Taking an antidepressant is incredibly common—more than 1 in 10 Americans do.
But despite their prevalence, these drugs are often misunderstood, in part because of stereotypes and stigma around mental health. That may keep some people who could benefit from an antidepressant from learning more, says UNC Health psychiatrist Elizabeth Cox, MD.
“Medication is an important part of treatment. Therapy is also extremely important, and I recommend therapy to pretty much 100 percent of my patients,” she says. “But sometimes it can be difficult to participate in the therapy (because symptoms are too strong), or the therapy itself might not be enough.”
Here are eight important things to know about antidepressants:
1. Antidepressants are not just for depression.
Antidepressants are a class of drug that includes selective serotonin reuptake inhibitors (SSRIs, such as Zoloft, Lexapro and Prozac); serotonin and norepinephrine reuptake inhibitors (SNRIs, such as Cymbalta and Effexor); and atypical antidepressants (such as Remeron and Trintellix).
These drugs might be called “antidepressants,” but they also work to treat anxiety. Typically, higher doses are needed for anxiety than for depression.
2. Antidepressants should make you more—not less—like yourself.
People are often concerned that taking a psychotropic drug (that means it acts on the brain) will change who they are, Dr. Cox says.
“Medication should not change your personality. That is never the goal,” she says. “The goal is to feel like yourself but rid of the problematic symptoms—to not feel totally overwhelmed with depression or anxiety.”
3. Antidepressants won’t make you a “zombie.”
Again, the goal is to help you enjoy your life, not to numb you. “If somebody feels in a daze or zombielike, that can mean the medication is too high, and we need to lower the dose,” Dr. Cox says.
But sometimes people actually feel dazed or foggy because of high levels of anxiety or depression, she says, and taking medication helps them feel more clearheaded.
4. Antidepressants take four to six weeks to reach full effectiveness.
When you start taking an antidepressant, you probably won’t feel better right away. It takes about a month and a half for the medication to build up in your body, and your doctor will increase your dose gradually, Dr. Cox says.
People sometimes get discouraged when their medication doesn’t work quickly, but patience is key, she adds.
For fast-acting anxiety relief, doctors may prescribe as-needed medications that work more quickly to be used temporarily until the SSRI, SNRI or atypical antidepressant reaches full effect. These medications include benzodiazepines, such as Ativan and Klonopin.
“These can be helpful when appropriate, but caution should be exercised as they can be addictive and cause sedation and falls,” Dr. Cox says. “Safer, nonaddictive alternatives include Vistaril or Inderal.”
5. It might require trial and error to find the right antidepressant for you.
Just as not every therapist matches with every person, not every antidepressant will work for everyone who tries it. You might try one antidepressant and not feel better after a few months, and then switch to another similar antidepressant that works for you.
Doctors also have a tool called GeneSight, in which they take DNA by cheek swab that is analyzed to determine which medication will be most effective based on the person’s metabolism and susceptibility to side effects.
“Just because you have to change medications because the first one didn’t go well doesn’t mean things aren’t treatable,” Dr. Cox says. “Anxiety and depression are highly treatable. It just requires patience and working with your physician.”
6. Doctors can help with antidepressant side effects.
Most antidepressants are well tolerated, but side effects are a possibility. When first starting antidepressants, some people have mild stomach upset, headache or fatigue, but these side effects often diminish in the first few weeks as the body adjusts. Some people gain weight, though many stay “weight neutral,” and some even lose weight, Dr. Cox says.
Problems with sexual desire or function are fairly common, but this isn’t inevitable or irreparable, she says.
“A lot of patients feel nervous talking about that with their provider, but I want people to feel free to talk to me about that,” she says. “There are things we can do to help,” such as adding a low dose of another medication.
7. You don’t necessarily have to stop taking your antidepressant if you’re pregnant or breastfeeding.
Some antidepressants, particularly SSRIs, are considered safe to take while pregnant and breastfeeding.
Women and their doctors must make a risk-benefit calculation, Dr. Cox says. While it’s best to be on the fewest medications possible during pregnancy, the risk of untreated symptoms of depression and anxiety may be greater than any risk from medication.
“When moderate to severe, untreated symptoms can pose risk of serious harm to the mother and baby,” Dr. Cox says. “These symptoms deserve to be treated just like any other health condition that arises during a pregnancy.”
8. Starting an antidepressant doesn’t mean you’ll be on it forever—but don’t go off cold turkey.
People who take antidepressants don’t need to feel trapped, Dr. Cox says. Some people need medication indefinitely, but many do not. Their life circumstances change, or they make progress in therapy, and the antidepressants aren’t as critical anymore.
“Just because you’re struggling and you reach out to your doctor about medication doesn’t mean you’re signing up to take something for the rest of your life,” she says.
If you are interested in stopping your medication, it’s important to do so in consultation with your doctor, who will tell you how to taper off slowly. This has two purposes, Dr. Cox says: One, it reduces the chance of withdrawal symptoms. Two, if you start to decrease your dose and your anxiety or depression worsens, you can increase back to your previous dose easily.
Think you might be dealing with depression or anxiety? Talk to your doctor or find one near you.