FAQ: Antidepressants

Research shows that people who take antidepressants experience improvements in their depression, as well as subtle, but significant, improvements in quality of life. They report feeling less reactive to difficult life events, having fewer negative obsessive thoughts, and they can pause and consider their feelings and actions in a more balanced way. They also report they can let go of negative thought patterns more easily and they feel less haunted by past traumatic events.

People taking antidepressants may have more energy, may sleep better, and may concentrate better. Antidepressants are also effective for reducing panic attacks, general worries, and anxiety. 

It is better for people who are depressed not to drink alcohol. Although alcohol can provide some short-term relief, it usually worsens depression in the long run. Most people find that they get more intoxicated on less alcohol while taking an antidepressant, so if you choose to drink, it is important to do so carefully.

Alcohol can also reduce inhibitions, including inhibitions against suicide and self-destructive behavior. More than 50 percent of people who commit suicide are found to have been drinking.

If you drink while taking an antidepressant and find that you are very depressed or thinking of suicide, you should immediately call the clinician who prescribed your antidepressant or go to an emergency room. 

Like other medications, antidepressants can produce withdrawal symptoms if stopped suddenly. The most common symptoms are dizziness, vertigo, nausea, gait instability, fatigue, and headache. You may also have a brief reoccurrence of the symptoms you had before starting the medication (such as depression, anxiety, irritability, or oversensitivity). Other symptoms can be quite unusual and have been described as feeling as if “the brain is sloshing around in the head” or feeling “electrical zaps” in the brain or arms and legs. In general, the symptoms of withdrawal last one or two weeks.

It’s important to realize that the symptoms you experience when stopping an antidepressant abruptly are not necessarily the way you would feel if you were taken off the medication gradually. 

Clinicians began hearing this question from patients after news articles reported on a 2002 analysis of published and unpublished studies submitted to the U.S. Food and Drug Administration (FDA) as part of the approval process for several new types of antidepressant medication. This analysis concluded that the newer types of antidepressants are only marginally more effective than placebo.

However, these analyses do not reflect how antidepressants are used in actual practice. Drug trials measure only how a person responds to a single medication taken at a specific dose for a limited time. In clinical practice, however, the patient and clinician work together to find the dose and the medication or combination of medications most effective for you. Most clinicians believe that this process results in much better results than these analyses imply. 

Antidepressants work by affecting neurotransmitter systems in the brain. Neurotransmitters and receptors are the way nerve cells in the brain communicate. A neurotransmitter represents a message sent from one nerve cell to another, and the receptor on the adjacent cell is like the mailbox. Antidepressants increase available levels of some neurotransmitters (messages), which, in turn, improve mood and anxiety. This happens over a period of several weeks.

People commonly refer to antidepressants as “correcting a chemical imbalance,” but this is incorrect. It is more accurate to say the medications create a new equilibrium that results in beneficial brain changes.

We don’t know the exact cause of depression, though it may be the result of a natural response that goes awry at times. But we do know that changing the levels of certain neurotransmitters has a proven, clinically significant impact, and that antidepressants can have therapeutic benefits for patients.