Even if you’ve never taken an antidepressant, you’re probably familiar with the criticism and controversy that surrounds these drugs. It’s not uncommon to hear things like: “Those pills are just a placebo.” “You’ll definitely gain weight.” “Once you start, you’ll become dependent on them.”
Is any of this true?
Some of these statements have “a kernel of truth,” said Dr. Gerard Sanacora, a professor of psychiatry at the Yale School of Medicine. And it’s important to set the record straight because the expectations people have about their treatment — whether good or bad — “really do play a large role in how the treatment actually unfolds,” he added.
Dr. Sanacora and other experts addressed some common questions and misconceptions about antidepressants.
Will antidepressants change who I am?
When an antidepressant starts to work, you may feel like a different person in some ways, said Naomi Torres-Mackie, a clinical psychologist in New York City.
“Picture this giant, dark cloud weighing you down — as that lifts, the world is going to look different,” she said, adding: “But as you get used to it, you may see that it actually allows you to have more joy in your life.”
On the other hand, up to half of people who take antidepressants may experience some degree of emotional blunting or numbed emotions, and research suggests that the blunting is more likely to happen with a higher medication dosage.
When antidepressants are working correctly, patients should still feel a range of emotions, even if the sadness they used to feel every day is gone, said Dr. Laine Young-Walker, chair of the department of psychiatry at the University of Missouri School of Medicine.
If you’re experiencing emotional numbing, it’s worth a discussion with your provider. And if you take medication, it may help to lower the dose.
Will antidepressants make you gain a lot of weight?
On average, patients will gain a little weight — one to three and a half pounds over two years, according to a recent study. But there’s a lot of variability from patient to patient.
Initially, selective serotonin reuptake inhibitors, or S.S.R.I.s, and their chemical cousins S.N.R.I.s often have the opposite effect, causing people to temporarily lose their appetite (and also lose weight). But studies have shown that patients tend to gain weight when these drugs are used for several months or more. Bupropion (branded as Wellbutrin), which is not an S.S.R.I. or an S.N.R.I., tends to be the least likely to make people gain weight, the recent study found.
In some cases, patients may put on pounds simply because the medication is working, the experts said, and one of the side effects of depression is a loss of appetite. Some may not gain any weight at all, and others may gain much more than expected, said Dr. Jonathan E. Alpert, chair of the department of psychiatry at Montefiore Einstein.
If you notice that you’re starting to gain weight, let your doctor know right away so that you can discuss strategies to manage your weight, he added.
Do these medications work right away?
Generally, it takes about four to six weeks for an antidepressant to start working, the experts said. But sometimes the first medication you try isn’t the right one.
“A lot of the folks I work with who have had the most success on antidepressants have tried a couple — like two or three — because, like a lot of things in life, there actually isn’t one size fits all,” Dr. Torres-Mackie said.
A large study of multiple antidepressants found that half of the participants had improved after using either the first or second medication that they tried, and nearly 70 percent of people had become symptom-free by the fourth antidepressant.
Will antidepressants make you feel suicidal?
In 2004, the F.D.A. ordered pharmaceutical companies to include a “black box” warning on antidepressant drugs stating that some may be linked to suicidal ideation and behaviors in adolescents. The warning was later extended to include people ages 18 to 24.
The F.D.A. based its decision on an analysis of drug trials in which there was a significant risk of suicidal thoughts but no suicides.
But now some experts say that the warning ought to be re-evaluated, given that other studies have found S.S.R.I.s to be associated with lower suicide rates as well as a lower risk of suicidal behavior among young people.
Are they addictive?
Antidepressants aren’t considered addictive by mental health experts because people don’t crave them — and they don’t risk their jobs, relationships or lives to use them, Dr. Alpert said.
But antidepressants can produce withdrawal symptoms, particularly among long-term users, including restlessness, trouble sleeping, sweating, mood changes, stomach problems and “brain zaps,” which feel like electric shocks.
To minimize these problems, it is important to consult your health care provider if you plan to stop taking an antidepressant.
Won’t they ruin your sex life?
It’s not guaranteed that you’ll experience sexual problems while taking an antidepressant, but with some medications, particularly S.S.R.I.s and S.N.R.I.s, it is likely.
More than half of people taking antidepressants report sexual side effects like lowered libido, delayed orgasm and numb genitals, making sexual dysfunction one of the most common problems associated with the drugs.
And some people have said that their sexual problems continued long after they stopped taking S.S.R.I.s. — a condition known as post-S.S.R.I. sexual dysfunction. Researchers have not yet quantified how often this tends to occur.
It’s worth noting that untreated depression can also dull someone’s sex drive and create difficulty reaching orgasm.
Are they any better than placebos?
Antidepressants, like many medications, don’t always perform markedly better than placebo in clinical trials — but that doesn’t mean that they’re the same as a sugar pill, Dr. Sanacora said.
Overall, studies suggest that antidepressants do improve depression symptoms but the benefits are modest. The drugs are generally more effective for severe depression than for mild depression.
It’s a difficult thing to study because depression may get better on its own, and different types of depression may require different types of treatments. In addition, the placebo effect can deliver a powerful benefit to some patients that is often hard to tease apart from the effects of the drug itself.
At the end of the day, “what we’re most concerned about is people’s well-being and improving their mental health,” Dr. Torres-Mackie said.
