An antidepressant is a depression medication used in psychiatry to treat such mood disorders and help ease the symptoms. It comes in the form of a tablet or a pill. Antidepressants form an important part of the treatment of depression.

For these depression medications to work well, it is necessary to take them religiously in the dose prescribed and for the prescribed period.

This is necessary because antidepressants work by balancing the chemicals in the brain, which helps to ease the symptoms and taking them for the time prescribed helps to prevent a relapse.

People who are affected by these disorders experience a therapeutic effect with antidepressants while healthy people do not.

Depression medications are available by prescription only and are among the most commonly prescribed drugs by psychiatrists and other physicians.

First developed in the 1950s, their use and popularity have increased rapidly over the years due to the mounting prevalence of depression and other mood disorders throughout the world.

In 2008, prescriptions for antidepressants and benzodiazepines (a tranquilizer) rose to more than 250 million in the United States. This was thrice the number of prescriptions for calcium channel blockers, twice as many as for beta blockers, and approximately 90 million more than those for angiotensin-converting enzyme (ACE) inhibitors.

Antidepressants are the most commonly used drugs in adults between the age 20 to 59 years and are taken by 11% of young people aged 12 and older.

Besides being indicated in all types of depression, antidepressants are also commonly used to treat other conditions such as obsessive-compulsive disorder (OCD), generalized anxiety disorder, post-traumatic stress disorder (PTSD) and long-term pain of unknown etiology.

What antidepressants do and how they work?

Most of the antidepressants work by helping to slow down the removal of neurotransmitters from the brain and thus correcting the chemical imbalance caused by depression. These are chemicals, which the brain cells or the nerve cells use to communicate impulses.

Neurotransmitters are naturally occurring chemicals in the brain, such as dopamine, serotonin or norepinephrine, and which are responsible for the mood sentiment and regulating other functions such as sleeping, eating, thinking and feeling pain.

In depression, changes in the levels of these chemicals are seen and are believed to have a direct bearing on the depression.

Fall in their levels leads to a depressive mood. Antidepressants correct their levels to normal thus improving the mood of the person.

Antidepressants are beneficial in depression because what they do is that they restore the balance of these natural brain chemicals and make them more available to the brain thereby helping to relieve the symptoms of depression.

Some researchers, however, believe that depression and constant stress may actually destroy the connections between nerve cells. According to them, antidepressants work by reconnecting these nerve pathways.

Lists of antidepressants

There are many different types of depression medications. Some are more commonly used while others are prescribed less often.

Most commonly prescribed are:

  • Tricyclic antidepressants (TCAs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Selective serotonin noradrenaline reuptake inhibitors (SSNRIs)

Of these, Tricyclic antidepressants are considered to be the first generation antidepressants and they have been prevailing in the market for the longest period. SSRIs and SSNRIs are the second-generation antidepressants.

The following are prescribed less often:

  • Alpha-2 blockers
  • Monoamine oxidase (MAO) inhibitors
  • Selective noradrenaline reuptake inhibitors
  • Selective noradrenaline/dopamine reuptake inhibitors
  • Melatonin receptor agonists and serotonin 5-HT2C receptor antagonists

Trazodone and lithium are other types of antidepressants that mental health professionals sometimes prescribe.

Antidepressant treatment guidelines

These guidelines educate you on the various aspects you need to know when you are on these depression medicines. These do’s and the don’ts will help you to get the most benefits from your therapy.

  • It is important to know that just taking the right depression medication is not enough, but taking the right dose is also necessary to get good results.
  • Often, it becomes necessary to change the depression drug or its dose during treatment.
  • An antidepressant useful for one person may not necessarily suit another.
  • At times a combination of antidepression medicines may be necessary for better results. Doctors often prescribe another drug, usually also an antidepressant with another mode of action, to augment the action of the depression medication in case of unsatisfactory response.
  • Depression medicines do have their dangers and one should come to know about them by reading the boxed warnings or from your psychiatrist.
  • Never drink alcohol when you are taking antidepressants. It will reduce the efficacy of the antidepressants, increase the medication side effects and worsen your depression and anxiety.
  • Once started, you should adhere to the full dose of the depression medicine prescribed by your psychiatrist and for the full prescribed length of time.
  • Usually, the most effective and first line of depression treatment prescribed and which works well is a combination of depression medication and psychotherapy (also called psychological counseling).
  • It may take 3 to 8 weeks after the start of the first depression medication to see any improvement.
  • At times, hospitalization of the depressed patient may be required for severe and unresponsive depression or the patient could be treated in an outpatient treatment program.
  • Do not, repeat, do not change or add any depression medicine or its dosage on your own. Follow your psychiatrist’s advice religiously.
  • Take your medicines at about the same time every day.
  • See your doctor every one or two weeks after starting antidepressant medication.

For how long you should take depression medication? Duration

Antidepressants are not prescribed for mild depression because they are ineffective in such cases. Mild depression responds well to psychotherapy and self-help measures such as a balanced diet, meditation, and an exercise programme.

However, moderate and severe depression requires that you be put on depression medications.

An antidepressant starts acting within one or two weeks but it may take a while for the symptoms to improve.

And if your symptoms improve and you feel better, it does not mean that you should stop taking the depression medication. There is a protocol to be followed that has been formulated to give full cure and also to prevent a relapse.

Antidepressants are to be taken for 4 weeks to see if they are working. If there is an improvement, they are to be continued for a further four to six months without a gap, to prevent recurrence. In the elderly people, antidepressants are prescribed for 12 months.

In cases where a previous history of depression attack is present, depression drugs may be advised to be taken for 5 years or more.

Chronic depression may require lifelong therapy with depression medicines.

You should follow-up with the doctor every one or two weeks after starting depression medication.