Don't expect a "high"
Antidepressants aren't like narcotics or alcohol. They don't make you high, or cause hangovers. Their effectiveness is gradual and the benefits are subtle.
"People who respond to antidepressants find that their sadness is more subject to logic—they can talk themselves out of it," says George I. Papakostas, MD, an assistant professor of psychiatry at Harvard Medical School. "You tend to feel less nervous, and you're better able to control worries. Energy levels go up, and you take pleasure again in your hobbies, friends, and loved ones."
The drugs may also help relieve physical manifestations of your depression—like neck pain or backaches, he says.
"It's not like a Disney movie, where you wake up and the birds are chirping," says Kate Meyers, 47, who lives near Boulder, Colo. She has had success with Zoloft and Effexor XR. "The drugs don't make you happy, they make you even."
She says that people tease her about her "happy pills," but she describes them differently: "I feel calm and relief on the drugs. Bad news and difficulties don't incapacitate me when I'm on medication."
What about side effects?
Roughly 20% to 30% of people experience side effects serious enough to make them stop taking the medication. Minor side effects such as headache, nausea, diarrhea, dizziness, sweating, tremor, and dry mouth usually ease or go away within a few days or weeks.
More serious or annoying side effects include nervousness and agitation, panic, insomnia, daytime drowsiness, loss of libido or other sexual problems, and weight gain. In very rare cases patients may experience an increase in suicidal thoughts.
Sometimes such side effects can be serious enough that you should ask your doctor to adjust or switch your medication.
"I ask my patients to come in for a visit within one to two weeks after I prescribe an antidepressant, to make adjustments, if necessary," says Dr. Papakostas. Sometimes lowering the dosage can eliminate side effects.
Psychiatrists usually recommend avoiding alcohol if you are depressed and/or taking an antidepressant because alcohol is itself a depressant.
And since most of the drugs are equally effective, if you dislike the side effects of the one you're taking, you can usually switch. "I took Lexapro, but I got so jumpy that I stopped taking it," says Meyers.
Zoloft provided her with the calm and relief she was looking for: "I felt like I was coming to peace with myself, and I was better able to use humor to diffuse bad feelings."
Later, when she felt a need to go back on the drugs, she tried Effexor XR, which worked just as well. "There doesn't seem to be any rhyme or reason to it," she says. "When they work, the drugs function so that you're not fighting yourself."
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