Do I Need Antidepressants?

If you’ve been diagnosed with depression, anxiety or another mental health condition, you may hear the word “antidepressants” come up when you’re talking about treatment options with your provider.

Antidepressants are medications that are believed to work by altering the levels of certain natural chemicals throughout your brain and body. The effects of antidepressants can make handling the symptoms of major depressive disorder (MDD) and many anxiety disorders easier. 

If you’ve ever heard about antidepressants on TV, in news articles or in YouTube videos, there’s a good chance you may have questions about them.

One of these questions could be whether you need antidepressants in order to treat depression, anxiety or other forms of mental illness. 

Antidepressants are controversial, but they help millions of people every year affected by clinical depression, anxiety disorders and other issues. They’re also backed up by real science showing significant improvements in many aspects of well-being and daily life.

Below, we’ve explained what antidepressants are, as well as why your healthcare provider may recommend using an antidepressant as part of treatment for depression, anxiety, post-traumatic stress disorder (PTSD) or a related condition.

We’ve also discussed how it may take time to find the right antidepressant for you, including the need to try multiple medications before finding one that treats your specific symptoms.

Antidepressants are, simply put, prescription medications that are used to treat depression. You may be prescribed an antidepressant if you have major depressive disorder, or if you suffer from another form of depression.

In addition to MDD, common types of depression treated with antidepressant drugs include:

• Persistent depressive disorder (dysthymia)

• Premenstrual dysphoric disorder (PMDD)

• Depression caused by other illnesses

In addition to the treatment of depression, antidepressants are also used to treat other mental and physical health issues. Common non-depression uses for antidepressants include:

• Treating certain forms of anxiety, such as generalized anxiety disorder (GAD)

• Managing the symptoms of post-traumatic stress disorder

• Improving sleep in people with disorders such as insomnia

• Managing chronic pain, including pain that develops after injuries

• Treating hot flashes and other menopause symptoms

Some of these uses are “off-label,” meaning a medication is prescribed to treat a condition other than its FDA-approved indication.

There are several different types of antidepressants. Currently, all popular antidepressants work by altering the levels of certain chemical messengers, called neurotransmitters, in your brain and throughout your body.

Common neurotransmitters targeted by antidepressants include serotonin and norepinephrine, which have been linked to depression symptoms such as changes in mood and stress. 

Experts believe that by altering the levels of these chemicals, antidepressants can improve your moods and make dealing with the symptoms of depression, anxiety, PTSD and other conditions an easier process. 

The most common antidepressants are selective serotonin reuptake inhibitors, or SSRIs. These medications work by increasing levels of serotonin.

SSRIs are modern medications, and they’re less likely to cause adverse effects than older drugs used to treat depression. Because of this, they’re typically used as the “first-line” form of therapy for managing depressive symptoms.

As such, if you have depression, it’s likely that your mental health provider will suggest using an SSRI before other types of antidepressants.

SSRIs work well for most people with depression, but they’re not the only type of antidepressant on the market. Other antidepressants include:

• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Monoamine oxidase inhibitors (MAOIs)

• Tricyclic antidepressants (TCAs)

• Atypical antidepressants

As we’ve discussed in more detail in our guide to depression symptoms and causes, there isn’t a one-size-fits-all experience of depression for everyone, nor is there an easy biological “box” to tick in order to treat depression successfully.

Because of this, there’s no best antidepressant for everyone. If you have depression and use an antidepressant as part of your treatment plan, you may need to try several medications in order to find the one that best suits you — a topic we’ve discussed more in depth further down the page. 

If you’ve ever read about antidepressants, watched TV coverage of mental health issues or just spent time browsing most websites, you may have come across suggestions that depression is best treated “the natural way,” or that antidepressants simply don’t work.

The reality is that antidepressants do work, particularly for depression, but they aren’t an on/off switch that you can take and immediately start feeling better.

In a Cochrane review published in 2009, researchers compared SSRIs and TCAs — two of the most common types of antidepressants — to placebo treatments in adults used in a day-to-day primary care setting.

The review, which used data from 14 separate placebo-controlled studies involving upwards of 2,000 people, found that adults with depression who used either an SSRI or a TCA were more likely to show improvements in depression symptoms than those who used a placebo.

In other words, both types of antidepressants were effective at treating depression in a primary care setting.

Other research has produced similar findings. For example, research suggests that out of every 100 people with depression, approximately 20 to 40 will experience improvements without using an SSRI or other antidepressant.

In comparison, about 40 to 60 out of every 100 people with depression who use antidepressants experience improvements.

Interestingly, research also shows that people with severe depression typically benefit the most from using antidepressants, and that antidepressants reduce the risk of relapse of depression — a situation in which your symptoms come back after treatment.

Put simply, antidepressants aren’t magic pills, but they do work well for most people. If you have depression, taking an antidepressant will likely reduce the severity of your symptoms, assist you in making progress toward feeling better and increase your chances of recovering. 

One important thing to be aware of about antidepressants is that they usually don’t start working right away. 

Most antidepressants require four to eight weeks of treatment before you’ll be able to notice any improvements in your depression-related symptoms, and they might improve your sleep, mental focus and appetite before you experience an improvement in your moods.

This means that it’s important to be patient if you’re prescribed an antidepressant and don’t feel better even after using it for several weeks. 

It’s also important to keep in mind that antidepressants can produce side effects, including some that may be bothersome or annoying.

Most modern SSRIs have the fewest side effects of any antidepressants, and it’s rare for severe side effects to occur during antidepressant treatment. 

However, there are some side effects that you should be aware of, including sexual side effects and minor side effects that may affect your quality of life. We’ve covered these in more detail in our full guide to the common side effects of SSRIs. It is important for you and your healthcare provider to discuss when and how to discontinue your medication as well as if you should go back on antidepressants or if another treatment plan is better for you.

If you’re concerned that you might be affected by major depression, it’s important to talk with a mental healthcare provider as soon as you can.

You can do this by talking to your primary care provider about a mental health referral or using our online psychiatry service to connect with a licensed provider from your home. 

It’s important to seek help even if you only have mild depression, as the earlier you get started with treatment, the more effective it typically is.

If you’re not sure if you have depression or not, you can learn about common symptoms in our guide to the signs of depression in women. 

Antidepressants aren’t the only form of treatment for depression, and talking with a psychiatrist doesn’t mean that you’ll simply be prescribed medication without any need to make changes to your daily activities and normal life.

Based on the severity of your symptoms, your mental health provider will weigh the benefits of antidepressants against the potential cons of antidepressants, then advise whether or not you should take medication. 

If you have moderate depression or severe depression, your mental health provider will usually suggest using medication to make recovery easier. 

Antidepressants and Therapy

Your mental health provider may also suggest certain alternative treatments that you can use at the same time as you take an antidepressant, such as therapy for depression. 

Therapy can be extremely helpful if you have depression, anxiety or a related condition. In fact, research shows that a combined treatment approach involving antidepressants and supportive psychotherapy is more effective than just using an antidepressant on its own. 

Several forms of psychotherapy are effective at treating depression, including cognitive therapy and cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT) and others. 

Your mental health provider will work with you to find a form of therapy that helps you, either on its own or in combination with an antidepressant. 

Antidepressants and Lifestyle Changes

In addition to using an antidepressant, your healthcare provider might recommend changes that you can make to your habits and lifestyle to reduce the severity of your symptoms and help you to recover from depression.

These might include increasing your physical activity level, prioritizing healthy foods as a part of your diet, talking about your feelings of depression with a close friend or loved one, or making a proactive effort to get out and connect with other people.

They may also recommend taking a break from making any major decisions until you’re feeling better.

Combined with medication and/or therapy, making changes to your lifestyle may enhance your moods and assist with your recovery from depression. Our guide to living with depression goes into more detail about lifestyle changes that you can make for better mental health. 

As we talked about earlier, antidepressants require time to start working, and there’s no single antidepressant that works best for everyone.

Most people with depression are prescribed SSRIs due to their lower risk of side effects when compared to other, older antidepressants.

However, if you’re prescribed an SSRI and don’t notice any improvements after eight weeks, it’s best to let your mental health provider know.

Different antidepressant medications work in slightly different ways. Some people with a history of depression find that they need to try several medications before finding one that “clicks” with them and provides relief from their symptoms without bothersome side effects.

This could mean switching from one SSRI to another, changing from an SSRI to a different type of antidepressant if your symptoms don’t improve, or taking additional medication if you get bad side effects during treatment. 

Getting depression under control is a process, and a big part of this process isn’t just starting an antidepressant, but identifying the right mix of medication, psychotherapy and healthy habits for your unique needs.

Antidepressants can reduce the severity of your depression symptoms, improve your chance of recovering successfully and make managing your daily routine easier. 

Finding the right antidepressant for your needs can often be a process, but the end result of this process is typically a happier life and a lower risk of relapse after treatment.

However, it’s ultimately your choice whether or not you decide to take an antidepressant. You’re in charge of making your healthcare decisions, and you and your mental health professional will work together to help you make progress regardless of whether you use medication or not.

Depression isn’t a choice, and using medication doesn’t make you weak or dependent on drugs to be “normal.” Taking an antidepressant is a common, everyday thing for millions of adults with depression. 

If you’d like to find out more about making informed health decisions about depression, you can learn what to do in our guide to dealing with depression.

You can also get help for depression, anxiety disorders and other common conditions using our mental health services, including psychiatry, online therapy and anonymous support groups.