What to Expect When Considering an Antidepressant

Posted on October 16th, 2014

What-to-Expect-When-Considering-an-AntidepressantBy Eric Metcalf, MPH
@EricMetcalfMPH

Depression is a common problem. According to the National Institute of Mental Health, an estimated 16 million adults in the U.S. struggled with a bout of major depression in 2012. Many turn to medication to manage their symptoms.

Approximately one out of every nine American adults takes an antidepressant drug. This number has skyrocketed over the past few decades, in part because people have become more willing to seek help for mental health issues and more antidepressants have become available.

Despite their popularity, antidepressants don’t work for everyone. When they do work, they’re not necessarily a quick fix. If you have depression, you can take action to help improve your chances that medication will provide relief.

Have a Plan for Your Depression Treatment

People often turn to their primary care provider, such as a family doctor, to treat their depression. As a result, research shows these healthcare providers now write the majority of prescriptions for antidepressants. When developing a plan with your primary care provider to manage your depression, keep these strategies in mind:

Be open and honest. Your care provider needs a lot of information to help ensure that your depression is treated properly. Your discussion should include:

  • Your symptoms. Depression can cause many mental, emotional and even physical symptoms. Talk about how your mind and body are feeling. How long have you had your symptoms? Has anything happened in your life that may be a contributing factor, such as the death of a loved one, problems at work or relationship changes?
  • Your history of depression. Have you had depression or other mental health issues in the past? If so, what medications did you take or what other treatments did you use?
  • Any medical problems you have or medications you’re taking. These may affect the treatment your doctor recommends.
  • If you may be pregnant or plan to become pregnant. Research has found that taking antidepressants during pregnancy may raise the risk of certain health problems for the baby, such as premature birth and attention-deficit hyperactivity disorder. Depression itself may have a negative effect on a pregnant woman and her baby, so in some cases antidepressants are warranted. Be sure to discuss the possible benefits and risks with your doctor.

Talk about alternatives. In some cases, you may be able to approach your depression without medication. Your doctor may want to discuss non-drug alternatives such as:

  • Watching your symptoms for a period of time to see if they go away on their own
  • Trying talk therapy (psychotherapy) or other interventions to treat your depression

Discuss side effects. Antidepressants can cause a number of side effects. These include:

  • Sleepiness or trouble sleeping
  • Impaired sexual performance
  • Weight gain
  • Dizziness
  • Shakiness

You may notice these side effects even before the drug has a positive effect on your mood.

If your doctor recommends a particular medication, talk about the possible side effects. Discuss if you’re unwilling to tolerate certain side effects. Keep in mind that in some cases, a side effect may turn out to be helpful, such as added sleepiness if you’ve had insomnia. Also, some side effects may fade over time.

Remember that the drug may take time to work. Antidepressants may need three or four weeks to take effect. Talk to your doctor about the types of improvements in your mental, emotional or physical symptoms you should see, and when you should start noticing them.

Follow up with your doctor. While you’re discussing what to expect from the antidepressant medication, ask your doctor when you should come back for a follow-up visit if the medication isn’t making a difference in your symptoms. Your doctor may want to increase your dose, switch you to a different drug, or add another medication.

Consider seeing a specialist. Your primary care doctor may recommend that you see a psychiatrist (a physician who specializes in mental health issues) if:

  • You’ve had episodes of depression in the past, especially if medications didn’t help.
  • You might have bipolar disorder, which causes both depressed and manic mood swings.
  • Mental health or substance abuse issues run in your family.
  • You’re only having side effects but no benefits from the medicine, or if there are no effects at all from the medication.
  • You have other medical conditions that may cause mental or emotional symptoms.

Take the medication for the proper length of time. Ask your doctor how long you should keep taking the antidepressant once you’re feeling better. Some experts recommend taking the drug:

  • For six months to a year if you’re treating your first episode of depression.
  • For at least a year when treating a second episode.
  • Indefinitely when treating a third episode or more. The idea is to prevent depression from recurring or to lessen its severity if it does come back.

Take precautions when stopping your medication. Talk to your doctor before you stop taking an antidepressant. When you quit taking these medications, you may notice a variety of symptoms. Some may be sensations you haven’t felt before. With a common group of antidepressants known as serotonin reuptake inhibitors, symptoms that may occur when stopping a medication include:

  • Odd noises that feel like they’re in your head
  • Changes in your field of vision (after you look at objects, after-images linger)
  • Dizziness
  • Numbness
  • Shakiness
  • Mood changes

Your doctor may recommend that you taper off slowly from the antidepressant to help lower the chance of having symptoms such as these. The longer you’ve been taking the drug, the more slowly you may need to lower the dosage.

Know what to do about suicidal thoughts. The Food and Drug Administration has warned that young people taking antidepressants may be more likely to have suicidal thoughts or behaviors after they begin treatment.

Talk to your doctor if you notice that your depression is getting worse or you’re starting to have thoughts of suicide or other symptoms that seem linked to the medication. If you notice these developments in your child, teen or another person under your care who’s taking an antidepressant, call the care provider who prescribed the drug.

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