6 Things to know before starting antidepressants

Medications for depression can help you feel better. But for the best results, look before you leap.  Here’s what physicians think you should know before starting antidepressants.

Lost your get-up-and-go? Feeling sad, hopeless, and moody? If you answered yes, and if your symptoms have lasted more than a few weeks, it could be depression. And if it is, it’s important to know that you’re not alone, and there is help. 

Nearly 1 out of every 5 adults in the U.S. has been diagnosed with depression at some point in their lives. Luckily, treatments like medication and talk therapy are available. And they’re very effective. In fact, about 13% of all U.S. adults take antidepressants. About 40% to 60% of those who take antidepressants see an improvement in their symptoms in 6 to 8 weeks. That’s about twice as many seeing improvements as those who took a placebo. 

But as with any medication, antidepressants come with risks and possible side effects. They also only work if you take them consistently. Here are 6 tips you should know before starting antidepressants to get the most benefit out of your treatment. 

The Wellframe digital health management app can help connect you with the mental health support and services you need. Many health plans offer Wellframe to their members for free. To find out if you have Wellframe, reach out to your HR team.

The most common first-line treatment for depression is a group of medications known as selective serotonin reuptake inhibitors (SSRIs), says Ryan Sultan, M.D. Dr. Sultan is an assistant professor of clinical psychiatry at the Columbia University Irving Medical Center/New York State Psychiatric Institute in New York City. Examples of SSRIs include sertraline (Zoloft®) and fluoxetine (Prozac®). These drugs are effective, but they do take time to work.  

“There are medications you can take, like ketamine, that immediately lessen symptoms. But SSRIs aren’t one of them,” Dr. Sultan explains. SSRIs work by raising levels of certain brain chemicals, such as serotonin. This helps to enhance your mood. Some people do notice they feel better a few days after starting SSRIs. But for most, it takes weeks to feel the full effects, Dr. Sultan says.  

All antidepressants can cause stomach troubles such as nausea at first, or when you increase the dose. But this usually disappears after about a week. Other possible side effects include:  

These sometimes improve with time, too, says Dr. Sultan. “It’s important to remember that many people who take antidepressants don’t experience any side effects and are able to stay on these medications for years.”  

If you do have side effects that last more than a week or two, let your doctor know. They may be able to lower the dose or switch you to another medication entirely. Finding the right medication may involve some trial and error. Being patient will help you here, too. 

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Medication has been shown to work best when it’s combined with talk therapy treatments such as cognitive behavioral therapy. This is a type of therapy where you work with a therapist to pinpoint the thought patterns that worsen your depression. Together, you and your therapist can work on ways to change those patterns. 

For the best results, you’ll also want to adopt healthy lifestyle habits, adds Dr. Sultan. Key habits include:

Treatment-resistant depression occurs in about 30% of patients who take medication. (Depression is considered “treatment-resistant” when symptoms don’t improve after trying at least 2 different antidepressants.) “It’s very common,” says Dr. Sultan. Your doctor may decide to have you try a different antidepressant. Or they may add a second one to your regime. 

“There are other treatments available if you don’t respond to first-line drugs, Dr. Sultan adds. What’s most important is sticking with your goal of getting your depression under control. “If it’s left untreated, it can be toxic to your brain,” Dr. Sultan says.

Feeling better after a little while of treatment? That’s great. But don’t stop taking your meds without talking to your doctor first.  

“It’s very tempting. People sometimes improve on their medication so much that their symptoms are completely gone,” says Dr. Sultan. “They want to believe this depression was a blip, and not a big deal.” But if you stop your treatment without the right plan in place, you could relapse. One study found that more than half of patients who stopped taking their antidepressants after using them for at least 2 years relapsed within a year. 

Dr. Sultan recommends that you stay on an initial course of antidepressants for at least a year, even if you feel completely fine. After that, you can ask your mental health provider if it makes sense to make a change. You can talk about going down to a lower dose, or even tapering off your medication completely.  

Research shows that some antidepressants may increase the risk of falling in older adults. If that’s you, talk to your provider about ways to reduce the chances that you’ll take a tumble.  

Other side effects may also be more pronounced in people over the age of 65. That’s because it’s harder for their bodies to break down medications, says Dr. Sultan. If you’re over 65, your doctor may recommend that you start at a lower dose. And they’ll want to watch you more closely for side effects such as memory loss. As always, having an open and regular dialogue with your provider can help you sidestep common side effects of antidepressants and make the most of your treatment.