How to manage your antidepressants

Antidepressant medication use has increased from 10.6% to almost 14%. According to the Centers for Disease Control and Prevention (CDC), the most current data shows that antidepressant medication use is higher among women (17.7%) compared to men (8.4%). In addition, the percentage of use increases with age, from almost 8% among adults ages 18–39 to 14.4% in those ages 40–59 and 19% in those age 60 and over.

In milder cases of depression, psychotherapy (such as talk therapy and cognitive behavioral therapy) may be considered first, but if a person is experiencing more severe forms of depression, medication may be added as part of their treatment plan. The medication selected by a licensed healthcare professional is based on the person’s individual situation and their response to treatment. Antidepressants usually take about four to eight weeks to work, so it is important to give yourself time to start feeling the beneficial effects of the medication. Below is a review on how to take antidepressant medication and manage the expected—and sometimes unexpected—side effects.

When someone's depression treatment includes taking an antidepressant medication, the most important thing is finding the one that is the best fit for you, as there are different types of antidepressants available. Antidepressants aren't a cure for depression; rather, they are a tool healthcare professionals recommend to help reduce symptoms of depression, and special care must be taken to get the right prescription.

When prescribing an antidepressant medication for you, your healthcare provider may consider several factors, including:

• Your specific depression symptoms
• The medication’s possible side effects
• Whether the medication worked for a close relative
• Whether the medication is safe for pregnant or breastfeeding women
• How the antidepressant medication works when taken with other medicine

Different types (classes) of antidepressants include:

Selective serotonin reuptake inhibitors (SSRIs)  SSRIs are a common starting point for people initiating antidepressant medication treatment for the first time. This type of antidepressant typically has fewer side effects, and when higher doses are needed is generally considered a safer option than others. Common side effects include nausea, diarrhea, dizziness, headaches and insomnia.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)  SNRIs are commonly prescribed, and people who take them may experience headaches, dry mouth, nausea, dizziness, constipation and sweating.

Norepinephrine and dopamine reuptake inhibitors (NDRIs)  NDRIs treat depression as well as seasonal affective disorder. This type of antidepressant is not likely to involve sexual side effects. The more common side effects are similar to those of SSRIs and SNRIs.

Tricyclic antidepressants  These medicines are usually only prescribed when an SSRI is not successful and generally are accompanied by more side effects, including blurred vision, bladder problems and increased heart rate.

Monoamine oxidase inhibitors (MAOIs)  MAOIs generally have the most side effects and safety guidelines. Special care must be taken when prescribed this type of antidepressant, as certain foods (such as certain cheeses and pickles), drinks (such as wines) and other medications (such as pain medications and decongestants) could be very dangerous or even fatal while taking an MAOI.

Atypical antidepressants  There are several medications that, despite being antidepressants, don't quite fit in any of these other categories. Talk to your doctor about what category your antidepressant fits in, if any.

Once you and your healthcare provider have determined a treatment plan and medication, it's important to adhere to the dosage and the schedule, even if you don't feel a change in your mood and other symptoms of depression. As indicated above, it takes a while for antidepressants to take effect. If you don't feel better after three weeks, talk with your provider, but remember to be patient with yourself. You may need a different medication, a different dosage or a different treatment, and your healthcare provider will help you explore different options.

Many people express concerns about becoming addicted to antidepressants. These medications aren't tranquilizers. You will not get high from them, and you can't become addicted to them, although some antidepressants may cause withdrawal-like symptoms or worsen depression symptoms unless you slowly taper off your dose.

Some people experience side effects with antidepressants. These often resolve within a few weeks once your body gets used to the medication. If the side effects persist, talk with your provider or your pharmacist.

Some strategies to deal with the most common side effects include:

• Nausea. To help with the nausea, take the antidepressant with a small meal, unless the medication's instructions include taking it on an empty stomach. Eat smaller, more frequent meals throughout the day, and drink plenty of fluids.
• Weight gain. People on antidepressants may gain weight because of fluid retention, lack of activity or increased appetite once the depression symptoms improve. Keep a food diary and track what you eat. Exercise regularly, eat lower-calorie foods and avoid saturated fats and sugar.
• Fatigue or drowsiness. Fatigue and drowsiness are common, especially when just beginning antidepressant treatment. Avoid driving or operating dangerous machinery when taking these medications. Consider regular activity, such as walking, and take your antidepressant medication at bedtime unless otherwise directed by your healthcare provider.
• Insomnia or restlessness. Some people experience an energy boost after taking an antidepressant, making it difficult to relax and fall asleep or stay asleep. If this happens, avoid caffeine, especially late in the day. If allowed by your healthcare provider, take your medication in the morning. Getting regular exercise several hours before bedtime may also help.
• Changes in sexual drive. Sexual side effects can include decreased sex drive or difficulty achieving pleasure. Talk with your provider about a medication that requires one dose per day, and schedule sexual activity before taking that dose. Other options include switching to antidepressant medications that may have fewer of these effects. Do not alter your antidepressant dosage or medication schedule or add additional medication without first discussing it with your provider.

Discuss persistent side effects with your healthcare provider or pharmacist to find solutions that work for you. Do not adjust taking the medication from how it is prescribed without talking to your provider or pharmacist first.

All people taking antidepressants should receive ongoing medical monitoring. Promptly seek medical advice and evaluation if you, your child or another family member is taking antidepressants and experiences suicidal thinking or behavior, nervousness, agitation, irritability, mood instability or sleeplessness that either emerges or worsens during treatment. Some children and adolescents may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially as they begin their medication treatment. If these symptoms occur, their healthcare provider should be contacted immediately, and you may need to get emergency care if a situation like this occurs.

Secure your medications so others can't access them, especially children. If you have concerns about your dosage or others taking your antidepressants, contact your provider immediately.

Once started, treatment with antidepressants should not stop abruptly. If you are ready to stop taking these medications, work with your provider to help you slowly reduce their use over time.

Get information on how to choose a mental health professional, video chat live with a therapist for an introductory consultation today, or visit Mental Health America for a comprehensive list of mental health support organizations and therapists in your area as well as to help you find the care you need.

Clinically reviewed and updated August 2022.