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How do antidepressants work?

Occasional sadness is normal, but persistent or overwhelming depression is not. Treatments are available, and if you experience depression, your doctor can help find what works for you.

Each year, about 1 in 5 adults in the U.S. deal with a mental illness, according to the National Alliance on Mental Illness. Many people managing depression benefit from counseling or lifestyle changes, says Jocelyn Joseph, M.D., a Piedmont family medicine physician.

Another option is medication, which can alleviate depression and anxiety that may not respond to other treatments.

Who can benefit from antidepressants?

Antidepressants aren’t right for everyone, Dr. Joseph says, but they can work well alongside other therapies. She recommends patients try more conservative treatments first, however.

“I always put therapy before the medication if it’s mild,” she says. When depression is more severe, she may prescribe antidepressants.

Some patients worry medicine might dull their personalities, but Dr. Joseph says fear is unfounded.

“A lot of patients say they don’t want to feel different or feel ‘zonked out,’” she says. But this assumption is “not true.”

How antidepressants affect the brain

There are many antidepressants on the market, but some of the most commonly prescribed kinds are selective serotonin reuptake inhibitors (SSRIs), Dr. Joseph says.

These medications, which include Prozac, Zoloft and Lexapro, work by boosting serotonin levels in the brain. Additionally, Dr. Joseph says SSRIs can effectively treat anxiety disorders.

Other antidepressants work in different ways. Serotonin and norepinephrine reuptake inhibitors (SNRIs) include drugs like Cymbalta, which can treat both depression and chronic pain.

Antidepressants can cause mild side effects, including gastrointestinal problems. These should level out after the first few weeks of a new regimen.

“We always say give it at least six to eight weeks,” Dr. Joseph says. If your side effects persist, tell your doctor.

Sometimes, medication can worsen depression. If you ever think about hurting yourself or experience suicidal ideation, let someone know as soon as possible.

Strategies to manage depression

Even if your doctor recommends antidepressants, you can still benefit from nonmedicinal interventions as well, says Dr. Joseph. These may include:

She says the key is to give yourself space to grow and change. Don’t try to do everything at once, or you may become overwhelmed.

“We try to take it one step at a time,” she says.

If your doctor prescribes medication as part of your treatment plan, use it as prescribed. Quitting antidepressants cold-turkey can cause severe withdrawal symptoms, Dr. Joseph says, especially if you are using SNRIs.

Fighting stigmas about depression

Dr. Joseph credits her husband, a psychiatrist affiliated with Morehouse College and the state prison system, for encouraging her interest in mental health. She says it’s important to recognize that depression and anxiety are health disorders, not secrets to feel ashamed of.

When she meets patients worrying about discussing their symptoms, she encourages them to feel proud for speaking up.

“I tell patients that not many people talk about it, and the fact that they come in the office and talk about it is a huge step,” she says.

When she prescribes antidepressants, she asks patients to follow up with her every six weeks or so to see how things are going. She also urges her patients to work with a therapist or counselor they feel safe confiding in.

“I believe in therapy and medication do go hand in hand,” she says. “It’s always good to talk to someone you’re comfortable with.”

If you are thinking about suicide, please call the National Suicide Prevention Lifeline at 988.


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