People don\u2019t typically wake up one day and decide to start an antidepressant.<\/p>\n
It usually comes after a long, debilitating period of feeling \u2018off\u2019 \u2014 you\u2019re still coming to work and checking emails, but everything is denser and harder than it should be. Dinner is cereal. Laundry sits in the washer for two days. You can\u2019t remember what you did last weekend.<\/p>\n
That\u2019s a good question.<\/p>\n
Antidepressants aren\u2019t for everyone, every day or every situation. They\u2019re not a magic pill for people who have \u2018gone down\u2019 \u2014 it\u2019s about duration, damage and disability, and whether you feel like this is something you can\u2019t recover from on your own.<\/p>\n
Sadness has its ups and downs. You might feel depressed for a few days after your heart is broken, dumped, or gets laid off, but there\u2019s still a sense of lightness, hope, or possibility that things will get better.<\/p>\n
Depression is more diffuse and less reactive. Your usual coping mechanisms fail you, and sources of pleasure and productivity become inaccessible. You have no interest in seeing friends but feel incredibly lonely. You can\u2019t stand being around your family. You eat too much and then nothing, or nothing and then too much. You sleep 12 hours a day and feel like garbage, or you can\u2019t sleep at all at 3 a.m. and spend the whole night reliving your mistakes from 2009.<\/p>\n
Some people are consistently tearful and melodramatic, others are emotionally constipated, others are more irritable, withdrawn, or detached.<\/p>\n
If this has been going on for weeks and it\u2019s affecting your work, relationships, or basic functioning, you should set up an evaluation. Our guide to all the symptoms of depression can help with that.<\/p>\n
Physicians should also rule out other medical causes for depressive symptoms, including hormonal imbalances, anemia, sleep apnea, chronic pain, substance abuse, and certain medications.<\/p>\n
They won\u2019t make you happy. You won\u2019t wake up one day after starting them and think, \u2018Oh, this is nice.\u2019<\/p>\n
When they start working, the first effects are often incredibly dull. You shower. You answer your friend\u2019s texts instead of ignoring them. You clean your kitchen before it becomes a crime scene. Mood lifts later, after sleep, appetite, and focus have begun to return.<\/p>\n
The most common medications take several weeks to months to demonstrate noticeable effects, albeit with side effects that may appear right away. It\u2019s incredibly frustrating to have the queasiness without the happiness \u2014 that\u2019s why it\u2019s important to go back to your doctor.<\/p>\n
A return visit is also crucial if you\u2019re considering psychotherapy as an alternative. Sometimes, depression is mild enough that it\u2019s reasonable to start there first.<\/p>\n
Cognitive behavioral therapy addresses distorted thought patterns that make depression persist, while other talk therapies can help you untangle depression from complicated grief, trauma, or difficult relationships.<\/p>\n
On the other hand, if you have moderate to severe depression or it\u2019s impacting your ability to work or enjoy life, therapy may be a good addition to antidepressants.<\/p>\n
Medications and psychotherapy are not mutually exclusive. You may want to use both to get the most out of each, as therapy can be difficult to engage with when your brain is in anhedonic overdrive. Sleep, exercise, and sunlight help too, but you wouldn\u2019t tell a lung cancer patient to \u2018just exercise.\u2019 Lifestyle changes are an important part of any treatment, but they don\u2019t make other approaches irrelevant.<\/p>\n
When in doubt, your doctor will most likely start with an SSRI like sertraline, escitalopram, fluoxetine, or paroxetine.<\/p>\n
They\u2019re versatile, generally well-tolerated, and effective at treating a range of anxiety and mood disorders.<\/p>\n
That doesn\u2019t mean they\u2019re all the same.<\/p>\n
Suppose one patient is already sleeping too much and doesn\u2019t need additional sedation, while another hasn\u2019t been able to eat and would benefit from the antidepressant\u2019s appetite stimulation. Another patient had a previous SSRI and couldn\u2019t have sex for months after quitting. These are all valid considerations when choosing between medications.<\/p>\n
Bupropion is much less likely to cause sexual dysfunction but can make some people feel restless or unable to sleep. It\u2019s also not right for everyone or every depression. Our Wellbutrin<\/a> guide goes more into depth on what it is and who might benefit from it.<\/p>\n Finding the right medication sometimes involves trial and error. This doesn\u2019t mean psychiatry is voodoo \u2014 it means there\u2019s no blood test available to tell you which one your brain will respond to best.<\/p>\n Nausea, headaches, diarrhea, dry mouth, sleepiness, and insomnia can come with antidepressants \u2014 usually early on and ease after a couple of weeks. Some people experience these for the entire time they\u2019re on the medication, which can be a reason to switch.<\/p>\nThe side effects you actually want to know about<\/h2>\n