By Mimi Winsberg, MD
“Antidepressants don’t work.”
“Antidepressants will make me gain weight.”
“Antidepressants will destroy my sex life.”
While antidepressants are in common use, myths abound about their benefits and risks. Here we hope to address some of the common misconceptions surrounding antidepressants so that you and your doctor can determine if they are right for you.
Medication can be a useful part of a treatment plan to help you feel better and manage your symptoms of depression. There is absolutely no shame in taking medication. Like using insulin for diabetes or antihypertensive medication for high blood pressure, antidepressant medication plays an important––though not a singular––role in the treatment of depression.
Medications commonly prescribed as a first line of treatment for depression include selective serotonin reuptake inhibitors (SSRIs) and norepinephrine-dopamine reuptake inhibitors (NDRIs). Common examples include Sertraline (Zoloft), Escitalopram (Lexapro) and Bupropion (Wellbutrin). There are other categories of medications that are used as well.
Many antidepressants work by boosting the levels of neurotransmitters available to your brain cells, particularly those associated with mood, anxiety, and cognitive function. Neurotransmitters are the chemical messengers used by the brain cells to communicate with each other. Several neurotransmitters play a role in depression, including serotonin, dopamine, and norepinephrine.
Depression is associated with some brain changes, including loss of volume in a region called the hippocampus that is involved in memory. The hippocampus is a brain region that continues to grow new brain cells (neurons) throughout life, and there is some evidence that the stress hormones produced in depression may reduce the brain’s ability to generate these new cells. Antidepressants may counter this effect by contributing to the formation of new neurons. These cells may be critical for mood regulation. Treatment with antidepressants may restore normal brain structure and function so that individuals can eventually wean from medication and lead healthy and happy lives.
Antidepressants: Myth or Fact?
There are many misconceptions around antidepressants. Arming yourself with the facts is crucial to making an informed decision on if antidepressants are right for you. Let’s debunk some of the common myths surrounding antidepressants––or investigate if there is any truth behind them.
Myth #1: Antidepressants are addictive.
Fact: Antidepressants are not physiologically or psychologically addictive, but they can cause a discontinuation syndrome if stopped abruptly.
The discontinuation syndrome is a consequence of abruptly stopping certain types of antidepressants––particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
Discontinuation syndrome can include a range of symptoms that may occur in patients who suddenly stop their SSRIs or SNRIs. These are the most common symptoms of discontinuation syndrome1:
- Feelings of vertigo
- Trouble sleeping
- Odd sensory symptoms, such as tingling feelings in the skin, or what some people describe as a “zapping” sensation in the brain
- Feeling anxious
Everyone should consult their physician before stopping an antidepressant. Discontinuation syndrome can be avoided by carefully weaning off the medication under a doctor’s supervision1.
Myth #2: Antidepressants don’t work.
Fact: Antidepressants are an effective means to treat depression and are best used with other therapy tools.
Studies have shown that antidepressants are effective at relieving symptoms of depression about 40–60% of the time2. While medication can be an effective part of a treatment plan, there are some common reasons people feel like antidepressants did not work for them in the past. These reasons include:
- Stopping antidepressants after only a couple of weeks because no improvement in mood was felt. In reality, it can take up to four to six weeks for the medication to take effect.
- Not allowing appropriate time to determine if a dose increase is necessary or if a switch in medications is needed. This trial-and-error process can be discouraging for some patients.
- Being prescribed the wrong medication in the first place.
- Stopping medication as soon as a mood improvement was felt. Doing this increases the likelihood of the depression returning.2
While we may have considered depression to be a “chemical imbalance” at the end of the 20th century, the truth is that depression is a highly complex condition. Depression may involve not only brain chemicals but also brain circuitry, genetics, neurotransmitters, hormones, and inflammation. This complexity underscores the need to move away from one-size-fits-all depression treatment and adopt a more tailored mental health care strategy for depression patients. To get the most effective depression care, consider these three strategies:
- Data can help. New approaches suggest that using data may help target the right treatments to the right patients based on symptom clusters and personal characteristics, delivering better outcomes.
- A comprehensive approach is needed. Comprehensive approaches to care, which combine multiple treatment approaches like self care, therapy, and medication, often have the best outcomes. A comprehensive approach can help address multiple underlying causes and symptoms of depression.
- Look to Measurement Based Care. To get the best results with medication, it’s important to consistently measure progress during treatment. This approach is known as Measurement Based Care. Measurement Based Care allows you and your doctor to make informed decisions for any necessary adjustment in your treatment. To minimize side effects and maximize benefits, adjusting medication or dosage is common when starting antidepressants.
Antidepressants are not a miracle cure3 nor a one-size-fits-all treatment and the first antidepressant you try may not work for you. It is important to select the one matched to your specific needs and subtype of depression. It is also important to measure and closely monitor care, making any necessary adjustments using a measurement-based care strategy. If a particular antidepressant hasn’t worked for you, talk to your doctor about increasing the dose or trying out a different medication.
Myth #3: Antidepressants will change my personality.
Fact: We don’t have medications that change people’s personalities.
Some people worry that using medication to affect their brain chemistry could change their personality or make them “artificially” happy. Antidepressants are not “happy pills,” nor do they change your personality. Antidepressants don’t change who you are––they help reduce some of the symptoms that are weighing you down. When they work, antidepressants return you to your previous level of functioning before depression.
Myth #4: Antidepressants have awful, long-lasting side effects.
Fact: While antidepressants can have side effects, it’s usually possible to find a medication where both the benefits outweigh the side effects, and side effects are minimal.
People are often reluctant to take antidepressants because they’re afraid of side effects. Like all medications, antidepressants can have side effects. Side effects usually occur during the first few weeks of treatment and are less common later on2. Patients who are taking SSRIs sometimes have a change in their sexual response, such that it can take longer to climax, or require more stimulation.
Side effects also depend somewhat on the drug, the dose used, and the individual. Sometimes, side effects can be used to our advantage. For example: if you are having trouble sleeping at night and a medication has the side effect of making you sleepy, then taking the medication at night will be useful.
These side effects are sometimes short-term, happening during the initial stages of treatment and tapering off as the patient’s body gets used to the medication. If the side effects persist, you may want to talk with your doctor about switching to another medication or figuring out the best way to treat them.
Myth #5: I’ll have to take antidepressants for the rest of my life.
Fact: If this is your first episode of depression, you will likely need to take antidepressants for nine to twelve months.
The goal in the first few weeks and months of treatment is to relieve the symptoms and, if possible, make the depression go away. Once that has been achieved, the treatment is then continued for six to nine months. This continuation therapy is necessary to stop the symptoms from coming back. Longer-term antidepressant usage is considered only for a smaller percentage of people who have had two or more relapses of major depression in their lifetime.
Myth #6: Antidepressants will destroy my sex life.
Fact: Some antidepressants, such as SSRIs, can have an effect on libido or make it difficult to achieve orgasm.
As with all things, some antidepressants can be more likely to cause sexual problems than others. Lowering your dosage of the SSRI may help. Side effects of SSRIs can range from decreased sexual desire to diminished or delayed orgasm in women, and delayed ejaculation and orgasm in men. About 35–50% of people will experience sexual side effects with SSRIs4. Sexual side effects can diminish with time, but other options include lowering the dose of the antidepressant, switching to another medication that does not have sexual side effects or adding an agent to minimize the sexual side effects.
Myth #7: Taking an antidepressant is a sign of weakness.
Fact: Just like any other organ in the body, the brain is also susceptible to illness. Taking medication does not make you a weak person.
Would someone who takes medication for diabetes or a heart condition be considered “weak”? Taking antidepressants to treat depression is an attempt to care about your wellbeing. Antidepressants are not a chemical crutch, and you do not need to feel shame or embarrassment for taking them to manage your depression.
There are many different forms of depression, and each person’s brain chemistry is unique. Therefore, getting the best result requires matching each individual to the right medication and then fine-tuning a treatment based on their response. If you are suffering from depression, it is crucial to seek treatment from a specialist like Brightside who can help you find the right medication to manage your symptoms. Click here to get connected with one of our doctors and figure out the treatment plan that is right for your needs.