Antidepressants: Overview

If you are suffering from major depression, antidepressant medication may relieve some of your symptoms.  Antidepressants aren't a 'silver bullet' for depression, and they come with their own side-effects and dangers.  Recent studies have also raised questions about their effectiveness.

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Researchers agree that when depression is severe, medication can be helpful – even life saving.  However, research also shows that antidepressants are not effective for many people.


The most widely prescribed antidepressants come from a class of medications known as selective serotonin reuptake inhibitors (SSRIs).

The SSRIs include: Fluoxetine (Prozac), Fluvoxamine (Luvox), Sertraline (Zoloft), Paroxetine (Paxil), Escitalopram (Lexapro), Citalopram (Celexa).

Function; Why it is Recommended

The big question is: Is depression caused by a chemical imbalance in the brain?  TV ads, newspaper articles and doctors tend to say it is.  According to the chemical imbalance theory, low levels of the brain chemical serotonin lead to depression and depression medication works by bringing serotonin levels back to normal.  The truth, however, is that researchers know very little about how antidepressants work.

In fact, there is no test that can measure the amount of serotonin in the living brain – no way to even know what a low or normal level of serotonin is, let alone show that depression medication fixes these levels.

While antidepressant drugs increase serotonin levels in the brain, this does not mean that depression is caused by a serotonin shortage.  In the same way, aspirin may cure a headache but this does not mean that headaches are caused by an aspirin deficiency.

Furthermore, experiments have shown that lowering people's serotonin levels does not always lower mood, nor does it worsen symptoms in those who are already depressed.  And while medications raise serotonin levels within hours, it takes weeks before medication kicks in to relieve depression.  Why is that?

If you have severe depression that is interfering with your ability to function, medication may be right for you.  However, many use medication when therapy, exercise or self-help strategies would work just as well or better, but minus the side-effects.  Therapy can also help you to understand the underlying issues and then develop the tools to beat depression for good.

If you are considering antidepressants as a treatment option, make sure you carefully consider all other options as well.  The following questions may help you to decide:

  • Is my depression severe enough to justify drug treatment?
  • Is medication the best option for treating my depression?
  • Am I willing to accept unwanted side-effects?
  • What non-drug treatments might help my depression?
  • Do I have the time and motivation to pursue other treatments such as therapy and exercise?
  • What self-help strategies might reduce my depression?
  • If I decide to take medication, should I pursue therapy as well?

Questions to ask your doctor:

  • Are there any medical conditions that could be causing my depression?
  • What are the side-effects and risks of the antidepressant you are recommending?
  • Are there any foods or other substances that I will need to avoid?
  • How will this drug interact with any other prescriptions I'm taking?
  • How long will I have to take this medication?
  • Will withdrawing from the drug be difficult?
  • Will depression return after I stop taking medication?

Expected Outcome; Side-Effects

A major government study released in 2006 showed that under 50% of patients become symptom-free on antidepressants, even after trying two different medications.  Other studies show that when it comes to mild or moderate depression, antidepressants are only slightly more effective than placebos.

SSRIs act on the chemical in the brain called serotonin.  Serotonin helps regulate mood, but it also plays a role in digestion, pain, sleep, mental clarity, and other bodily functions.  As a result, the SSRI antidepressants cause a wide range of side-effects ranging from sexual problems and drowsiness to sleep difficulties and nausea.  Common side-effects of SSRI antidepressants include:

While some side-effects go away after the first few weeks of drug treatment, others persist and may even get worse.  In adults over the age of 65, SSRIs pose an additional concern: SSRI medications may increase the risk for falls, fractures and bone loss in older adults.

SSRIs can also cause serious withdrawal symptoms if a person stops taking them abruptly.  It is essential to taper off slowly, allowing 1-2 weeks between each dosage reduction, and do it under a doctor's supervision; if you stop abruptly then you may experience crying spells, extreme restlessness, dizziness, fatigue, and aches and pains.  This is known as Antidepressant Discontinuation Syndrome.  Other withdrawal symptoms include:

  • Anxiety, agitation
  • Depression, mood swings
  • Flu-like symptoms
  • Irritability and aggression
  • Insomnia, nightmares
  • Nausea and vomiting
  • Dizziness and loss of coordination
  • Stomach cramping and pain
  • Electric shock sensations
  • Tremor, muscle spasms

When depression is a withdrawal symptom, it is often worse than the original drug treatment that led to drug treatment in the first place.  Unfortunately many people mistake this withdrawal symptom for the return of their depressive illness and resume medication, creating a vicious circle.

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