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Is Your Antidepressant Working?

How Antidepressants Work

Most antidepressants work by changing the balance of brain chemicals called neurotransmitters. In people with depression, these chemicals are not used properly by the brain. Antidepressants make the chemicals more available to brain cells like the one shown on the right side of this slide.

Antidepressants can be prescribed by any doctor, but people with severe symptoms are usually referred to a psychiatrist.

Realistic Expectations

In general, antidepressants work well, especially when used along with psychotherapy. (The combination has proven to be the most effective treatment for depression.) Most people on antidepressants report eventual improvements in symptoms such as sadness, loss of interest, and hopelessness.

But these drugs do not work right away. It may take 1 to 3 weeks before you start to feel better and even longer before you feel the full benefit. It's not common, but some people don't improve with antidepressants and need to try other treatments with their doctor.

Do You Need to Switch?

If your symptoms don't improve after 4 to 6 weeks, tell your doctor. Your may need a higher dose or a different medicine. 

Some people do not respond to the first antidepressant they try. Most of those people do respond to a different medicine. Remember, it can take up to 3 months to feel the full benefit of an antidepressant.

Also, antidepressants may stop working in a small number of people who have been taking them for a while.

 

Brand Name vs. Generic

According to the FDA, there is no difference in the strength, safety, or quality of generic vs. brand-name drugs.

But some studies suggest there may be variations in how well generics are absorbed and used by the body. If you switched to a generic and it doesn't seem to be working, tell your doctor.

Antidepressant Success

A successful course of treatment usually lasts several months to a year. Don't quit, even if you feel better sooner. If you do, it's likely your depression will come back.

Your doctor can help you develop a convenient routine for staying on your medication -- for example, taking your pills with breakfast every day.

Coping With Side Effects

Don't be shy in telling your doctor about side effects. There are often ways to manage them. For example, taking your antidepressant with food can help nausea. If you're having sexual problems, changing antidepressants may help.

If you feel fatigued, try taking your medicine 1 to 2 hours before bedtime. If the antidepressant causes insomnia, take it in the morning. Many side effects diminish on their own after a few weeks.

Drug Interactions

Antidepressants used most often today have fewer side effects and drug interactions than older versions. Still, any antidepressant can interact with other medications, and even with herbal or dietary supplements. Drug interactions can lead to more severe side effects and reduce how well your medicine works. 

Let your doctor know about any new prescription drug, over-the-counter medicine, or dietary supplement you plan to take.

Follow-Up Care

It is vital to continue follow-up care while you are on antidepressants.

Relapses are common. Your doctor may advise changing the dose -- or trying a new medication -- if your symptoms return.

Be sure to tell your doctor of major changes in your life, such as losing a job, developing another medical condition, or becoming pregnant.

Antidepressant Myths

Some people worry that antidepressants will leave them robotic. The fact is, antidepressants relieve feelings of sadness, but they do not eliminate your emotions.

Another myth is that you'll need to take the drugs for life. A typical course of antidepressants lasts 6 to 12 months. Antidepressants are not physically addictive but should not be stopped abruptly.

Benefits of Psychotherapy

Getting psychotherapy while you take antidepressants is the most effective way to treat depression, studies show.

Types of therapy include cognitive behavioral therapy, which focuses on changing negative thoughts and behaviors, and interpersonal therapy, which focuses on your relationships with others.

Depression and Exercise

Exercise releases endorphins, chemicals linked to improved mood and lower rates of depression.

Several studies suggest regular exercise, without medicine, is an effective treatment for mild depression. Exercise can also help your medicine work better. Group sessions or exercising with a partner may be particularly helpful.

Coming Off Your Antidepressant

Your doctor will help you determine the right time to stop your antidepressants. Quitting abruptly can cause unwanted side effects or even a relapse.

With many antidepressants, it's best to gradually reduce your dose according to your doctor's guidance.

The Truth About Antidepressants

Reviewed by Michael W. Smith, MD on March 12, 2014

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Additional Resources

Working Out Your Depression

Exercise is an effective but underused treatment for mild to moderate depression. Exercise releases endorphins, which trigger a positive feeling. Try to exercise at least 20 to 30 minutes, three times a week.

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