7 Things You Should Know before Taking Antidepressants ...

1. Effectiveness

People take antidepressants with the expectation that their depression will be treated. However, before taking antidepressants, you should know that they are not effective for all people. In fact, a 2006 study conducted by the U.S. Government found that fewer than 50% of people become symptom free and many who do respond fall back into a depression even when continuing treatment. Also, antidepressants are only slightly more effective than a placebo for mild to moderate depression. Clearly, antidepressants are not 100% effective, and they are not something you should take thinking you will definitely feel better.

2. Theory of Chemical Imbalance

There is a long standing theory that depression results from a chemical imbalance in the brain. According to the theory, levels of serotonin in the brain become low, which means that an antidepressant's ability to increase serotonin levels should make a person feel better. The problem with this theory is that serotonin levels can’t be measured in the brain, and there is no knowledge of how antidepressants affect brain levels of serotonin. Also, some people with low serotonin levels don’t become depressed. Researchers have found that other factors, such as inflammation, increases in stress hormones, and nutrient deficiencies can contribute to depression. These other factors explain why antidepressants are not effective for everyone. There are multiple factors to consider when explaining the causes of depression.

3. Different Classes

Antidepressants are categorized into different classes according to the chemicals they affect, which include the neurotransmitters serotonin, norepinephrine, and dopamine. Selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed and include Prozac. These work by preventing serotonin reuptake, which increases levels of serotonin. Cymbalta is in a different class of antidepressants that act on both serotonin and norepinephrine called serotonin and norepinephrine reuptake inhibitors. Another class is tricyclic antidepressants, which work on all three neurotransmitters. This is an older class that can be very effective, but is not prescribed as often because the side effects are worse and an overdose can be fatal. The last class is called MAOIs. This class of antidepressants is usually used as a last resort because the side effects can be very dangerous. All of these classes work in a slightly different way, which is why it is important to see a specialist when you are considering antidepressant medication.

4. Psychiatrists

Psychiatrists are doctors who specialize in psychiatric disorders including depression. They have extensive training in how to prescribe psychiatric medications like antidepressants. To achieve the best possible outcome, it is very important that you see a psychiatrist. Unfortunately, 80% of antidepressants are not prescribed by a psychiatrist, and of these 73% have not been given a proper psychiatric diagnosis. I realize that family doctors often prescribe antidepressants, but keep in mind that their psychiatric training is very limited. You will receive the most help from a psychiatrist.

5. Side Effects

Antidepressants do not come without side effects! The side effects can range from being mild to being very serious. Some of the more common side effects people experience include nausea, insomnia, anxiety, restlessness, dizziness, weight gain, headaches, and fatigue. Sometimes these side effects are severe enough that people discontinue the medication, which can result in other problems that I will talk about in the next point. The increased risk of suicidal thoughts or actions is a much more serious effect that should be taken very seriously. You will find warning labels on antidepressants or in the pamphlets that come with the prescription. These should not be ignored. Antidepressants should not be taken lightly, because the side effects can be life threatening.

6. Antidepressant Discontinuation Syndrome

When antidepressants are stopped abruptly after more than 6 weeks of use, very unpleasant symptoms can arise. People who don’t taper their medication down can experience flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, or hyper-arousal. These symptoms generally last 1 to 2 weeks, but going back on the medication will make the symptoms stop. If you are on an antidepressant and want to get off of it, you need to see your doctor to be given a proper tapering schedule.

7. Serotonin Syndrome

Although rare, antidepressants can cause serotonin syndrome. This occurs when you have too much serotonin in your body. The syndrome can be mild or very severe. Discontinuing the medication can make mild cases stop within a day, but more severe cases may need a medication to block the serotonin. The symptoms of serotonin syndrome include agitation, confusion, rapid heartbeat, loss of muscle coordination, shivering, headache, and goose bumps. More seriously, a person can have a fever, seizures, irregular heartbeat, and loss of consciousness. Serotonin syndrome requires medical care, so it is important to see a doctor if you suspect you are experiencing serotonin syndrome.

Depression is life changing and should always be treated. However, before taking antidepressants it is important to make sure they are the right course of action. Often, seeing a psychologist can be very helpful for depression, and even if you do choose medication, a therapist is always recommended so you can fix the underlying problem. What are your thoughts about antidepressants?

mayoclinic.com, mayoclinic.com, blog.doctoroz.com, helpguide.org, aafp.org