How Do Antidepressants Work?

Antidepressants are one of the most simultaneously effective and misunderstood tools in mental healthcare. 

From TV and film to political circuses, both mental health and the medications that can improve it have been misrepresented and misconceived in society.

For all their benefits when appropriately prescribed, it’s fair to say that antidepressants carry a lot of stigma. 

While it’s better today than it was a decade or two ago, the idea of taking a pill for depression still makes people uneasy, self-conscious, or judgemental. 

But aside from the movies and TV shows, the biggest reason for all that negativity, in our opinion, is a lack of education. 

People have misconceptions about depression, and so a pill that you take for depression is bound to have some misconceptions of its own. 

If you’re reading this, you’re probably wondering how antidepressants work, and we’re here to educate you. 

Whether you or a loved one is taking them (or considering them), it’s best to understand how they work. Before we get to that, though, let’s briefly explore what depression is.

Let’s start with the basics here. Depression is a mood disorder characterized by an ongoing set of down, sad or low thoughts, according to the National Institute of Mental Health (NIMH). 

According to the NIMH, those down, sad or low thoughts are strong enough to affect “how you feel, think, and handle daily activities, such as sleeping, eating, or working.” 

This definition is very important, because it designates two criteria for depression: what the feelings are like, and how often they are felt.

This is because depression, as a disorder, is very different from just “feeling bummed out.” It’s actually a recurring or constant set of feelings. 

According to the NIMH, those feelings must be present most of the day, nearly every day, for at least two weeks.

Within depression, there are also different types to be considered, and they have different symptoms to an extent. 

Seasonal Affective Disorder (SAD), for instance, may hit during the colder months. But the most common forms—and constant—are major depression and persistent depressive disorder.

The two have slightly different characteristics. The more severe of the two is major depression, which is typically characterized by moderate to severe depression for periods of approximately two weeks.

In contrast, persistent depressive disorder is longer lasting (at least two years) and can be characterized as a sort of ebb and flow less severe symptoms.

Depression could have a variety of causes, according to the NIMH, including genetic, biological, psychological and environmental ones. 

This wide range of topics could make a long list, with everything from diabetes, low sunlight, insufficient exercise or a poor social life making it onto the top tier.

But just because we understand the shape of depression’s effects, doesn’t mean we’ve delved into the effects themselves. Let’s do that next.

Like a fingerprint, every person’s version of depression can look a little different. That said, there are some frequently occurring and common symptoms that might give you a better picture of what depression could look like.

First, you might consider how your gender affects your symptoms. They can manifest differently in men and women. 

Typically, men will exhibit signs of depression with irritability, anger, or exhaustion. They may have sleep and motivation problems, use substances like alcohol and drugs abusively, or generally behave recklessly. 

Furthermore, you might lose interest in things you once enjoyed, or your weight might fluctuate. 

You might have suicidal thoughts, feel tired all the time, or hopeless. You might physically feel ill as well, and have cramps, headaches or stomach issues.

Check out our complete guide to depressive symptoms for more, and if you’re wondering if you’re depressed, check our “Am I Depressed” Checklist.

In the simplest terms, antidepressants manipulate the serotonin levels in your brain and how your brain interacts with serotonin to effectively regulate your mood disorder.

There have been a lot of studies about efficacy among different medications, and they’re all considered equally effective to some extent. 

But a comprehensive examination of studies found that tricyclic antidepressants (TCAs) and serotonin reuptake inhibitors (SSRIs) were the most effective medications.

One way to fight depression is to keep more serotonin in your brain, and that’s what TCAs do. 

These medications have been around for more than 60 years, and they treat other conditions, including migraines and obsessive-compulsive disorder (OCD). Common side effects include dry mouth, constipation and dizziness. 

The most commonly prescribed antidepressants are SSRIs, which block serotonin from being reabsorbed by neurons, keeping more of it available to improve transmission between neurons. 

They have some side effects, which can include weight changes, disturbed sleep, anxiety, headaches, dizziness, dry mouth and sexual dysfunction.

In contrast with a common misconception, antidepressants aren’t actually for the worst of the worst. In fact, they’re typically prescribed quite early on—as early as two weeks if the patient hasn’t shown immediate signs of improvement.

One of the common misconceptions is that antidepressants are addictive or create dependence, and while going off them will certainly cause some changes, they aren’t habit forming.

Research shows little difference in efficacy among the different types of antidepressants, but each one has different potential interactions with other drugs, as well as different or complicating side effects.

As such, you might want to talk with a healthcare provider before picking a particular course of medication, as side effects can include sexual dysfunction, weight gain, or sedation.

Doses may be lower for the elderly, but it’s not unsafe for pregnant women. Children can be prescribed antidepressants as well, though they come with serious warnings about the risk of suicide.

There are a variety of variables to be considered when answering the question of whether antidepressants are effective. 

For a lot of people, they are an effective way to deal with depression. But that doesn’t mean that everyone has the same experience. 

A number of things can affect how effective yours are. Certain side effects may cause more worry than the medicine is actually fighting (sexual dysfunction and weight gain among them). 

And dosages are not the same from person to person, and from medication to medication—and some are not taken at the same frequency as others.

Furthermore, studies have shown that antidepressants are about as effective as psychotherapy. That means that talking could be as effective as taking pills for you, or more, or less.

What this all means is that finding the right antidepressant is more like trying on clothes than one-size-fits all purchasing. A variety of solutions may have to be tried before you find the right one for you.

You can read our article Wellbutrin vs Zoloft: Differences & Similarities for a comparison between two commonly prescribed antidepressants.

There are other ways to fight depression, including therapeutic practices. 

One of the most well-known and effective forms of therapy is Cognitive Behavioral Therapy (CBT). CBT is a way of recognizing patterns of disordered thinking that may be worsening your symptoms and learning to correct and manage them.

Other techniques might include the use of meditation, which limited studies show could help reduce symptoms of depression. 

In fact, some practices of mindfulness have shown improvement in certain areas of anxiety, depression and pain that mantra meditation methods haven’t.

Other therapeutic techniques may be employed by a mental health professional once you begin talking to someone, but regardless of what style of treatment works for you, contacting someone and getting that dialogue started should be one of your first steps.

The real first step, however, is to consult a healthcare professional generally. They may give you referrals to mental healthcare providers, but first they may help you narrow down other potential causes of depression—and there are many factors that could be involved.

Your blood pressure, weight, lifestyle, habits, diet or other factors could be impacting your mental health or exacerbating your condition. 

You may be told to quit drinking or smoking, or to begin an exercise regimen, which in some cases can be as effective as drugs. 

What may work effectively for your friends and family might not be so effective for you, so just because you’ve seen something work for someone else, don’t get upset if you don’t get the same results. 

Trying several treatments is normal in fighting depression, and it’s easy to feel despair when something doesn’t work the way it’s supposed to at first. 

What will help you is to talk to someone now, soon, and quit delaying. If you are having the feelings we described earlier frequently, it might be a bigger job than a parent, partner, or trusted friend can handle. 

That’s when it’s definitely time to schedule an online psychiatry evaluation.