According to the National Institute of Mental Health, “an estimated 16.2 million adults in the United States had at least one major depressive episode” in 2016. That figure represents 6.7 percent of the adult population and makes depression the most common mood disorder in the United States. To treat this common condition that can be deadly or debilitating, antidepressant medications were developed in the mid-20th century.
Since those first drugs were introduced, the field of psychopharmacology and our understanding of depression have evolved significantly: Where once these drugs could themselves be deadly and often had severe side effects, today, antidepressants are among the most commonly prescribed drugs. A 2017 survey from the Centers for Disease Control and Prevention found that between 2011 and 2014, 12.7 percent of Americans aged 12 and older had taken at least one antidepressant medication in the previous month. They aren’t a cure-all and they’re not right for every patient, but their use has grown more than 65 percent over the past 15 years as more people look for help in dealing with mental health issues.
[See: Am I Just Sad — or Actually Depressed?]
Dr. Julie Hyman, a psychiatrist at the Ohio State University Wexner Medical Center in Columbus, says that “antidepressants are commonly used as a treatment for major depressive order,” a condition the Mayo Clinic defines as “a mood disorder that causes a persistent feeling of sadness and loss of interest.” Also sometimes called clinical depression, the Mayo notes “it affects how you feel, think and behave and can lead to a variety of emotional and physical problems.”
Major depressive disorder can manifest in different ways for different people and can be challenging to diagnose. Dr. Stephen Paolucci, chair of psychiatry, Geisinger in Danville, Pennsylvania, says that a diagnosis of major depression must meet certain criteria including “at least two weeks of continually depressed mood,” which usually includes some sleep abnormalities, “either too much or too little sleep. Appetite changes, loss of interest, changes in your concentration and focus” and thoughts of suicide are also common hallmarks of major depressive disorder.
Unlike many diseases that have objective diagnostic criteria that can be pinpointed through blood work or an X-ray, major depressive disorder is a more nebulous and difficult-to-diagnose condition, Paolucci says. And finding the right medication for each individual patient can involve a bit of trial and error, a process that should be carefully monitored by your physician because some antidepressants can cause serious side effects.
“Because people come at depression from many different ways, it’s not like we can do a blood test and say, ‘OK, this is major depression and they’re going to respond to Prozac. Or this is the kind of major depression that responds to Zoloft,” Paolucci says. “The reason we have so many different antidepressants is because they work differently in different people and depression is a fairly ill-defined entity.” He says this is why it’s so important that you talk through all your options with your physician prior to beginning any antidepressant medication.
Paolucci notes the use of antidepressants is most often managed by primary care physicians, but that in more severe cases or instances where antidepressants don’t seem to work, it may be time to seek the assistance of a psychiatrist to help manage your illness.
For anyone who’s experiencing depression and considering taking antidepressant medications, it’s important you ask several questions to be sure you’re on the right track.
[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]
Is an Antidepressant Necessary for My Situation?
Paolucci says it’s important to speak with your doctor about other changes you can make, such as increasing your level of physical activity, quitting drinking or using other drugs, getting better sleep, improving your diet and other non-pharmacologic interventions that can help alleviate symptoms of depression.
Some antidepressants also interact negatively with other medications you may be taking or reduce their efficacy, so it’s critical that you tell your doctor about all other medications you’re taking.
What Should I Expect From This Medication and How Long Will I Be on It?
“These medications generally take some time to begin working,” Hyman says, and anywhere from two to eight weeks is a common timeline before the patient feels a benefit, depending on the medication and the severity of the depression. Therefore, she says “we often recommend giving the medication 4 to 6 weeks to work.” However, she adds people generally start to notice a benefit earlier than that. Research is still ongoing into why it takes so long for antidepressants to provide relief.
Depending on the specifics of your situation, you may be on the medication for several months or even years. In most cases “we wouldn’t recommend stopping the medication right away once the patient starts to feel better,” Hyman says. A typical timeline is nine to 12 months for many patients who’ve had a single depressive episode, but if you’ve had several major depressive episodes, you may be on the medication for years.
And when you do go off the medication, it’s critical that you not stop abruptly, but rather taper off gradually on a managed schedule. Most antidepressants require a long taper period to allow the body to adjust, so be sure to follow your doctor’s dosing instructions closely.
What Are the Side Effects and What Should I Do if I Experience Them?
Some antidepressants can bring serious side effects, and these will be detailed in full in the printed information you receive from the pharmacy when you fill a prescription. These side effects vary from drug to drug but often include nausea, diarrhea, weight gain, dizziness, loss of sexual function and changes in mood or increased suicidality.
You should discuss all possible side effects with your doctor and develop a plan for what to do if an antidepressant you’re taking is causing side effects. “Everyone should be leaving [the doctor’s office] with a safety plan,” Paolucci says. “Ask ‘what if something else happens or I need something more? How do I best access the doctor?’ You don’t want to leave a message on the doctor’s machine saying, ‘I’m feeling more suicidal’ and then have to wait three days for an answer,” he notes. Your action plan should also include instructions for what to do if you miss a dose.
You might feel uncomfortable talking about some of the other side effects, such as the potential loss of sexual function some antidepressants can cause, but it’s important to have those conversations with your doctor so that you “can make informed decisions about whether to take the medication,” Paolucci says. “A lot of times we don’t ask those questions, and many times it can affect different aspects of your life” that may become a bigger problem over time. For example, after the medication starts to work, the symptoms of depression may fade, but for some patients not being able to have sex can be a problem that outweighs that benefit. “It’s an important aspect of life you need to figure out,” Paolucci says.
When Should I Take This Medication?
Hyman says that some medications are better taken in the morning, because they may cause you to feel more alert, while others may cause sleepiness, and are thus better taken at bedtime. With some medications that cause nausea and diarrhea, taking them with food can help ease these side effects. In any case, ask your doctor about how and when to take your medications for best results.
[See: 7 Apps to Mind Your Mental Health.]
What Else Should I Do to Manage My Depression?
In addition to taking medications, most patients are advised to seek counseling or psychotherapy to help alleviate symptoms of major depression. Having someone to talk to and help you develop better ways of coping with life’s stressors can be enormously helpful and can augment the effectiveness of any medications you do take. “There’s generally no side effects to talking,” Paolucci says.
He says you shouldn’t let the stigma that still surrounds mental health problems prevent you from seeking the help you may need. He says current antidepressants are “much safer” than their predecessors, and that “it’s important to know that they’re not going to take your emotions away. Some patients say, ‘I don’t want it to affect my mind or take my personality away. I don’t want it to make me not feel anything.’ But that’s not how these medications work. They’re fairly safe and if you and your doctor decide it’s worthwhile to try,” then you should see if it will help.
At the same time, he says to keep your own expectations in check. “Don’t have overly glorious expectations that it’s going to fix you instantly. There’s pros and cons and risks and benefits. Understand the side effects and what to watch out for and talk to your doctor.” If one medication isn’t helping or the side effects are too bothersome, there are other options you can try.
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5 Questions to Ask Your Doctor Before Starting Antidepressants originally appeared on usnews.com
