I’ve been on antidepressants more than half my life. I started on them when I was about 19, and despite trying to go off them a few times throughout my life (with the help of my psychiatrist), I always ended up back on them. The truth is, I’m not exactly sure how much help they do me, but I tend to feel unbalanced when I’m not taking them.
I’m not alone. According to The New York Times, as of 2018, nearly 25 million Americans have been on antidepressants for at least two years, and approximately 15.5 million Americans have been taking antidepressants for at least five years.
But despite being so widely and commonly prescribed, antidepressants are not without drawbacks. And not all doctors are completely upfront with their patients about antidepressant use. Keep in mind, this is most certainly not an attempt to convince anyone not to go on antidepressants. Not even close. It’s just providing you with some information you might not get from your doctor.
6. They can take a while to work.
Antidepressants aren’t like aspirin or like anti-anxiety pills, which kick in immediately. Selective serotonin reuptake inhibitors (SSRIs), for example, can take four to six weeks to start working. There’s a reason for this, but that reason is science, and definitely over my head. The link explains it.
It can feel weird to keep taking pills that you’re not sure are working. And sometimes by the time they do start working, it can be hard to tell whether it truly is the antidepressants finally doing their job, or if you’re just feeling better in general.
5. You might have to try more than one.
Antidepressants are not one size fits all. You could get lucky and the first antidepressant you try could be the one that works. But that might not be the case — you may need to try different doses of that drug, or different drugs altogether. In some cases, you might end up on more than one drug. But have faith, you do have options. Don’t give up if the very first drug prescribed to you doesn’t end up being the one that works for you.
4. There can be side effects.
According to Dr. Heidi Combs, MD, an associate professor of psychiatry and behavioral sciences at the University of Washington in Seattle, “Some people are exquisitely sensitive to antidepressant side effects.” Boy howdy, is that the truth. I am in that subset of people, hard core. If there is a side effect to be had, I will get it. She adds that other people can take medications without any side effects at all.
The possible side effects differ depending on the medication, but let’s go over the ones that you can get from SSRIs, which is a class of drug that includes Zoloft, Prozac, Celexa and Lexapro.
About 40 percent of people on SSRIs have side effects, and about 25 percent of those side effects are considered “very bothersome,” according to a report in the Journal of Psychiatry. Two of the most common side effects, weight gain, and sexual side effects, are sometimes serious enough to make people stop taking or change their antidepressant medication.
Sure, when you’re depressed, you’re probably not into having sex a lot anyway (that’s not a fact! That’s just completely presumptive). But over time, the lower sex drive, decreased orgasm and erectile dysfunction are tough to navigate.
The one most significant side effect that no one told me about was nocturnal hyperhidrosis, a.k.a. night sweats. I’d had them for years, and never connected to them my meds. It wasn’t until I was searching the internet one night, desperate for some sort of cure or at least an answer, that I came across research showing the prevalence of night sweats among people taking certain antidepressants, especially sertraline and venlafaxine, the generic names for Zoloft and Effexor, respectively.
3. Exercise may sometimes be just as effective.
Not many doctors are going to prescribe exercise for your depression, but it might be a good idea if they did. In clinical studies, “regular aerobic exercise is as effective as antidepressants in reducing symptoms of mild to moderate depression.” You’ve probably heard that exercise causes the release of endorphins, which can elevate your mood. But that’s not all — as it turns out, exercise “causes the same structural changes to the brain as antidepressants.” Those changes include neuroplasticity, which means the creation of new neural pathways, and growth in the hippocampus, the part of the brain that’s usually smaller in people with depression.
While exercise might not work as well for some people as it does for others, it’s an important part of dealing with depression and anxiety. The good thing is that it can be used in conjunction with any medication as part of your overall treatment plan.
2. Sometimes antidepressants alone aren’t enough — you might want to get a therapist, too.
Finding a therapist who’s a good fit can take time and I’ll be honest, it can be frustrating as hell. But sometimes drugs alone aren’t enough to deal with depression — often there’s a root cause that you can only address by working through it with a therapist.
There are lots of ways to find therapists. You could start off by asking a friend in therapy how they feel about their therapist, and if they’d recommend him or her or not. If you have insurance, you can also look through the list of the people who accept your plan. Some places have online reviews for therapists — if there’s one you’re considering trying, you can Google them and see what comes up.
1. Some antidepressants can be very hard to stop taking.
If you do decide to stop taking antidepressants, it’s extremely important that you do so with the help of your psychiatrist. Quitting cold turkey can lead to withdrawal symptoms (that doesn’t mean that you’re addicted to your antidepressant, just that your body is getting used to being without it). You might experience digestive distress, sleep changes, or mood swings. Some discontinuation symptoms can seem like a relapse of depression sometimes.
Your doctor might recommend tapering the dose. That can ease the transition, and it also decreases the risk that the depression will come back. In a Harvard Medical School study, almost 400 patients were followed for a year after they stopped taking antidepressants.
Besides easing the transition, tapering the dose decreases the risk that depression will recur. In a Harvard Medical School study, nearly 400 patients (two-thirds of them women) were followed for more than a year after they stopped taking antidepressants that had been prescribed for anxiety and mood disorders. The study participants who discontinued rapidly (from cold turkey to over a period of seven days) were more actually more likely to have a relapse of depression within a few months than the participants who gradually reduced their doses over a period of two or more weeks.
Above all else, never be ashamed of taking antidepressants. They’re medicine for a sickness, just like any other medicine. It doesn’t mean that you’re weak or defective. In fact, seeking help for depression shows just how very strong you are. Be safe and keep taking care of yourself.