Antidepressants: What are they and what can they do?

Antidepressants are medications commonly used to treat anxiety and depression. In the United States, about 13% of adults use antidepressant medications, according to the Centers for Disease Control and Prevention. Today’s most popular medications are the result of years of research and safety data going back to the invention of antidepressants in the 1950s.

There are a variety of antidepressant medications available, so it’s important to understand what you need these medications to do, and which side effects you might expect.

What are antidepressants and what do they do?

Though they are called “antidepressants,” this type of medication is used for a variety of conditions. Antidepressants are commonly used to treat depression and anxiety, but they can also address pain, insomnia and eating disorders.

Modern antidepressants treat depression and anxiety by targeting the chemicals that are causing problems in the person’s brain.

“Chemicals like serotonin, norepinephrine and dopamine are neurotransmitters that carry messages in our brain. If we don’t have enough of them or we have too many, they get out of balance and can lead to things like depression and anxiety,” said Jake Peters, a pharmacist at IU Health. “These medications work in different ways to balance out those chemicals.”

Symptoms of depression can include a depressed mood, losing interest in doing things you like and changes in sleep or appetite. There are a variety of anxiety disorders, and the symptoms typically include feelings of extreme worry or panic. Antidepressants are often prescribed in combination with therapy to help regulate the out-of-balance chemicals in the brain that are causing these symptoms.

“It can be similar to how someone with an injury may take Tylenol to help them overcome pain as a barrier to rehabilitation,” said Dr. Michael Metrick, a psychiatrist and Director of the Division of Adult Psychiatry at IU Health. “Antidepressants won’t fix your life, but they can be a tool within your comprehensive treatment plan that give you greater agency over the changes you need to make to feel better.”

Are antidepressants safe?

Antidepressants are considered a safe medication, though they can have side effects. Part of what makes them so safe is the long history of successful use and scientific data supporting it.

The most common antidepressants today focus on serotonin transmitters in the brain. This concept was discovered in the 1970s and led to the production of the first selective serotonin-reuptake inhibitor, or SSRI, in 1987 called Prozac. SSRIs remain the most widely prescribed class of antidepressants in the United States.

“Antidepressants have a really long track record of use, which lends itself to the safety and efficacy of these drugs,” Peters said. “We’ve been using them for a long time and there are multiple research studies that consistently show benefits to short- and long-term use.”

Studies have shown that antidepressants are not addictive, either. While about 20% of patients may experience withdrawal symptoms from antidepressant discontinuation syndrome, the symptoms are typically mild, lasting only a week or two. However, they may experience concern or worry about stopping use of an antidepressant that has been helpful.

“The power of belief is important, so someone may be confidently using an antidepressant and believe that they can’t get off of it because it’s important to them,” Dr. Metrick said. “But there’s no evidence from an addiction psychiatry perspective that there’s chemical dependency.”

What are the different types of antidepressants?

There are several types of antidepressants, and each of them targets a different neurotransmitter chemical in the brain:

• SSRIs: Selective serotonin reuptake inhibitors
• SNRIs: Serotonin-noradrenaline reuptake inhibitors
• NDRIs: Norepinephrine-dopamine reuptake inhibitors
• NaSSas: Noradrenaline and specific serotonergic antidepressants
• TCAs: Tricyclic antidepressants
• MAOIs: Monoamine oxidase inhibitors (these are less common today)

Every person’s brain chemistry is slightly different, so a drug that may work for one person may not be effective for another.

“These medications target different chemicals, so this gives us different ways to approach treatment for folks. We understand a decent amount of what causes depression and anxiety, but even that’s somewhat limited,” Peters said. “Having different tools and different medications that target these things a little differently helps us pick the best medication to help folks with the specific problems they’re experiencing.”

What are the side effects of antidepressants?

While antidepressants are safe, they can have side effects, which vary depending on the medication. Talking with your doctor can help you choose an option that avoids the worst side effects for your body. For instance, someone who experiences migraines may want to avoid a drug that is likely to cause headaches. However, some side effects can be lessened. Stomachaches and gastrointestinal problems are the most common side effects, so you might need to take the medication with food. Some side effects could make you sleepy, and so you might take these before bed.

Recent studies have suggested a concerning risk that taking antidepressants could increase a young person’s risk for suicidal ideation. As patients get older, that risk falls or reverses. Additional studies have suggested that all patients—but especially children—should be closely monitored for thoughts of suicide before and during any course of antidepressant treatment.

“We are very vigilant with younger patients on antidepressants. We’re using FDA-approved medications, and we build a partnership with that young person’s support network to educate them on early warning signs and risks,” Dr. Metrick said. “We tell them we’re not anticipating that they’ll experience these symptoms, but they need to be prepared. If they do have worsening anxiety, more negative thinking or suicidal thinking, they need to contact their doctor right away or call a crisis line.”

How long can you be on an antidepressant?

Each person’s use of an antidepressant is different. The goal of this type of medication is to reduce symptoms and improve a person’s quality of life. This could happen in a few months or a year. There’s no limit for how long you can take antidepressant medications.

“People can experience depression and anxiety off and on throughout their lives. Taking these medications long term is okay,” Peters said. “A lot of these newer antidepressant have been around for more than 20 years, so we know patients are safe in the long term. If they’re still finding benefit from taking antidepressants, there’s no harm in continuing to take them.”

Sometimes antidepressants are used to prevent problems, such as major depressive episodes. These folks may be more likely to begin an SSRI and then stop it if they are working with a doctor who can help estimate their risk of recurrence.

“The risk for a recurrence may be partly based on your medical history. For instance, someone who’s had one depressive episode in their entire lifetime and wants to reduce the medications they take may be better positioned for a short-term course of treatment,” Dr. Metrick said. “But if someone’s had multiple prior depressive episodes, we’re not just treating the depressive episode state. These medications may also have a positive preventative quality, and the benefits may outweigh risk.”

Keep in mind:

• Antidepressants may be used to treat a variety of medical conditions.
• If you and your doctor decide to begin using an antidepressant, it can take six to eight weeks to take full effect.
• Talk with your doctor about any side effects or concerns.
• There are many options for antidepressants, so if one doesn’t work, you might find another one that will.
• Antidepressants are considered generally safe and non-addictive.