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the-courage-to-heal · 4 years

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If you have moderate to severe depression that affects your daily life, you and your doctor may discuss treatment: usually a combination of antidepressants and a referral to a therapist. In research, antidepressant medications have been found to be similar when it comes to safety and how well they work. Still, my patients tend to bring up similar concerns about using them—and you might, too. Let’s look at 10 of the most common myths and misconceptions about antidepressants here.

1) My depression can go away on its own

Some people think, “Maybe I should just ride it out and not take any medication at all.”

Depression tends to get worse the longer it isn’t treated, and untreated depression can lead to a number of other problems, including weight gain, physical pain and illness, alcohol and drug use, relationship difficulties, and suicidal thoughts or attempts. Additionally, the longer you have untreated depression, the harder it is to achieve full recovery.

2) Antidepressants don’t work

In many folks, they do work. Studies show that anywhere between 40% to 60% of people who take antidepressants see their symptoms improve within 6 to 8 weeks.

Are there differences in how well they work? Not major ones, according to research. For example, selective serotonin reuptake inhibitor antidepressants (SSRIs) like sertraline (Zoloft) and fluoxetine (Prozac) are just as effective for depression as SNRI antidepressants like duloxetine (Cymbalta) and venlafaxine (Effexor).

In controlled research environments, small differences have been observed. Studies seem to show that some of the most effective antidepressants are amitriptyline (Elavil), mirtazapine (Remeron), duloxetine, venlafaxine, and paroxetine (Paxil). Trazodone, fluoxetine, and bupropion (Wellbutrin) may be less effective.

But again, the differences in how well they work are very small. Which one you choose will likely depend on other factors, like if you experience side effects or are taking other medications.

3) Antidepressants have horrible side effects

Antidepressants do cause side effects, but these effects will vary depending on the person, dose, and type of antidepressant.

As a whole, SSRIs such as escitalopram (Lexapro) and fluoxetine (Prozac) reportedly cause the fewest side effects, while tricyclic antidepressants (TCAs) such as imipramine (Tofranil) and nortriptyline (Pamelor) and monoamine oxidase inhibitors (MAOIs) such as tranylcypromine (Parnate) and phenelzine (Nardil) tend to cause more side effects. It’s worth discussing with your doctor if you have concerns.

Antidepressant side effects often go away after a few weeks, but your doctor may adjust your dosing or recommend a different treatment regimen if needed.

4) Antidepressants will make me gain weight

How an antidepressant affects weight depends on the specific drug, and it can also vary from person to person.

In general, most SSRI antidepressants do not cause weight gain. Paroxetine is the only SSRI that might be associated with weight gain, while the others tend to have no effect on weight. Mirtazapine is also a culprit in weight gain. On the flipside, bupropion SR and bupropion XL might actually cause weight loss.

5) I won’t be able to sleep if I take antidepressants

This is a valid concern if you experience insomnia. First, insomnia can be a symptom of depression, so treating your depression might resolve your insomnia. Second, know that different antidepressants have different effects on sleep.

The antidepressants that may lead to trouble sleeping are paroxetine, sertraline, and bupropion.

On the other hand, folks struggling with sleep might want to take advantage of antidepressants with drowsy side effects like amitriptyline, trazodone, and mirtazapine, which may counteract insomnia.

6) If I choose to stop taking antidepressants, I’ll have horrible withdrawal symptoms

Antidepressant withdrawal is possible if you abruptly stop taking an antidepressant. You’re more likely to have withdrawal symptoms if you’ve been taking the antidepressant for at least 6 weeks.

Certain antidepressants are more likely to cause withdrawal symptoms than others. In general, medications that leave your system faster, such as paroxetine, are more likely to cause withdrawal symptoms than those that stay in your system longer, such as fluoxetine.

Symptoms are similar for SSRI and TCA antidepressants and include headache, tiredness, nausea, appetite problems, insomnia, dizziness, and anxiety. Symptoms for MAOIs tend to be more serious and include trouble thinking clearly, agitation, delusions, and hallucinations.

Weaning your dose down over 1 to 3 weeks is the best way to minimize side effects and help prevent withdrawal. Work with your provider on the best dose/schedule.

7) Antidepressants cause sexual side effects

Several types of antidepressants do have sexual side effects, particularly the SSRIs, SNRIs, TCAs, and MAOIs. Effects include lower sexual desire, delayed orgasm, and erection and ejaculation problems.

Bupropion, for example, has very little effect on sexual function and is a good alternative if you are having sexual side effects with another antidepressant. Of the SSRIs, the risk of sexual dysfunction is highest with paroxetine and lowest with fluoxetine and sertraline.

Also, it’s important to find out if your sexual problems are a symptom of your depression, or if they’re actually due to a medication side effect.

8) Antidepressants will make my headaches worse

Not true. Headaches are not commonly reported with antidepressants. In fact, some may even help with headaches. If you have chronic, tension-type headaches, amitriptyline taken at night has been shown to help prevent them. Mirtazapine and venlafaxine are second-line choices that may also help prevent tension-type headaches.

9) Antidepressants will make me sick to my stomach

Most antidepressants do not cause an upset stomach once you and your provider have settled on a fixed dosage. SSRIs cause higher rates of nausea than bupropion and mirtazapine, and rates between SSRIs and trazodone and duloxetine are about the same. Venlafaxine is known for causing nausea more often than SSRIs

10) Antidepressants are expensive

Also not true. Just stay away from newer, brand-name antidepressants because the rest are significantly cheaper. Viibryd and Trintellix are brand-name antidepressants that cost a lot more than generic SSRIs, but they haven’t been found to be much better in terms of treating depression. The only side note is that researchers are looking into whether Trintellix might have an added benefit. In a study from 2018, Trintellix significantly improved cognition (thinking and understanding) among study subjects. Interesting.

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#depression #self help #psychology

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