Understand Antidepressants & How They Work December 13, 2023 Antidepressant consumption among Americans is growing. According to data from the National Center for Health Statistics, “12.7% of people aged 12 and over used antidepressants in the past month” – a number that has only increased since the pandemic. “Nationally, there has been an increase in use of antidepressants, especially in the pediatric population since the pandemic,” said Megan Jones, director, Outpatient Pharmacies for Samaritan Health Services. Common Antidepressants & Their Use Antidepressants are used primarily for the treatment of clinical depression and are often the first course of treatment for patients having moderate to severe depression. They can be used in conjunction with psychotherapy such as cognitive behavioral therapy. Antidepressants are also used to treat generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, phobias and other psychiatric conditions, and are sometimes used to treat chronic nerve pain and other conditions. There are several classes or types of antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), Atypical Antidepressants and Tricyclic Antidepressants (TCAs). SSRIs (Celexa, Prozac) and SNRIs (Cymbalta, Effexor) are the most widely used. TCAs (Aitriptyline, Nortriptyline) are part of “first generation” antidepressants and may be used when an SSRI or SNRI aren’t effective, for obsessive compulsive disorder or for conditions like insomnia, migraine and chronic pain. Atypical antidepressants, (Welbutrin, Remeron) are also FDA approved to treat depression and other mental health issues. The reason for depression is not yet fully understood, and why antidepressants work for some and not others also is not clear. While there is much research on depression being a result of chemical imbalance, some newer research suggests that adverse or traumatic life events are key to the emergence of depression more so than brain chemistry. For those who find relief from symptoms of depression or anxiety, these medications may be used on a short-term basis or for long-term use, typically starting with a small dosage and increasing as needed. “As with any medication treatment plan, the duration of using antidepressants should be tailored to each unique patient and their diagnosis,” Jones said. “There are some cases where it may be appropriate to be on an antidepressant for one year, and sometimes where it may be a lifelong treatment plan. Generally speaking, antidepressants are safe for use on a short- or long-term basis.” According to the National Center for Health Statistics, 14% of Americans who take antidepressants have been taking them for 10 years or more. Potential Side Effects of Antidepressants Side effects from antidepressants differ among the various medications and among individuals. The most common side effects can include: Drowsiness, fatigue. Nausea, upset stomach. Headache. Weight gain. Sexual issues — diminished desire, erectile disfunction, decreased orgasm. Some side effects are less common than others and many can improve as the body adjusts to the medication. “We generally like a patient to try a medication for 6 to 8 weeks before deciding if it won’t work for them,” Jones said. Patients Have Options With so many medications on the market, a patient has options for treatment if side effects are intolerable, or if a patient has additional conditions that need addressed, noted Jones. “For a patient who is concerned about weight gain, I might recommend starting with fluoxetine. Or if they are also looking to stop smoking, we might try bupropion,” said Jones. “Most of the newer antidepressants like Lexapro are also well tolerated by many patients.” Additionally, any side effects could be mitigated by an increase or decrease of the medication dosage, a change from one class of medications to another, such as switching from an SSRI to a SNRI, or by combining multiple medications. “The takeaway is that there are options, and each patient will need to work with their provider and pharmacist to determine the medication that best fits their particular situation,” said Jones. Take As Recommended All medications should be taken as prescribed, and antidepressants are no different in that regard. However, abruptly stopping an antidepressant could lead to withdrawal-like symptoms including brain fog, headache, fatigue, nausea and/or return of depression symptoms. “Some patients decide they no longer want to take their antidepressants, which could be totally appropriate. But I recommend that an individual discuss discontinuing the medication with their provider or a pharmacist. Your clinical team can help with a schedule so that you can taper off the medication slowly and avoid or minimize any of these symptoms,” Jones said. “Generally speaking, antidepressants are safe and effective in treating multiple mood disorders,” said Jones. “It is important to have regular follow up care with your provider to ensure that the medication continues to be effective for you. Learn more about Samaritan Pharmacies at samhealth.org/Pharmacy.
