Antidepressants: What They Are and How They Work
Antidepressants are commonly prescribed to help people cope with the symptoms of mental health conditions such as depression and anxiety. Yet, despite being a common part of treatment, many people feel apprehensive or fearful about what will happen when they take an antidepressant.
What are antidepressants, and how do they work? Do the side effects of antidepressants cause personality changes or weight gain? Will they mask my symptoms instead of help me deal with them? Are antidepressants expensive? Will people think I’m weak for taking medication?
When faced with the idea of medication for managing your mental health, concerns such as these may arise – and this is normal. Yet, rest assured that needing antidepressants is not a sign of weakness. Mental health conditions are widespread in the U.S. and around the world, and many people often turn to medication to help them manage their symptoms.
Having said as much, the decision to take antidepressants shouldn’t be taken lightly. It’s important to consider a healthcare professional’s advice, have a say in your treatment, and fully understand your full range of choices. Mission Connection can help; we assist people with understanding their treatment options and how to choose the best fit for their needs.
This guide to antidepressants can also break down whether antidepressants are the right choice for your mental health or that of a loved one. It covers:
- What antidepressants are
- How antidepressants work
- The potential side effects of antidepressants
- What can happen if you stop antidepressants suddenly
- Questions to ask your doctor or mental health professional before starting antidepressants
- Where to find professional support for mental health treatment
What Are Antidepressants?
“Antidepressants” is an umbrella term used to describe a variety of medications designed to treat mental health conditions such as depression and anxiety.
Unfortunately, even though the level of understanding around mental health conditions and the need for antidepressants has improved in recent years, there are still many misconceptions around medication. For instance, people might feel like they’re “going against the grain” or “failing” if they need meds to manage their mental health.
Make no mistake; antidepressants are commonly used across the U.S. Therefore, if you require meds for your symptoms, you’re neither deviating from the norm nor at fault for needing them.
The Centers for Disease Control and Prevention reported that just over 13% of American adults had recently taken antidepressants. What’s more, women were more likely than men to have taken medication for a mental health issue, and usage increased with age. In fact, almost a quarter of women over the age of 60 claimed to use antidepressants.1
As a note, just because you have signs of a mental health condition doesn’t necessarily mean you need antidepressants. For some people, therapy is enough to manage their symptoms. However, many people do need antidepressants to help them achieve more stability – and a combination approach of medication and therapy often works best.
If you suspect you could benefit from antidepressants, a doctor or mental health professional can talk to you about your options. The following signs may also indicate that antidepressants and therapy could benefit you.
Signs You Need Antidepressants
Remember, medication for mental health issues works best when combined with therapy. If you recognize some of the following signs in yourself or a loved one, a mental health professional can help.
- Persistent feelings of hopelessness
- An ongoing sense of anxiety or dread
- Loss of interest in activities that once brought joy
- Feelings of guilt or worthlessness
- Problems concentrating or making decisions
- Relationship difficulties
- Changes to sleeping patterns
- Withdrawing from social groups
- Mood shifts
- Self-harm or suicidal thoughts
Additionally, a doctor or mental health professional may prescribe antidepressants for off-label issues. This happens frequently and simply means that a medication can be used to treat issues beyond those for which it was created, like for chronic pain management.
How Do Antidepressants Work?
To put it simply, mental health conditions such as depression are thought to create a state of chemical imbalance in the brain.2 The truth is that these conditions are often more complicated than just a lack of neurological balance, as they can result from experiences, genetics, and circumstances. Nevertheless, antidepressants can help create a more stable footing for tackling life’s challenges.
Antidepressants work by changing the levels of chemicals called “neurotransmitters” in the brain. However, because the underlying mechanisms behind many mental health conditions still aren’t fully understood, the exact hows and whys behind antidepressants’ effects also aren’t completely grasped. But we do know that different types of antidepressants work in unique ways to target the symptoms of mental health conditions.
The most commonly prescribed antidepressants include:
Selective Serotonin Reuptake Inhibitors (SSRIs):
SSRIs are usually the first port of call when treating anxiety and depression, so your doctor or mental health professional may discuss these with you based on your needs and symptoms. These medications work by blocking the brain’s ability to absorb the “happy hormone” serotonin, leading to improved mood, behavior, physical well-being, and overall outlook. SSRIs include medications such as fluoxetine (Prozac), sertraline (Zoloft), Citalopram (Celexa), Escitalopram (Lexapro), and Paroxetine (Paxil)
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):
Similar to SSRIs, SNRIs also block the absorption of serotonin in the brain, but they additionally inhibit the reuptake of another chemical called “norepinephrine.” Norephinephrine plays a role in alertness, attention, sleeping patterns, mood, and memory. Therefore, if SSRIs don’t prove to be effective for someone’s needs, SNRIs are often considered as the next course of action. SNRIs include meds such as venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq)
Tricyclic Antidepressants:
Tricyclic antidepressants are considered to be a “first wave” treatment for conditions such as depression, in comparison to later “second wave” treatments such as SSRIs and SNRIs. While tricyclics work similarly to SSRIs and SNRIs by blocking the reuptake of brain chemicals, they also tend to have more serious side effects, so they’re not as commonly prescribed. Tricyclic antidepressants include bupropion (Wellbutrin), mirtazapine (Remeron), and trazodone (Desyrel)
When it comes to treating mental health conditions with antidepressants, there tends to be a trial-and-error process.3 This means that a medical or mental health professional may have to try different medications to determine the best fit for your physical and mental reactions. They’ll typically start with SSRIs as these tend to have the least amount of side effects, before transitioning to SNRIs or tricyclics if required.
What Are the Common Side Effects of Antidepressants?
SSRI Side Effects
SSRIs tend to have the least amount of side effects in comparison to SNRIs and Tricyclics, but they can still pose some problems, such as:5
- Insomnia
- Skin rashes
- Gastrointestinal issues, such as stomach ache and diarrhoea
- Joint and muscle pain
- Headaches
- Blood clotting issues
- Reduced sexual satisfaction
SNRI Side Effects
Due to SNRIs’ dual ability to block absorption of both serotonin and norepinephrine, they may pose the risk of more side effects than SSRIs. For instance, in addition to the side effects of SSRIs, SNRIs could also cause:6
- Dry mouth
- Blurry vision
- Constipation
- Urinary retention
- Weight gain
- Fatigue
- Agitation and anxiety
Tricyclic Antidepressant Side Effects
Although tricyclics are considered to work as well as SSRIs and SNRIs for treating certain conditions, they also carry a much higher risk of side effects – including overdose. These side effects may involve:7
- Dizziness
- Constipation
- Dry mouth
- Blurred vision
- Fatigue
- Weight gain
- Rapid heartbeat
- Confusion
- Cardiovascular issues
- Suicidal thoughts
Just as every mental health condition can differ, so too can peoples’ physical and emotional responses to medications. At Mission Connection, we don’t just focus on prescribing – we build relationships, monitor, and communicate at every step of the way. This way, we can ensure that side effects are limited and treatment goals are reached.
What Happens if You Stop Antidepressants Suddenly?
Antidepressants work by altering the amount of chemicals in your brain, so stopping them suddenly means that the body and brain may need time to readjust. Depending on how long you’ve been taking antidepressants, what type you’re on, and the dosage, stopping them suddenly could lead to withdrawal symptoms. Additionally, certain medications can come with greater severity of withdrawal symptoms.8
Common antidepressant withdrawal symptoms include:9
- Return of emotional and mental symptoms
- Insomnia
- Sweating
- Stomach upset
- Brain jolts (feeling like there’s an electric shock in your head)
- Dizziness
- Agitation
- Flu-like symptoms
Stopping antidepressants safely means coming off them slowly – and consulting a medical or mental health professional. There’s no need to rush this process; allow your body the time it needs to readjust. If you’re looking to come off antidepressants, Mission Connection can put together a tapering plan for you.
What Should I Ask My Doctor Before Starting Antidepressants?
Just as every mental health condition can differ, so too can peoples’ physical and emotional responses to medications. At Mission Connection, we don’t just focus on prescribing – we build relationships, monitor, and communicate at every step of the way. This way, we can ensure that side effects are limited and treatment goals are reached.
Considering whether antidepressants are the right choice for your needs can be daunting. For this reason, we’ve put together a list of useful questions you can ask your doctor or mental health professional. Knowledge is power, so preparing yourself ahead of time can ease anxieties or concerns.
What Is the Safest Antidepressant Medication?
The “safest” antidepressant medication will depend on your symptoms and needs, and a doctor or mental health professional can talk you through your options. However, in general, SSRIs are considered to be the antidepressants with the least risk of side effects, so professionals usually start treatment with one of these. If they prove to be ineffective for your needs, a different course of action will be considered.
How Long Do Antidepressants Take to Work?
If your mental health has been affecting your life, you’re likely keen to see improvements as soon as possible, so it’s natural to ask your doctor when you’ll see benefits. In truth, the speed of antidepressant effects differs from medication to medication and person to person. However, in general, most people don’t see improvements for several weeks after treatment.10
Do Antidepressants Help With Sleep?
Many people with conditions such as anxiety and depression suffer from sleep disturbances like insomnia, which can create further problems with daily functioning and significant distress. Therefore, antidepressants may seem like a “cure” for sleep problems.
In the long term, antidepressants have been shown to improve sleep quality. However, it’s good to understand that this effect isn’t immediate. It may take several weeks or even months before sleep improves – and antidepressants may even initially worsen the ability to sleep as they can “activate” the brain. Yet, this impact may depend on the specific medication, as some antidepressants might cause early sedative effects.11
Are There Natural Alternatives to Antidepressants?
Lifestyle changes such as a balanced diet, exercise, and adequate sleep can all improve the symptoms of mental health conditions such as anxiety and depression. However, they may not be enough by themselves – especially if your symptoms are severe. A combination approach of lifestyle changes, therapy, and medication may work best, but your mental health professional can discuss this balance with you. Additionally, while there are “natural” antidepressants, such as St. John’s Wort, many of these can interact with medications and create negative side effects, so it’s important to seek medical advice.
How Effective Are Antidepressants for Bipolar Disorder?
If you have bipolar disorder, this is an important question for your doctor or mental health professional. Overall, the evidence for antidepressants in treating bipolar disorder is weak – and even controversial at times.12 For instance, there’s some speculation that antidepressants could speed up the acceleration of the bipolar cycle, leading to greater fluctuations in mood. Yet this effect may be more associated with the older meds, such as tricyclics. Essentially, the answer to this question boils down to your specific symptoms and needs. A doctor or mental health professional can advise about using medications such as antidepressants and mood stabilizers – or a combination of both.
What Are the Best Antidepressants for Teenagers?
Similar to adults with mental health conditions, the “best” antidepressants for teenagers are considered to be those with the least risk of side effects – SSRIs. Specifically, fluoxetine is the most studied antidepressant for treating children and teenagers with depression.13 However, other antidepressants may be more appropriate for other conditions, such as sertraline for OCD. Doctors will usually start by prescribing a medication that has FDA approval for use with minors. However, if this doesn’t work, they may consider going off-label and using one that has adult approval.
Mission Connection: Supporting You Throughout Mental Health Treatment
Medication is an effective, evidence-based choice for the treatment of mental health conditions such as anxiety and depression. But not everyone with a mental health issue needs antidepressants. For people with mild to moderate symptoms, therapy might be enough.
Mission Connection can support you throughout your mental health journey. Whether you need medication monitoring, are wondering how to switch antidepressants, or are interested in therapy options, our team can tailor treatment to your needs.
Medication works best when it’s combined with therapy, so we can discuss the best approach for your symptoms, including:
We understand the toll mental health conditions can take on someone’s life. For this reason, we aim to make treatment as flexible to your schedule as possible, offering remote telehealth services to ensure you get the support you need. Not all mental health providers are created equal – your mental health deserves the right space, treatment, and options for healing.
If you’re ready to talk about Mission Connection’s treatment options, or just have more questions to ask about medication, our team is here to help. Contact us today at 866-561-4108 or fill out our confidential contact form.
References
- Centers for Disease Control and Prevention. (2020, September). Antidepressant use among adults: United States, 2015–2018 (Data Brief No. 377). National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db377.htm
- Andrade, C., & Kumar Rao, N. S. (2010). How antidepressant drugs act: A primer on neuroplasticity as the eventual mediator of antidepressant efficacy. Indian Journal of Psychiatry, 52(4), 378. https://doi.org/10.4103/0019-5545.74318
- Leuchter, A. F., Cook, I. A., Hunter, A. M., & Korb, A. S. (2009). A new paradigm for the prediction of antidepressant treatment response. Dialogues in Clinical Neuroscience, 11(4), 435. https://doi.org/10.31887/DCNS.2009.11.4/afleuchter
- Duong, Q. A., Pittet, L. F., Curtis, N., & Zimmermann, P. (2022). Antibiotic exposure and adverse long-term health outcomes in children: A systematic review and meta-analysis. Journal of Infection, 85(3), 213-300. https://doi.org/10.1016/j.jinf.2022.01.005
- Harvard Health Publishing. (2021, August 17). What are the real risks of antidepressants? Harvard Health. https://www.health.harvard.edu/newsletter_article/what-are-the-real-risks-of-antidepressants
- Santarsieri, D., & Schwartz, T. L. (2015). Antidepressant efficacy and side-effect burden: A quick guide for clinicians. Drugs in Context, 4, 212290. https://doi.org/10.7573/dic.212290
- Moraczewski, J., Awosika, A. O., & Aedma, K. K. (2023, August 17). Tricyclic antidepressants. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557791/:contentReference[oaicite:2]{index=2}
- Henssler, J., Schmidt, Y., Schmidt, U., Schwarzer, G., Bschor, T., & Baethge, C. (2024). Incidence of antidepressant discontinuation symptoms: A systematic review and meta-analysis. The Lancet Psychiatry, 11(7), 526–535. https://doi.org/10.1016/S2215-0366(24)00133-0
- Gabriel, M., & Sharma, V. (2017). Antidepressant discontinuation syndrome. CMAJ : Canadian Medical Association Journal, 189(21), E747. https://doi.org/10.1503/cmaj.160991
- Bighelli, I., Castellazzi, M., Cipriani, A., Girlanda, F., Guaiana, G., Koesters, M., & Barbui, C. (2018). Antidepressants versus placebo for panic disorder in adults. Cochrane Database of Systematic Reviews, 2018(4), CD010676. https://doi.org/10.1002/14651858.CD010676.pub2
- Wichniak, A., Wierzbicka, A., Walęcka, M., & Jernajczyk, W. (2017). Effects of Antidepressants on Sleep. Current Psychiatry Reports, 19(9), 63. https://doi.org/10.1007/s11920-017-0816-4
- Gitlin, M. J. (2018). Antidepressants in bipolar depression: An enduring controversy. International Journal of Bipolar Disorders, 6(1), 1-7. https://doi.org/10.1186/s40345-018-0133-9
- Emslie, G., Kratochvil, C., Vitiello, B., Silva, S., Mayes, T., McNulty, S., Weller, E., Waslick, B., Casat, C., Walkup, J., Pathak, S., Rohde, P., Posner, K., March, J., & Team, T. (2006). Treatment for Adolescents With Depression Study (TADS): Safety Results. Journal of the American Academy of Child and Adolescent Psychiatry, 45(12), 1440. https://doi.org/10.1097/01.chi.0000240840.63737.1d
