7 Things You Should Know Before Starting Antidepressants

Mia,* a 41-year-old CPA, started seeing me for help with her depressive symptoms. A combination of work stress at a new firm plus worry about her mom's health challenges contributed to a recurrence of depression that had first occurred when she was in her 20s.

She was given an antidepressant at the time but had significant nausea early on and stopped after three weeks. "I don't think antidepressants work for me," she said.

This time around, though, the depression was debilitating enough that she started to miss important work deadlines. Given her overall impaired functioning, I made the recommendation that we add antidepressants to our therapy work. However, she had concerns: "They didn't help me before and I'm worried they won't do much for me this time, either."

According to a U.S. National Center for Health Statistics survey, antidepressants are the most common drugs used by 18- to 44-year-olds, and the third most common for all adults. Yet frequently, patients don't have the full picture of how they work.

Informed is always better. Here are seven key points people should be aware of once considering a course of treatment:

1. Antidepressants take time to work. While it is true that some people begin to notice a difference even within a week or two, it's common for psychiatrists to wait four to six weeks to see if there is a positive response and up to 12 weeks to achieve full remission. It's important to know that this isn't a quick fix and to allow adequate time for improvement.
2. Side effects happen. A wide range of side effects such as gastrointestinal distress, headaches, and sedation occur in 10 to 40 percent of patients, depending on the drug, and often occur within the first few weeks of starting the medications. For many people, the side effects are mild and dissipate over time. But for others, significant and persistent side effects may require medication treatment themselves or a trial with another antidepressant. It's possible to have a completely different side effect experience with a different medication.
3. Antidepressants are not foolproof. The typical response rate for all antidepressants is about 70 percent. That leaves a significant percentage of people for whom these drugs are not fully effective and underscores the role of psychotherapy in treating depression.
4. It may take more than one shot. If a trial with one type of antidepressant does not lead to a significant change in mood and functioning, your doctor may recommend either a switch to another antidepressant or adding another psychopharmacological agent. Studies show that treatment-resistant depression, defined as two or more unique ineffective antidepressant trials, occurs in approximately 30 percent of patients.
5. Time is of the essence. People often want to stop antidepressants once they are feeling better. It seems intuitive to stop taking medicine once they are doing well. But research shows that without continued medication, the relapse rate after an initial depressive episode is approximately 40 to 50 percent within the next one to two years. As a result, psychiatrists will usually treat for six to 12 months after a first episode. After two episodes of depression, the relapse rate without medications is 75 percent within five years. After three or more episodes of depression, it is common practice to continue medication as a maintenance treatment.
6. Stopping cold turkey is a bad idea. Although stopping antidepressants does not lead to psychological cravings, there can be discontinuation effects in up to 40 percent of people who stop using them abruptly. These include brain "zaps" (a sensation of electric shocks to the brain), nausea, dizziness, and flu-like symptoms. While not life-threatening, the effects can be immobilizing. Antidepressants should generally be tapered off slowly, under medical supervision.
7. Therapy with medications remains important. Studies have shown that the combination of therapy with medication appears more effective than either one alone. This may be due to the fact that there are now two complementary pathways for improvement. For example, learned therapy skills and insights persist whereas the drug effect may end after the drug is stopped. Similarly, when the impact of depression is so severe that engaging in therapy is difficult, then the addition of antidepressants can create the improvement needed to allow the person to make better use of therapy.

To find a therapist, please visit the Psychology Today Therapy Directory.

Disclaimer: This content is for educational purposes only and is not a substitute for direct medical advice from your doctor or other qualified clinician. If you need medical or psychological help, seek guidance from your physician, licensed health clinician, or call 911.

*Names and personal identifiers have been changed to protect patient confidentiality.