Even most sceptics agree that antidepressants have psychological effects. These vary from person to person, but many describe a slight dampening of their emotions — a feeling of being chilled out.
Yet strangely, although the flattening happens quickly, within days or sometimes even hours of the first dose, depression itself usually does not abate until several weeks later, as if it takes time for people to relearn their old ways. One alternative explanation for how antidepressants work is that they boost the growth of new brain cells, which takes weeks.
On top of their mysterious mechanism, there is also controversy about just how many people benefit from antidepressants. That stems from work by Irving Kirsch , a psychologist at Harvard Medical School, beginning in the s. He says he initially had nothing against antidepressants and sometimes recommended them to his psychotherapy clients. Kirsch was studying the placebo effect , the mysterious improvement in some cases of illness, apparently by the power of mind over matter, after people take medicines known not to work.
Antidepressants had been known for decades to show a much bigger placebo effect than other commonly prescribed medicines such as antibiotics — a case of mind over mind. When Kirsch and his colleagues pulled together results from many different trials that compared antidepressants with placebo tablets, they found that about a third of people taking placebo pills showed a significant improvement.
This was as expected. Aside from the classic placebo response, it could have been due to things such as the extra time spent talking to doctors as part of the trial, or just spontaneous recoveries. What was surprising was how people on antidepressants were only a little more likely to get better than those on the placebos.
They have since been reproduced in several other analyses, by his group and others. As a result, some clinical guidelines now recommend medication only for those with severe depression, where meta-analyses suggest a bigger benefit.
But these are no panacea, and the wait for such treatment on the NHS can be many months. In practice, pills are often still the first resort in the UK and many other places.
For mild or moderate depression, UK, Australian and New Zealand guidelines among others recommend talking therapies such as cognitive behavioural therapy. Lifestyle changes can also help, including cutting down on alcohol , establishing regular sleep patterns and being physically more active. For people with severe depression, the last resort is electroconvulsive therapy: subjecting the brain to electric shocks under anaesthesia. This is thought to be quite effective, but often causes memory loss.
New medicines based on ketamine may become available in the next few years. Although developed as an anaesthetic and snorted as a recreational drug, doctors have found that a single injection can alleviate severe depression, with benefits lasting for many months.
A recent development suggested that the criticisms of antidepressants were misplaced after all. It covered 21 of the commonest antidepressants and encompassed more than international trials, both published and unpublished, with over , participants.
For each drug, people were more likely to benefit from antidepressants than dummy pills. The size of the effect varied, but most medicines were about 50 per cent more likely to produce a response than placebos. You may have to try a few different ones before you and your provider find the best one for you.
Antidepressants can help balance chemicals in our brains. This can lead to improved moods, concentration, and sleep. It may take a few weeks often four to six for these medications to fully work. Selective serotonin reuptake inhibitors SSRIs are the most prescribed type of antidepressant and include:. Common ones include venlafaxine and duloxetine. It also treats seasonal affective disorder and helps people stop smoking.
To improve the symptoms of depression, the effectiveness of antidepressants can be improved when used together with psychological therapies and lifestyle changes. Read more about depression.
There is a variety of groups or classes of antidepressants available in New Zealand. Each class works on different chemicals in your brain and may cause different side effects. We don't know for certain, but we think that antidepressants work by increasing the activity of certain chemicals working in our brains called neurotransmitters. They pass signals from one brain cell to another. The chemicals most involved in depression are thought to be serotonin and noradrenaline.
S ome people will respond to one antidepressant better than another so changes may be needed. Selective serotonin reuptake inhibitors SSRIs are the most frequently prescribed antidepressants. SSRIs are called selective because they only affect serotonin. The exact antidepressant medication you are prescribed will depend on the severity and type of your illness, if you have other medical conditions, if you are taking other medication, your response to antidepressant medication in the past and possible side effects.
When deciding on the best medication for you, it's important to discuss with your healthcare provider the possible side effects of the medication and how they are likely to impact on your lifestyle. There are many ways to manage side effects. And lowering the dose or changing medicines may also help. Are you depressed? The symptoms of depression include a loss of interest in daily activities or feeling sad or hopeless and having at least four of the following symptoms: A change in eating patterns that causes either weight gain or weight loss Sleeping too much or not enough Feeling restless and unable to sit still, or feeling that moving takes a great effort Feeling tired all the time Feeling unworthy or guilty without an obvious reason Having problems concentrating, remembering, or making decisions Thinking often about death or suicide.
What are antidepressants? Antidepressants don't change your personality. They help your symptoms. How well do antidepressants work? What side effects can antidepressants cause?
Side effects may vary depending on the medicine you take, but common ones include: Nausea. Dry mouth. Loss of appetite. Diarrhea or constipation. Sexual problems loss of desire, erection problems. Trouble falling asleep, or waking a lot during the night. Weight gain. Feeling nervous or on edge. Feeling drowsy in the daytime.
What are other treatments for depression? Counselling Counselling is an important part of the treatment for depression. The types of counselling most often used for treatment of depression include: Cognitive-behavioural therapy , which teaches you how to become healthier by changing certain thought and behaviour patterns. Interpersonal therapy , which focuses on your relationships and the problems they may be causing. Problem-solving therapy , which focuses on the problems you are facing and on helping you find solutions.
Family therapy , which involves the entire family. Lifestyle changes There are also lifestyle changes you may be able to make that may help your depression symptoms: Eat healthy foods. Don't drink alcohol. Get regular exercise. Get a good night's sleep. Get social support from family and friends. Try to keep a positive attitude—remember that feeling better takes time, and your mood will improve little by little.
Other treatment choices Besides counselling and lifestyle changes, there are some other treatments you can try: Alternative treatments such as massage therapy and yoga may help you get better faster and make your life better. You can try relaxation exercises at home to lower your stress. Complementary therapies are sometimes used for depression. Talk to your doctor before taking any of them, because they can interfere with other medicines.
Electroconvulsive therapy may be used to treat severe depression or depression that hasn't responded well to other treatment. It also may be a treatment choice for someone who cannot live with the side effects of antidepressants. Why might your doctor recommend antidepressants? Your doctor might suggest that you try antidepressants if: You have tried counselling and lifestyle changes, and they haven't worked. Your symptoms are bad enough that they interfere with your daily life.
Compare your options. Compare Option 1 Take antidepressants Don't take antidepressants. Compare Option 2 Take antidepressants Don't take antidepressants. Take antidepressants Take antidepressants You take a pill or liquid medicine one or more times a day for months or sometimes years. Antidepressants can improve or completely relieve symptoms. Antidepressants usually help when counselling and lifestyle changes haven't worked.
It takes weeks, and sometimes months, for the medicine to start working. You may have to keep taking antidepressants for a long time. Side effects—which can include nausea, diarrhea or constipation, sexual problems, weight gain, and trouble sleeping—cause many people to stop taking the medicine. Don't take antidepressants Don't take antidepressants You treat your depression with counselling, such as cognitive-behavioural therapy CBT or interpersonal psychotherapy IPT.
Many studies show that CBT helps mild to moderate depression as much as antidepressants. You may try alternative treatments, such as massage and relaxation techniques. Counselling works well for many people who have depression.
Studies show that people who receive CBT have lower rates of relapse after treatment has stopped compared to people treated only with antidepressants.
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