work? 

The physical basis of depression involves neurotransmitters in the brain. Neurotransmitters are chemicals that carry messages from one nerve cell to another. Nerve cells do not touch. There are microscopic gaps between them called synapses. For a nerve impulse to travel from one nerve cell to another, the sending cells releases a tiny amount of one of the neurotransmitters, which transmits the signal to the second cell, and so on around the body. After a nerve impulse has been sent across a synapse, special enzymes clear away the neurotransmitter so that another impulse may be sent.

Depression is strongly associated with abnormally low levels of certain neurotransmitters, among them: serotonin, epinephrine, and norepinephrine. Antidepressants increase the levels of these chemicals by interfering with the enzymes that eliminate them from the synapses, a process called "re-uptake inhibition." The different types of antidepressants have different effects on the various neurotransmitters. The various antidepressants may act on the same neurotransmitter(s), but each has a subtly unique action, which distinguishes them from one another:

The choice of one drug over another depends on your symptoms. Describe your symptoms clearly and completely to your doctor so that you can receive the medication best suited to your individual situation.

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Selected Sources:

Yudofsky, S., Hales, R., & Ferguson, T., (1991)  What you need to know about psychiatric drugs.  New York: Grove Widenfield.

Drug Facts and Comparisons, (1998) St. Louis: Lippincott

1999 Physicians' Desk Reference (1999).  New York:

Common Anti-Depressant Medications

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