Your Guide to Antidepressants and Staying Well

Depression affects millions of Americans. It is a lifelong mental health disorder that can severely impact your ability to work and engage in healthy social relationships. It is most commonly diagnosed among adults between the ages of 18 and 64, but most people experience the onset of depressive symptoms in their 20s.¹

In many cases, a combination of therapies will be used to treat depression. This therapeutic strategy may include psychotherapy (talk therapy), a complementary self-care regimen, pharmacotherapy (antidepressant medications), or any combination thereof. Antidepressants are a class of medications used to manage several mental health issues, and are the quintessential class of pharmacotherapeutic agents prescribed for the treatment of major depressive disorder. Medications commonly used to treat MDD include:²

• Selective serotonin reuptake inhibitors (SSRIs).
• Serotonin-norepinephrine reuptake inhibitors (SNRIs).
• Tricyclic antidepressants (TCAs)

What Are Antidepressants Prescribed For?

Antidepressants are mainly prescribed to treat the symptoms of extreme sadness and exhaustion most often associated with depression. As a class of drugs, antidepressants are thought to work by restoring a person’s emotional balance via specific neurotransmitter activity so that they can function in their day-to-day lives.

People may also be prescribed these medications to relieve anxiety, sleeping issues, suicidal thoughts, and restlessness.⁶

How Do Antidepressants Work?

In our brains, certain nerve cells, or neurons, interact with each other via the release of signaling molecules called neurotransmitters. When these chemicals (e.g., serotonin and dopamine) are out of balance, it can lead to mental health problems such as depression. Although scientists continue to study and learn more about the exact mechanisms of depression, experts believe that when a person is depressed, there may actually be a problem occurring between interconnected neurons. Taking medications, such as SSRIs or TCAs, can help increase the availability of certain neurotransmitters throughout the brain to improve the symptoms of depression and some other mental health conditions.⁶

Generally, antidepressants are taken on a daily basis. During the first weeks and months of taking one, the primary goal is to manage depressive symptoms. It’s not always the case that symptoms will disappear completely, but they should improve and feel manageable. To achieve this, most people stay on their medication for a year or two, after which your doctor will assess your condition and make a recommendation for the next phase of treatment. Staying on your antidepressant consistently helps prevent symptoms from reappearing or becoming unmanageable. Those who are ready to discontinue medication (at their doctor’s approval) do well to continue with individual therapy or counseling to manage any minor symptoms that linger. Regardless of what works best for you, this decision should always be made between you and your doctor.⁶

It is important to keep regular appointments with your doctor while you are taking antidepressants. There are many variables that come into play when taking a medication for a mental health disorder, so it’s essential to talk with your doctor about whether your symptoms have improved or worsened, or whether you are experiencing any side effects. Depending on how you are affected by the medication, your doctor may adjust your dose, but you should never adjust the dose on your own. The primary risk of doing this is that the medication may not work as it is intended, and you could experience unpleasant side effects.⁶

Antidepressants vs. Self-Medication

It is often common for people to turn to negative or maladaptive “self-medicating” activities like drinking alcohol or using drugs to temporarily avoid experiencing the feelings of depression. Other self-medicating activities might include the misuse of prescription medications, self-harming behaviors, or engaging in risky sexual activities.

The safest and most effective way to treat depression is to see a trained medical or mental health professional to receive behavioral therapy, medication, or both. Some people object to taking medication for a mental health disorder because they believe it’s a problem of that can be overcome by sheer will. However, depression is thought to be a disease of the brain that arises from impaired neurochemical functioning. Medication is designed to help correct this brain imbalance. It is often a first step to stabilize symptoms with an antidepressant so you can more effectively take part in other therapeutic options, such as psychotherapy or peer support groups.

It is important to remember that not everyone responds positively to antidepressants, so you should share your full medical history with your doctor before you begin any medication and work closely with an experienced psychiatrist to determine the best way to manage your depression.

What Happens When You Stop Taking Antidepressants?

Depression is a naturally fluctuating condition. Many people begin feeling much better after taking medication for a few weeks and believe that they can stop using antidepressants as a result. However, these early improvements in mood are simply an acute response to the medication and not a true remission.⁷ Studies show that stopping antidepressant medication prematurely can actually increase the risk of relapse or recurrence, especially when the withdrawal is abrupt.

When people use antidepressants consistently for a long time, it can protect them from experiencing the following:⁷

• Relapse and recurrence of depressive symptoms
• Worsening of existing depressive symptoms
• Discontinuation symptoms (aka, withdrawal)

The question of when to stop taking antidepressants is one that every person must consider at some point. Because complete remission of depressive symptoms is the goal of therapy, it is important to confirm that your depression has sufficiently resolved before you discontinue your medication. Your doctor will work with you to determine the severity and improvement of your depression using clinical scales. New recommendations state that treatment should be continued for 9 months to prevent relapse, while other experts believe that medication should continue anywhere between 3 years to a lifetime.⁷

Most drugs use the term withdrawal syndrome when referring to stopping use of a drug. However, in the case of antidepressants, experts prefer the term discontinuation syndrome since the effects of stopping TCAs, MAOIs, SRIs, SSRIs, and SNRIs are usually mild and not long-lasting. In most cases, drug withdrawal symptoms peak in the first week and gradually fade away, however, discontinuation symptoms differ depending on the drug taken and can range widely in their severity.^7,8

Some of the discontinuation syndrome symptoms you may experience include:^7,9

How to Get Help for Depression

Depression affects every person differently, but a few common signs of the disorder include:¹⁰

Fortunately, depression can be treated, starting by making an appointment with your primary care physician and asking for a referral to a mental health clinician or a psychiatrist. Having an open conversation with your doctor will help them refer you to the appropriate mental health professional.

If you do not have a primary health care provider or you do not feel comfortable visiting with one, a few other places you can go to get help for depression include:

• Community clinics.
• Church resource centers.
• Inpatient treatment centers.
• Outpatient treatment centers.
• Support groups.
• Counselors or social workers.
• Family service agencies.
• Social services.

During your visit with your doctor, they may check to see if you have other health conditions that need to be addressed. For example, a thyroid disease can lead to depression or worsen symptoms.

Getting the help you need will improve not only your life, but those closest around you. Don’t be afraid to reach out to your family, friends, neighbors, community, or religious leaders for support as you begin working through your depression. It can be scary and overwhelming to admit you have a mental health problem, but it is an important and necessary step to healing.