Antidepressant Medications – When the Blues Turn to Black

Sometimes you feel “off” or lackluster for so long that it becomes the new normal. Low level depression, or dysthymia, can be like that: you stop noticing until someone – a friend, doctor, or therapist – points out that life doesn’t have to be like that. Maybe medication is suggested. But realistically, what can you expect from antidepressant medication? Will you suddenly feel happy? Will you still be able to cry or get upset? Will you still feel like yourself? It is normal to wonder about medications that seem to change your personality or your emotions. How do they work and what should they do, and perhaps most importantly of all, what side effects should you be on the lookout for? Antidepressants: What Are They and What Do They Do? Antidepressant medications fall into several categories or groups, some of them very commonly prescribed and some now only prescribed in rare or unusual incidences. The newest, most commonly prescribed, and touting the fewest side effects are the serotonin-specific reuptake inhibitors (SSRIs). These medications prevent serotonin, a naturally occurring chemical found in the brain, from being “sucked up” into receptors and help keep serotonin circulating. This, it has been theorized, helps to lift and stabilize mood. These medications are known by their trade names: Prozac, Zoloft, Paxil, and several others. While these medications are known for being well tolerated, some side effects including decreased libido and headaches or stomach distress, are fairly common. An older and less commonly prescribed class of antidepressant medications worked very well: these were known as tri-cyclics. They fell out of favor due to their uncomfortable side effects (including dry mouth, constipation, changes in blood pressure and changes in blood sugar levels), and the availability of the newer SSRIs. Finally the monoamine oxidase inhibitors (MAOIs) were among the earliest medical treatments for depression. These medications also were effective but also carried high risks due to dangerous reactions with a variety of foods and other substances. What Can You Expect if You Have Been Advised to Take Antidepressants? What should you expect when you start to take antidepressant medication? Initially, you might feel only the side effects. All the types mentioned above may cause some stomach upset, nausea, or even vomiting initially. Sometimes this goes away and no more side effects are likely to occur. Sometimes it is necessary to discontinue use of the medication. Be sure to discuss any side effects you experience with your doctor. Ok, aside from the side effects, what might you expect? In most cases, the medications need to build up in your body, reaching a therapeutic level after several days or weeks. SSRIs commonly take 4-6 weeks to become effective. At that point, what can you expect? Antidepressant medications don’t make you happy. You won’t suddenly feel light and happy, but the complete sense of doom and gloom will lift. It should become easier to let things go, to shrug off little annoyances or disappointments. You might feel like you have a longer fuse, or that you can just “not sweat the small stuff” more easily. Depressive symptoms often include trouble sleeping (both too much and too little sleep are symptoms of depression) and irritability. Once your medication is working, you should notice that your sleep improves or at least becomes somewhat more normal. Appetite changes are also common with depression and these too should improve. Irritability and anxiety (also commonly associated with depression) may ease, further helping you to feel better without exactly making you happy. Most people describe the medications as “lifting the dark cloud” or “taking the knot out of my stomach.” According to some research, only about 30% of people who start an antidepressant medication find relief from that medication. It is very likely that your doctor will need to try different dosages and/or different medications to find the one that works best for you. Try to be a patient, patient! Be sure to give your doctor a complete medical history, being careful to include any information about any close family members that have taken antidepressant medications. Sometimes this information can be a real time saver, as what works well for one family member is often an indicator of what will work well for others. Also bear in mind that medications seem to be most effective for severe depression. When the depression is in the mild to moderate range, psychotherapy and lifestyle changes may be as effective or more so than medications – without the risk of side effects. Discuss your options with your doctor and be sure to ask about non-drug interventions. Recent research has begun to question the serotonin connection. Some researchers have shown that depression and serotonin levels are not as closely linked as may have originally been thought. Further, some research has shown that low serotonin levels are not necessarily linked to depression, and that depression can exist in people with normal or high serotonin levels. While it isn’t time to throw the baby out with the bath water yet, as some relationship between serotonin and depression may well exist, what has become increasingly clear is that the once relied upon explanation of depression as simply low serotonin levels is insufficient to fully explain both what depression is and how the medications help.

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