Antidepressants may be prescribed to treat and relieve symptoms of depression and anxiety. Decisions about medication and dose adjustment(s) are best made in consultation with your medical provider. As a psychologist, I do not prescribe but together we can work closely to help you benefit maximally from therapies customized for you.
Is an antidepressant for you and how and when do you know?
These are important questions to discuss with your medical provider and therapist. For example, a time may come in the future or may be right now when life and/or therapy are deeply stuck for an extended period because of high anxiety, depression, etc. An antidepressant (or dose change) can sometimes help nudge things unstuck by reducing overall distress, which in turn enables greater engagement in and benefits from any therapy—CBT, meditation, exercise, etc.
What are commonly prescribed Antidepressants and how long for their best effects?
Lexapro (Escitalopram) is by far the most commonly prescribed in primary care settings because of fewer side effects and it may kick in positive effects by the 10th day. However, some PCP (primary care providers) instead favor Zoloft (Sertraline) particularly when the client is pregnant or elderly. All of the serotonin agents typically can take up to 2-3 months at any dose level to show their best effects as well as up to 3 months for best control of OCD obsessive thinking.
What are some important details about Antidepressants?
As a group, Selective Serotonin Reuptake Inhibitors (SSRIs) are the most prescribed group and include: Prozac, Zoloft, Celexa, Paxil, and Lexapro. Other serotonin agents are the SNRIs—serotonin norepinephrine reuptake inhibitors (Effexor, Cymbalta, others). SNRIs may be preferred when pain is a significant presenting problem. There are also older Antidepressants such as tricyclics and MAO inhibitors which are much less used today. Of the SSRIs, Paxil may have side effects of more fatigue and weight gain compared to other SSRI’s.
Can expectations for Antidepressants be too high?
Answers vary. Yes, some are greatly helped but others may be sorely disappointed. Some solid studies reveal full symptom improvement in 1st time antidepressant users (in the first 3 months with dose adjusted) to be only 33%. This means that the majority (67%) of 1st time antidepressant users are helped only partly or not at all in 3 months. Of this 67% group, only 1 in 4 may achieve full improvement by 6 months even with more dose adjustments, etc. However, take heart because more individuals are helped over time, particularly WITH PATIENCE, dosage adjustments, or addition of a second antidepressant. Of course, if the prescriber is very experienced, this is often helpful too!
To take an antidepressant or not…to discontinue it or not?
Again, these are questions for your primary care office. Rather than agonizing over whether to take it or not, it may be more skillful to have an extended trial (such as 9-12 months) and then compare advantages versus disadvantages? If wanting to stop earlier than planned, your primary care provider can give you advice regarding pace of discontinuation.
How does exercise compare to Antidepressants as a treatment for depression and anxiety?
Some individual disinclined toward Antidepressants may want to first try a daily exercise program—probably equivalent to an hour a day and involving some aerobic and strength training components. A number of solid studies find regular exercise alone to be helpful and even equivalent to Antidepressants in improving mild to moderate depression/anxiety. If hesitant about Antidepressants and can carve the time, a daily exercise program might be the place to start for you!
Are Antidepressants associated with weight gain?
The answer varies. Some menopausal or post-menopausal women as well as others report weight gain over time on serotonin Antidepressants. Of all of the serotonin choices, Paxil is often less prescribed because of its side effects of most weight gain and/or most fatigue. By contrast, the antidepressant Wellbutrin—not a serotonin agent–is much less associated with weight gain but not as good at treating anxiety as serotonin agents. Many complicated factors are involved and so this question is another one to discuss fully with your medical/health providers.
Do I need to do medication and therapy at the same time?
Research has shown that, for some, combining Talk Therapy and antidepressant medication outperforms either medication or psychotherapy alone. On an ongoing basis, we can evaluate effects of your therapies as well as help you prepare feedback for your prescribing provider. The goal is to help you find the treatments that best lead to a more satisfying life.
Take away thoughts…
The combo of Talk Therapy and Antidepressants may accelerate your progress in therapy and life. If you are open to trying an Antidepressant or have used them and been disappointed, I encourage you to work closely with your therapist and medical provider to reach the best outcomes for you.