Common Questions About Antidepressants
- How do antidepressants work?
Antidepressants act in a variety of ways to alter brain neurochemical systems. Neurochemicals act as messengers between brain cells. Although there are many neurochemicals in the brain, the main ones affected by antidepressants are serotonin, norepinephrine, and occasionally dopamine.
Some antidepressants act by increasing the levels of serotonin and/or norepinephrine, which are then more available to interact with the receptors on brain cells where the neurochemicals communicate. Other antidepressants interact directly with these receptors.
After exposure to either of these antidepressant effects, brain cell receptors adapt in a number of ways. It is this adaption of the brain cell receptors that appears to account for improvement in mood, though the exact mechanism leading to improved mood is not completely understood. Because it takes time for the receptors to adapt, it takes from 2-4 weeks for antidepressants to take affect.
- How long will I have to take the antidepressant?
Once you respond to an antidepressant, it is recommended that you continue to take the medication for at least six months. If you stop taking the antidepressant before six months have passed there is an increased chance that your depression will return. For depression that has lasted a long time (a year or longer), or for a recurrent depression, longer periods of treatment should be considered. If you wish to discontinue your medication, it is recommended that you do this during times of decreased demands, such as during breaks or during the summer months.
- If I don’t respond to the antidepressant does this mean I won’t respond to others?
No. There are many antidepressants that treat depression in a variety of ways. Some people will respond to one medication but not to another. Therefore, changing medications is a useful strategy if the first medication doesn’t work. Your clinician may also suggest combining antidepressants or adding another kind of medication when a single antidepressant isn’t enough.
- Will the antidepressant change my personality?
The short answer is no. Antidepressants will reduce the amount of excessive or disabling depression you feel. They will not artificially produce happiness and you should still be able to experience mood changes.
Sometimes, a person on antidepressants notices a dulling of mood, numbness, or sense of apathy. This is considered a side effect and is not the goal of treatment. This dulled state may also mean that your depression has been partially treated and will improve with time or with a change in the dose of medication.
Occasionally, people with a long history of depression have adjusted their feelings, thoughts and actions so that their feelings of depression actually become incorporated into their concepts of self. In such cases the lifting of depression and irritability could indeed be seen as a change in “personality.” However, these are usually the aspects of “personality” that the person has sought help for.
Antidepressants are not a substitute for therapy. However, if you are in a difficult situation, antidepressants may prevent you from going into a deeper depression.
- Are there any long-term risks for staying on antidepressants?
Although all antidepressants do have potential side effects (including infrequent serious side effects) there have been no recognized common side effects related to long-term use of antidepressants. However, several antidepressants have been available for only a few years and haven’t been used long enough to assess the long-term risks.
- Can I just stop taking antidepressants on my own?
It is not recommended that you stop taking antidepressants without consulting your clinician. If you abruptly stop taking your antidepressants, you may have discontinuation symptoms or an acute exacerbation of depression or anxiety.
- If I’m having a bad day will an additional pill help?
No. Antidepressants do not take effect immediately. The body’s response to antidepressants is based on sustained levels of medication over weeks, not hours or days.
- Can I take herbal preparations such as Saint John’s Wort with antidepressants?
Saint John’s Wort should not be combined with antidepressant medication. In order to prevent interactions between drugs, you should always tell your clinician about any prescribed, over-the-counter, and herbal remedies that you are taking.
- What if I think I am pregnant?
You should contact your clinician immediately in the case of a known or suspected pregnancy. Although some antidepressants appear to be safe for pregnancy, you should discuss any risks and benefits for continuing or stopping medication with your clinician.
- Are antidepressants addictive?
Antidepressants do not have addictive properties. Some patients may require antidepressant treatment for extended periods of time and experience an exacerbation of their illness if they decrease or discontinue their medication. However, this does not mean that they are addicted, only that their illness is more chronic and requires continued treatment.
- Can I drink alcohol if I am taking antidepressants?
The use of alcohol is discouraged by all manufacturers of antidepressants. In addition, alcohol is known to cause or worsen depression and should be avoided in general while on antidepressants. The recurrent use of even small amounts of alcohol (e.g. one drink per day) has been shown to impair the full benefits of antidepressants. Although most people can enjoy a drink or two per week without adverse consequences while taking antidepressants caution should be initially exercised as the antidepressants may make the drinking experience uncomfortable, be heavily sedating, induce a feeling of intoxication, or the result in a hangover not otherwise expected.
- Is there any risk of getting worse before I feel better?
This is usually not an issue for the majority of patients treated with antidepressants. However, the immediate time period after starting an antidepressant is associated with a low but real risk of irritability, uncomfortable side effects, worsening depression and even thoughts of suicide. The new appearance of suicidal thought in such cases may reflect the progression of the illness before the medication has a chance to work, a response to the added burden of side effects, different rates of recovery for different depressive symptoms (e.g. improved motivation and energy before improvements in mood and feelings of hopelessness), and/or a direct effect of the medication. Worsening depression or suicidal ideation can come on quickly. Therefore, it is extremely important that you contact your provider or an emergency service immediately if these symptoms emerge or already existing symptoms worsen rather than wait until your next scheduled appointment.