What you should know about medication for depression

It’s estimated that almost 7% of adults struggle with depression (aka major depressive disorder), making it among the more common mental health conditions. Of course, just because it’s common, doesn’t mean it’s easy to live with. Symptoms of depression can feel unbearable. If you’re living with depression, it’s natural to want to get help fast.  

One of the most common treatments for depression is medication, and there’s a range of medications that can help manage your symptoms. While you should only get medication from a licensed provider, the good news is that finding one can be easy. We turned to our staff of psychiatrists to find out exactly how to do it.

What are the symptoms of depression?

Many people confuse depression with everyday “sadness.” But it’s important to know that there’s a difference between everyday sadness and depression. Everyone feels sad from time to time; that’s a normal, even healthy, part of the human experience. However, depression goes well beyond periodic sadness. Depression causes feelings of extreme sadness or hopelessness, as well as a lack of interest or pleasure in activities or hobbies you once enjoyed. Other symptoms of depression may include:  

• Difficulty thinking, concentrating, or making decisions  
• Feelings of worthlessness or excessive guilt  
• Increased fatigue or loss of energy
• Restlessness or sluggishness  
• Sleep problems—sleeping too little or too much  
• Changes in appetite—unintentional weight gain or weight loss  
• Thoughts of death or thoughts of suicide

These symptoms have been present for at least 2 weeks (although in many cases much longer) and are severe enough to interfere with your everyday life.

How is depression treated?

Generally, depression is treated with a combination of talk therapy and medication. If your depression is very mild, it’s possible your provider will recommend concentrating just on therapy.  Cognitive behavioral therapy (CBT), is one effective talk therapy option. CBT for depression focuses on problem solving and re-routing negative thought patterns.

Most people living with depression, however, respond best to a combination of therapy and medication. The goal is to help correct the chemical imbalances in the brain that are thought to contribute to the development of depression.  

The most prescribed medications for depression are antidepressants.

What are antidepressants?

Antidepressants are a type of medication that increases the levels of certain neurotransmitters, or chemical messengers, in the brain. They are most often prescribed to treat depression, but can also be used to treat other conditions, like anxiety, chronic pain, insomnia, OCD, or PTSD.  (Learn more about depression vs. anxiety.)

How do antidepressants work?

There are several different types of antidepressants, and each works differently, but the overall goal of this type of medication is to correct imbalances in neurotransmitters which lead to the development of depression or other mental health conditions.

Your brain produces different neurotransmitters which affect your mood, sleep, and bodily functions. These include serotonin, norepinephrine, and dopamine. In people living with depression or other mental health conditions, the levels of these neurotransmitters can be depleted. Antidepressants are thought to increase these levels, which can help stabilize your mood.  

What are the main types of antidepressants?

The main types of antidepressants include SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors), TCAs (tricyclic antidepressants), and atypical antidepressants.

SSRIs

SSRIs (selective serotonin reuptake inhibitors) are among the most prescribed types of antidepressants, and include Prozac (fluoxetine), Lexapro (escitalopram), Paxil (paroxetine), Zoloft (sertraline), and Celexa (citalopram). These drugs work by increasing serotonin levels in the brain, which can help stabilize your mood, emotions, and sleep.  

SNRIs

SNRIs (serotonin-norepinephrine reuptake inhibitors) are another commonly prescribed class of antidepressant. Some common SNRIs are Cymbalta (duloxetine), Effexor (venlafaxine), Pristiq (desvenlafaxine), and Savella (milnacipran). These drugs increase the levels of both serotonin and norepinephrine in the brain.  

For more on the difference between SSRIs and SNRIS, check out: SSRis vs SNRIS.

TCAs

TCAs (tricyclic antidepressants) also increase the levels of serotonin and norepinephrine in the brain, but have the potential to affect more body systems than newer SSRIs or SNRIs. These drugs may be an effective option for people whose depression is resistant to other medications, but they come with more side effects. Common TCAs include Elavil (amitryptiline), Norpramin (desipramine), Asendin (amoxapine), Silenor (doxepin), and Tofranil.

MAOIs

MAOIs (monoamine oxidase inhibitors) increase levels of serotonin and norepinephrine in the brain by blocking them from being broken down.  While MAOIs were the first antidepressants introduced, they are not the first choice in treating mental health disorders due to several dietary restrictions, side effects, and safety concerns. MAOIs are only a treatment option when all other medications are unsuccessful.  Examples of MAOIs include Marplan (isocarboxazid), Nardil (phenelzine), Emsam (selegiline), and Parnate (tranylcypromine).

Atypical antidepressants

Atypical antidepressants work differently than any other class of antidepressant. Many have multiple mechanisms of action, which means they don’t fit neatly into any other class, although they all work to increase levels of serotonin, norepinephrine and dopamine in the brain. Common atypical antidepressants include Wellbutrin (bupropion hydrochloride), Remeron (mirtazapine), Trintellix (vortioxetine), and Viibryd (vortioxetine).

Not every type of antidepressant is appropriate for everyone living with depression. The type of antidepressant that’s right for you depends on your symptoms, the possible side effects, as well as any health conditions you live with, other medications you’re taking, if you’re pregnant or breastfeeding, etc. A qualified provider can work with you to ensure you are taking the appropriate medication for your situation.

Can you get antidepressants over the counter?

No, antidepressants are not available over the counter. Although antidepressants are considered safe and effective when taken as intended, all drugs carry the potential for serious side effects. As such, it’s important to take them under the supervision of a professional healthcare provider.  

Your healthcare provider will monitor your response to the medication and ensure your body is responding appropriately. They can also make adjustments to your prescription—say, if you experience any side effects or have a negative reaction to the drug. Or, if you decide together that a given antidepressant isn’t right for you, they can help you safely stop taking the drug.  

If you don’t respond to one antidepressant, it’s possible you may respond to another. Your healthcare provider will determine the right options for you.

Who can prescribe antidepressants?

Only a licensed healthcare professional—a psychiatrist or other M.D., or an N.P. (nurse practitioner) or P.A. (physician’s assistant)—can prescribe antidepressants.  

If you are interested in taking antidepressants for depression or a related condition, you must seek the care of a professional.  

How can you start medication for depression?

The first step to treating depression is getting a clinical diagnosis from a qualified healthcare professional, like a psychiatrist. Your psychiatrist will ask you questions and may perform some tests to rule out any other causes of your symptoms, like other medical or mental health conditions.    

Although getting a diagnosis can seem scary, it may also be validating to put a name to what you’ve been experiencing. And a diagnosis will allow you to access the professional resources needed to start feeling better, including medication like antidepressants. To that end, you'll work with your provider to determine a treatment plan—usually a combination of medication and supportive therapy—that best fits your needs and condition.  

Supportive therapy is a kind of psychotherapy, which is flexible, can fit and address the needs of a wide range of clients with different diagnoses. Further, it is also often used as the initial form of therapy. It is generally aimed at symptom relief and behavior change without focusing on modifying personality or resolving unconscious conflicts.  Supportive therapy should be part of any visit with a mental health provider.

What should you keep in mind when starting antidepressants?

After you start medication, it may take several weeks before you start to notice a change in your symptoms. Rebalancing your brain chemistry doesn’t happen overnight, but your provider will work closely with you to ensure that your symptoms improve.  

Depression is among the most treatable of mental health conditions, with up to 90% of people eventually responding well to treatment. To help ensure you’re among that majority, it’s important to remember to take your medication exactly as prescribed, and keep your provider informed of how you’re responding to the treatment—including any and all side effects that you experience.  

Getting professional help with Talkiatry

If you’re interested in getting professional treatment for depression but not sure where to start, Talkiatry might be a good fit. With Talkiatry, you can see a psychiatrist from the comfort of your home, and you can schedule your first appointment in a matter of days. To get started, take our free online assessment, to see if Talkiatry is right for you and get matched with a psychiatrist.

About Talkiatry    

Talkiatry is a national psychiatry practice that provides in-network, virtual care. Co-founded by a patient and a triple-board-certified psychiatrist, Talkiatry has over 300 doctors, 60 insurance partners, and first visits available in days. We treat patients with anxiety disorders, depression, bipolar disorder, ADHD, and more. Get started with a short online assessment.    

The information in this article is for informational and educational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.