About Antidepressants

In recent years, there has been a significant rise in antidepressant prescriptions in the US. Over the last decade, antidepressant prescriptions nearly doubled in number. What is happening? Are we getting more depressed and miserable as time passes? Are antidepressant medications safe and effective? How do antidepressants actually work? Are there any alternatives?

First and foremost, I am not your family medicine doctor. Any advice I might give you is based on my research and experience with antidepressants. Every question you might have will be best answered by your family medicine doctor or your psychiatrist.

With that out of the way, we have to answer some basic questions when talking about antidepressants.

What are antidepressants?

Antidepressants are medications used to relieve symptoms of depression, anxiety disorders, obsessive-compulsive disorder, chronic pain conditions, as well as other conditions. From this definition, you can already conclude that antidepressants are not used only for treating depression. They have a variety of different mechanisms, with some of them not yet fully known to us.

Types of antidepressants

A few types of antidepressants are divided by their mechanism of action.

The most common types of antidepressants are:

1. Selective serotonin reuptake inhibitors (SSRIs)
2. Serotonin and norepinephrine reuptake inhibitors (SNRIs) 
3. Tricyclic antidepressants (TCA)
4. Monoamine oxidase inhibitors (MAOI)
5. Noradrenergic and selective serotonergic antidepressants (NASSAS)

Each of these types has a specific mechanism of action, different side effects, different efficacy rates, and several other characteristics that separate them from each other.

For example, Selective serotonin reuptake inhibitors, or SSRIs, are the most commonly prescribed antidepressants due to their high efficacy and low side effects profile. 

In most cases, SSRIs are sufficient in lowering the symptoms of anxiety and/or depression, but in some instances, it is necessary to introduce an older generation of antidepressants like TCAs or MAOIs into your therapy regimen. These older (or first) generations of antidepressants have a high side effects profile and therefore are not as well tolerated as their newer counterparts.

Additionally, using these older-generation antidepressants increases the chances of developing a condition called serotonin syndrome.

Serotonin syndrome is a potentially life-threatening condition caused by too much serotonin activity in the brain. It usually results from taking medications or drugs that increase serotonin levels, especially in combination or at high doses.

Symptoms usually start within hours of taking a combination of serotonin agonists, or two or more drugs that boost serotonin in the brain. Symptoms include mental changes like confusion, hallucinations, and other systemic symptoms like a high fever, hypertension (high blood pressure), tachycardia (fast heart rate), tremor, and muscle rigidity or twitching. If left untreated, it can lead to a seizure or coma and can be fatal.

Are there any side effects?

Antidepressants come with a variety of possible side effects depending on the type of antidepressant medication.

SSRIs and SNRIs usually have a mild side effects profile, with the most common side effects being: 

• Increase in depressive symptoms or anxiety at the start of the treatment
• Fatigue
• Gastrointestinal problems such as loss of appetite, indigestion, or stomach aches
• Dizziness
• Headaches
• Problems with falling asleep or maintaining sleep 
• Vivid dreams 
• Sexual problems such as low sex drive, inability to achieve an orgasm, or difficulties obtaining and maintaining an erection in men

Older generations of antidepressants, such as TCA’s have a higher side effects profile, with the most common being:

• Dry mouth
• Blurring of vision
• Gastrointestinal problems 
• Urinary problems, such as problems passing urine
• Drowsiness
• Dizziness
• Weight gain
• Excessive sweating (especially at night)
• Heart rhythm problems, such as noticeable palpitations or a fast heartbeat (tachycardia)

It is important to notice that some of these side effects may persist for a longer time, but most of them decrease after a few weeks of starting the therapy.

How do antidepressants work?

These medications have a wide variety of mechanisms of action.

The two most important mechanisms are the increase of certain neurotransmitters and a change in brain structures, a process called neuroplasticity. In theory, an increase in neurotransmitters like serotonin, noradrenaline, or dopamine causes a slight change in the person's mood. 

However, the true effects of antidepressants can only be seen after a few weeks of regular use. This is due to an increase in the concentration of certain neurotransmitters, which induces brain plasticity and reverses some of the damage caused by anxiety and/ or depression. That’s why patience is the key when starting these medications.

Are they effective?

Studies have shown that antidepressants are safe and effective in lowering the symptoms of depression and/ or anxiety, but also prove valuable in other conditions I mentioned earlier.

It is important to notice that the highest efficacy is seen when antidepressants are combined with psychotherapy, such as cognitive-behavioral therapy. 

Are there any alternatives?

I had unfortunately seen many primary care physicians and psychiatrists prescribe antidepressants without assessing other aspects of the patient’s life. Whether because they're overworked, or they simply do not care, is a topic for another day.

Before starting your antidepressant regimen, it is crucial to change other aspects of your life that might be causing or exacerbating your mental health problems. Are you getting enough sleep? Are you eating a balanced diet? Do you get enough exercise? Do you have a balance between your career and social life?

Once you improve other aspects of your life but don’t see a positive change in your mental health state, you can consider getting an appointment with a psychiatrist. Alternatives to antidepressant medications include psychotherapy, which has proven to be an effective way of dealing with mental health problems. These include cognitive-behavioral therapy, interpersonal therapy, or counseling with a trained professional.

Important notion

Contrary to popular belief, antidepressants are not miracle drugs. In order to see the full effect, you have to be really patient when starting a therapy regimen. 

One of the problems with starting an antidepressant regimen is the waiting period.

For most antidepressants, it takes 6-8 weeks for the full effect to be visible, so patience is the true key to a successful therapeutic effect of antidepressant medications. To make matters worse, your first antidepressant might not be the one for you (usually because of the side effects or low effectiveness), and you will have to wait another 6-8 weeks when your psychiatrist changes you to another antidepressant.

While antidepressants remain a somewhat controversial way of tackling your mental health problems, it is important to emphasize that these medications are safe and effective in dealing with many illnesses.  One of the most important missions of modern psychiatrists and mental health experts is to break the stigma surrounding medication for mental health.

While antidepressants are not a cure-all solution and require good psychotherapy to go with, they might be the most effective force in "getting the ball rolling" and enabling you to take the first step toward full recovery.

Summary:

🔹 What are Antidepressants?

Antidepressants are medications primarily used to treat depression, but also anxiety, OCD, chronic pain, and other conditions. They work by influencing brain chemicals (neurotransmitters), though some of their mechanisms are still not fully understood.

🔹 Types of Antidepressants

1. SSRIs – Most common, mild side effects (e.g., fluoxetine, sertraline)
2. SNRIs
3. TCAs – Older, more side effects
4. MAOIs – Rarely used due to risk of interactions
5. NaSSAs

⚠️ Side Effects

• SSRIs/SNRIs: fatigue, GI issues, sleep problems, vivid dreams, low libido
• TCAs/MAOIs: dry mouth, blurred vision, weight gain, heart rhythm issues

Most side effects improve after a few weeks.

🔥 Serotonin Syndrome

A rare but serious condition caused by excess serotonin (often from drug interactions). Symptoms: confusion, high fever, tremor, hypertension, seizures, or coma. Requires urgent care.

🔹 How Do They Work?

Antidepressants increase neurotransmitters like serotonin and norepinephrine, which, over time, promote neuroplasticity, helping the brain recover from the effects of depression or anxiety. Full effects usually take 6-8 weeks.

✅ Effectiveness

• Most effective when combined with psychotherapy (like CBT).
• Not a “quick fix” — patience and consistency are key.
• May require trying more than one type to find the right fit.

🌿 Alternatives & Lifestyle Factors

Before starting medication, it's important to evaluate:

• Sleep
• Diet
• Exercise
• Social balance

Non-medication treatments like CBT, interpersonal therapy, and counseling can be highly effective, either alone or alongside meds.