Antidepressants are psychiatric medications that work by increasing levels of a group of chemicals in the brain called neurotransmitters (primarily serotonin, norepinephrine, and dopamine) which are involved in regulating mood.

When it comes to treating mental health conditions, consumers have a multitude of options available to help them deal with these debilitating disorders. While most experts agree that psychotherapy is critical in developing long-term coping mechanisms for managing conditions such as depression and anxiety, they also point to the use of antidepressants as an effective way to reduce the severity of the symptoms resulting from these disorders.

Antidepressant Use in the U.S.

increase in antidepressant use from 1999 – 2014CDC

Antidepressants form one of the three most commonly used therapeutic drug classes in the United States. Furthermore, the use of antidepressants in America has been on the rise in recent years according to a report from the Center for Disease Control (CDC).

Data from the National Health and Nutrition Examination Study also found that from 2011 – 2014, about one in eight Americans aged 12 and over reported taking antidepressants in the previous month. This reflects an increase of nearly 65% over a 15-year time frame, from 7.7% in 1999 – 2002 to 12.7% in 2011 – 2014.

What to Consider Before Taking an Antidepressant

Taking an antidepressant comes with certain risks. And while each individual drug has its own warning label, there are a few common factors to consider before adding an antidepressant to your treatment plan.

Communicate with your healthcare team. If your doctor prescribes an antidepressant, make sure they know about any other medications or supplements you are taking. Before leaving the office, take the time to ask questions about how to take the medication and what you should do if you experience any adverse side effects.

Dual Treatment: Medication alone may not be enough to manage a mood or anxiety disorder. Experts have found that a combination of an antidepressant medication and psychotherapy (“talk therapy”) has been more successful in treating patients than treatment with antidepressant medication alone.

Medication alone may not be enough to manage a mood or anxiety disorder.

Common Side Effects: Side effects such as nausea, insomnia, decreased sex drive, dizziness, weight gain, headaches, sweating, fatigue, constipation, anxiety, and diarrhea. Not all side effects are experienced with each of the antidepressants (or by each individual). That’s why it’s important to talk with your doctor ahead of time about side effects you are trying to avoid. This information can help in determining the best drug for you.

Suicide Risk: The FDA asked manufacturers to add a boxed warning to the labeling of all antidepressant medications about suicide that says: “Antidepressants increase the risk compared to placebo of suicidal thinking and behavior (suicidality), in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.” The complete warning can be found here. The FDA has also published a consumer guide on antidepressants and suicide risk.

Discontinuation: Discontinuing the use of antidepressants needs to be monitored by your doctor. Stopping the use of an antidepressant should be done under the supervision of your physician. Many people can experience severe withdrawal symptoms including anxiety, mood swings, irritability, insomnia, fatigue, nausea and vomiting, and more. It is recommended that you reduce your dose gradually to help minimize the negative withdrawal symptoms.

How Antidepressants Work

When it comes to improving symptoms for the short and long-term, the research says that all antidepressants all work by affecting the levels of certain chemicals in the brain that affect your mood. more specifically, antidepressants prevent (inhibit) the absorption or reabsorption of one or more mood-affecting chemicals produced in the brain. These chemicals include:

Serotonin: While serotonin is found all throughout the body, one of the effects of this neurotransmitter is to alter mood and modulate states of mind like anger, sleep, appetite, and body temperature. The precursor of serotonin is tryptophan, which is found in many high-protein foods (e.g., meats, dairy, nuts and beans) and may contribute to the reason people feel good after eating.

Norepinephrine (noradrenaline): This neurotransmitter (also sometimes referred to as a hormone) is used by the body for “fight or flight” responses. Normally, it fluctuates throughout the day, with the lowest levels of norepinephrine occurring during sleep and higher levels being released while active. In times of high stress or danger, large amounts of norepinephrine are released into the body, increasing overall alertness and anxiety levels. It also produces related physical responses, such as increased heart rate and blood pressure.

Dopamine: As moderator of our pleasure and reward centers of the brain, dopamine sometimes gets a bad reputation. In its most primitive state, it acts as a motivator to make us want to perform certain activities, including everything from exercise to sex. However, it can be manipulated by the foods we eat and the drugs we take, which can lead to unhealthy behaviors and possibly even addiction.

Antidepressants are generally categorized by which of these neurotransmitters they affect. Because everybody produces different levels of these chemicals in their body, doctors may need to try out different medications and dosages based on the severity of the symptoms to determine the correct prescription. It also can take up to six weeks for antidepressants to affect production of these chemicals before they begin working.

Types of Antidepressants

Antidepressants are generally categorized by how they work in the body. While all antidepressants affect the levels of certain chemicals in your brain some antidepressants, known as inhibitors, work by preventing certain chemicals from being absorbed by normal brain processes while others affect the levels of chemicals within the brain.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs work by increasing the level of serotonin in the brain. They are considered the most popular type of antidepressants because they do not cause as many side effects as older classes of antidepressants, and they seem to help a broader group of depressive and anxiety disorders.

List of SSRIs

  • Celexa (citalopram)
  • Cipralex and Lexapro (escitalopram)
  • Luvox (fluvoxamine)
  • Paxil and Seroxat (paroxetine)
  • Prozac (fluoxetine)
  • Zoloft and Lustral (sertraline)

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

SSNRIs work by increasing the levels of serotonin and norepinephrine that are active in the brain. Like SSRIs, this group is also used more frequently because they cause fewer side effects and help treat a broader group of disorders.

List of SNRIs

  • Cymbalta (duloxetine)
  • Effexor (venlafaxine)
  • Fetzima (levomilnacipran)
  • Ixel and Savella (milnacipran)
  • Pristiq (desvenlafaxine)

Tricyclic Antidepressants (TCAs)

TCAs are one of the oldest types of antidepressants which affect serotonin, norepinephrine, and dopamine. They are not used as often due to increased side effects.

List of TCAs

  • Adapin and Sinequan (doxepin)
  • Agedal, Elronon and Nogedal (noxiptiline)
  • Amioxid, Ambivalon and Equilibrin (amitriptylinoxide)
  • Anafranil (clomipramine)
  • Aventyl and Pamelor (nortriptyline)
  • Azafen/Azaphen (pipofezine)
  • Dixeran, Melixeran, Trausabun (melitracen)
  • Elavil and Endep (amitriptyline)
  • Insidon (opipramol)
  • Istonil (dimetacrine)
  • Lomont (lofepramine)
  • Norpramin and Pertofrane (desipramine)
  • Noveril and Victoril (dibenzepin)
  • Prothiaden (dosulepin)
  • Sintamil (nitroxazepine)
  • Tofranil (imipramine)
  • Surmontil (trimipramine)
  • Vivactil (protriptyline)

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs are a “last resort” medication that affects an enzyme in your brain called monamine. Side effects can be severe. Examples of MAOIs include Nardil (phenelzine) and Parnate (tranylcypromine).

List of MAOIs

  • Marplan (isocarboxazid)
  • Nardil (phenelzine)
  • Parnate (tranylcypromine)

Atypical Antidepressants: There are several antidepressants that do not fall into any of the other drug classes. Because of this, they are often referred to as “atypical” antidepressants.

  • Buproprion
  • Mirtazapine
  • Nefadar and Serzone (nefazodone)
  • Desyrel (trazodone)
  • Trintellix (vortioxetine)

Antidepressant Safety Regulations

The U.S. Food and Drug Administration (FDA) approves product labeling for all prescription drugs, including antidepressants. Their website also lists the latest warnings, patient medication guides, newly approved medications, and a list of antidepressant drugs (by name).

While antidepressants are approved by the FDA for the treatment of mood and anxiety disorders, some antidepressants are also prescribed for other “off-label” disorders and conditions. Since the approval of drugs used for certain conditions changes frequently, it is best to check the FDA website for further information.

If you experience serious side effects while taking an antidepressant, first, inform your doctor, and then report the information online to the FDA MedWatch Adverse Event Reporting program or by calling 1-800-332-1088.