Depression: Should I take an antidepressant?

The symptoms of depression include a loss of interest in daily activities or feeling sad or hopeless and having at least four of the following symptoms:

• A change in eating patterns that causes either weight gain or weight loss
• Sleeping too much or not enough
• Feeling restless and unable to sit still, or feeling that moving takes a great effort
• Feeling tired all the time
• Feeling unworthy or guilty without an obvious reason
• Having problems concentrating, remembering, or making decisions
• Thinking often about death or suicide

Antidepressants are medicines for treating depression. They work by helping to balance certain chemicals in your brain. They can make your symptoms better or get rid of them completely.

There are several kinds of antidepressants. There is no evidence that one works better than another. But the side effects are different.¹

Antidepressants don't change your personality. They help your symptoms.

You don't need to be ashamed about taking antidepressants. Depression is a health problem, not a character flaw or weakness.

Most people are able to find an antidepressant that helps their depression. But you may have to try a few before you find one that works for you. The right medicine is one that helps your symptoms and has the fewest side effects.

You may start to feel better within 1 to 3 weeks after you start taking an antidepressant. But you may need to take it for as long as 6 to 8 weeks to see more improvement.

It's best to keep taking your medicine for at least 6 months after you feel better. If this is not the first time you have been depressed, your doctor may want you to take these medicines even longer.

The thought of needing to take medicine for a long time can be scary. But many people are able to slowly stop taking antidepressants after a while.

Antidepressants can change how you feel and respond in certain situations, but they don't change who you are. You may feel more relaxed, more social, more assertive, or more outgoing when you are taking an antidepressant.

Most antidepressants cause minor side effects that go away or improve in the first few weeks of treatment. If you keep taking your medicine, there is a good chance that you will start to feel less depressed and that the side effects will decrease. Most people feel that the benefits of antidepressants are well worth the price of living with some side effects.

Side effects may vary depending on the medicine you take, but common ones include:

• Nausea.
• Dry mouth.
• Loss of appetite.
• Diarrhea or constipation.
• Sexual problems (loss of desire, erection problems).
• Headaches.
• Trouble falling asleep, or waking a lot during the night.
• Weight gain.
• Feeling nervous or on edge.
• Feeling drowsy in the daytime.

Some side effects may not go away, but usually there are ways to manage them. See:

Depression: Dealing with medicine side effects.

Problems with sexual arousal and a lack of interest in sex are common side effects. If this happens to you, talk to your doctor. There are other medicines that may help with these problems.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.

Counseling

Counseling is an important part of the treatment for depression. The types of counseling most often used for treatment of depression include:

• Cognitive-behavioral therapy, which teaches you how to become healthier by changing certain thought and behavior patterns.
• Interpersonal therapy, which focuses on your relationships and the problems they may be causing.
• Problem-solving therapy, which focuses on the problems you are facing and on helping you find solutions.
• Family therapy, which involves the entire family.

Lifestyle changes

There are also lifestyle changes you may be able to make that may help your depression symptoms:

• Eat a healthy diet.
• Don't drink alcohol.
• Get regular exercise.
• Get a good night's sleep.
• Get social support from family and friends.
• Try to keep a positive attitude—remember that feeling better takes time, and your mood will improve little by little. You also can use some cognitive-behavioral therapy methods on your own. For more information, see:

  Depression: Using positive thinking.

  Positive thinking: Stopping unwanted thoughts.

Other treatment choices

Besides counseling and lifestyle changes, there are some other treatments you can try:

• Alternative treatments such as massage therapy and yoga may help you get better faster and make your life better.
• You can try relaxation exercises at home to lower your stress.
• The herb St. John's wort may help if you have mild depression. But it can cause problems with other medicines you may be taking, so talk to your doctor before you try this herb.
• Electroconvulsive therapy may be used to treat severe depression or depression that hasn't responded well to other treatment. It also may be a treatment choice for someone who cannot live with the side effects of antidepressants.

Your doctor might suggest that you try antidepressants if:

• You have tried counseling and lifestyle changes, and they haven't worked.
• Your symptoms are bad enough that they interfere with your daily life.