How to manage your antidepressants

Antidepressant medication use has continued to increase among adolescents and young adults in recent years, as depression is a common health concern. Although antidepressants aren’t intended as a cure for depression, they can help your symptoms. Symptoms of depression can vary from person to person, including the severity and frequency. That’s why it’s important to tell your healthcare provider about what you’re experiencing, so that they can help you find an appropriate treatment plan to help manage your symptoms.

In milder cases of depression, psychotherapy (such as talk therapy and cognitive behavioral therapy) may be considered first, but if a person is experiencing more severe forms of depression, medication may be added as part of their treatment plan. The medication selected by a licensed healthcare professional is often based on the person’s individual situation and their response to treatment. Antidepressants usually take about four to eight weeks to begin taking effect, so it’s important to give yourself some time to notice a difference. Below is a review on how to take antidepressant medication and manage the expected—and sometimes unexpected—side effects.

When someone's depression treatment includes taking an antidepressant medication, it’s important to find one that is most appropriate for you, as there are different types of antidepressants available. Antidepressants aren't intended as a cure for depression but rather, they may help manage the symptoms of depression.

When prescribing an antidepressant medication for you, your healthcare provider may consider several factors, including:

• Your specific depression symptoms
• The medication’s possible side effects
• Any other health conditions you may have
• Whether the medication worked for a close relative or which medications have worked in the past, if you’ve taken them before
• Whether the medication is safe for pregnant or breastfeeding women
• How the antidepressant medication works when taken with other medicine
• The cost of each medication 
• Your personal preference, such as the ease of taking the medication

Different types (classes) of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs):  SSRIs are a common starting point for people initiating antidepressant medication treatment for the first time. This type of antidepressant typically has fewer side effects, and when higher doses are needed, it’s generally considered a safer option than others. 
• Serotonin and norepinephrine reuptake inhibitors (SNRIs):  SNRIs are also commonly prescribed.
• Norepinephrine and dopamine reuptake inhibitors (NDRIs):  NDRIs treat depression as well as seasonal affective disorder. This type of antidepressant is not likely to involve sexual side effects. The more common side effects are similar to those of SSRIs and SNRIs.
• Tricyclic antidepressants:  These medicines are usually only prescribed when an SSRI is not successful, and in general, they may be accompanied with more side effects, including blurred vision, bladder problems and increased heart rate.
• Monoamine oxidase inhibitors (MAOIs):  MAOIs generally have the most side effects and safety guidelines. Special care must be taken when prescribed this type of antidepressant, as certain foods (such as certain cheeses and pickles), drinks (such as wines) and other medications (such as pain medications and decongestants) could be very dangerous or even fatal while taking an MAOI.
• Atypical antidepressants:  There are several medications that, despite being antidepressants, don't quite fit into these other categories. Your healthcare provider can provide more information about specific types of atypical antidepressants and determine if they’re appropriate for you.

Once you and your healthcare provider have determined a treatment plan and medication, it's important to adhere to the dosage and the schedule, even if you don't feel a change in your mood and other symptoms of depression right away. It may take a while for antidepressants to take effect. If you don't feel better after three weeks, talk with your provider, but remember to be patient with yourself. You should also notify your healthcare provider if you experience bothersome side effects or any changes in health conditions. You may need a different medication, a different dosage or a different treatment, and your healthcare provider will help you explore different options.

Many people express concerns about becoming addicted to antidepressants. Antidepressants are not addictive and do not produce the same effects in the brain as other addictive substances. Some antidepressants may cause withdrawal-like symptoms or worsen depression symptoms unless you slowly taper off your dose, but these are not symptoms of addiction.

Some people may experience side effects with antidepressants. These often resolve within a few weeks once your body adjusts to the medication. If the side effects continue, talk with your provider or your pharmacist, especially if they become more severe.

Some strategies to deal with the most common side effects include:

• Nausea. To help with the nausea, you may take the antidepressant with a small meal, unless the medication's instructions include taking it on an empty stomach. You may also try to eat smaller, more frequent meals throughout the day, and drinking plenty of fluids.
• Weight gain. People on antidepressants may gain weight because of fluid retention, lack of activity or increased appetite once the depression symptoms improve. Keeping a food diary and tracking what you eat may help you manage your diet. You should also try to exercise regularly, eat lower-calorie foods and avoid saturated fats and sugar.
  
• Fatigue or drowsiness. Fatigue and drowsiness are common, especially when just beginning antidepressant treatment. Avoid driving or operating dangerous machinery when taking these medications. Consider regular activity, such as walking, and take your antidepressant medication at bedtime unless otherwise directed by your healthcare provider.
• Insomnia or restlessness. Some people experience an energy boost after taking an antidepressant, making it difficult to relax and fall asleep or stay asleep. If this happens, avoid caffeine, especially late in the day. If allowed by your healthcare provider, take your medication in the morning. Getting regular exercise several hours before bedtime may also help.
• Changes in sexual drive. Sexual side effects may include decreased sex drive or difficulty achieving pleasure. Discuss your symptoms with your provider. They may be able to suggest other medication options to help manage this side effect.  They may also recommend switching to a different antidepressant medication that may have fewer of these effects. Do not alter your antidepressant dosage or medication schedule or add additional medication without first discussing it with your provider.

Discuss any persistent side effects with your healthcare provider or pharmacist to find solutions that work for you. Do not try to adjust taking the medication from how it is prescribed without talking to your provider or pharmacist first. 

All people taking antidepressants should be monitored by their healthcare provider, with scheduled follow-up visits. Promptly seek medical care if you, your child or another family member is taking antidepressants and experiences suicidal thinking or behavior, nervousness, agitation, irritability, mood instability or sleeplessness that either emerges or worsens during treatment. Some children and adolescents may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially as they begin their medication treatment. If these symptoms occur, contact their healthcare provider immediately and get emergency care if a situation like this occurs. You can also contact the 988 Suicide & Crisis Lifeline, 24/7 any day of the year-- via text, phone call, or chat.

Keep all medications in a secure location so others can't access them, especially children. If you have concerns about your dosage or others taking your antidepressants, contact your provider immediately.

Once started, treatment with antidepressants should not stop abruptly. If you are ready to stop taking these medications, work with your provider to help you slowly reduce their use over time.

Get information on how to choose a mental health professional, video chat live with a therapist for an introductory consultation today, or visit Mental Health America for a comprehensive list of mental health support organizations and therapists in your area as well as to help you find the care you need.

Updated by Julie McDaniel, MSN, RN, CRNI, November 2024.