What to Expect When You Start Depression Medication

Nearly one in five people with ADHD will have a depressive episode this year. If you’re one of them, antidepressants can be game-changing. But with so many medications available, questions abound. Here, find your questions answered by a leading expert.

ADHD prescription bottles with blue and red pills
ADHD prescription bottles with blue and red pills

Depression impacts at least 18% of people with ADHD, and the risk of developing depression is about 2.5 times higher for people with ADHD than it is for the general population. Perhaps even more sobering: half of all depressive cases are rated by the patient and the clinician as severe to extreme. In other words, early and effective detection and intervention are essential for patients with depression.

The best evaluation and treatment guidance will always come from a mental health professional who understands the specifics of your situation. However, we know from a large body of research that antidepressants can be incredibly helpful in treating depression in the majority of cases, especially when medication is paired with cognitive therapy.

What’s the Best Antidepressant?

There are seven different classes of medications used to treat depression and they’re all pretty much the same in terms of their response rate. About 70% of people are going to respond positively to whichever medication their doctor pulls off the shelf to try.

Given this, the choice is most often governed by two other considerations:

  1. cost and insurance coverage
  2. tolerability (i.e., the side effects of that particular medication)

If one kind of medication is causing side effects, such as weight gain, sexual side effects, dry mouth, or nausea, there are many others you can try to avoid these issues.

[Read: Treating Comorbid Mood Disorders Safely]

In some cases, doctors choose antidepressants based on which medication they think will treat associated symptoms most effectively. Patients that are experiencing anxiety in addition to depression tend to find success with SSRIs like Zoloft or Lexapro while patients experiencing lethargy might benefit from one of the more activating antidepressants such as Wellbutrin or Effexor XR. When chronic pain is also an issue, Cymbalta, which has a full FDA indication for treating several pain conditions, might be preferred. For patients with cognitive decline, Brintellix is a common choice.

Classes of Antidepressants: An Overview

  • SSRI (selective serotonin reuptake inhibitors)

Includes: fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil)

  • SNRI ​​(serotonin and norepinephrine reuptake inhibitors)

Includes: duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq)

  • Atypical Antidepressants

Includes: bupropion (Wellbutrin XL), mirtazapine (Remeron), vortioxetine (Trintellix)

  • Tricyclic Antidepressants

Includes: nortriptyline (Pamelor), amitriptyline (Elavil), doxepin and desipramine (Norpramin)

  • Monoamine Oxidase Inhibitors (MAOIs)

Includes: tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan)

  • Serotonin Modulators

Includes: nefazodone, trazodone, vilazodone, vortioxetine

  • NMDA Antagonists

Includes: esketamine intranasal, memantine, Namenda

[Read: 6 Unexpected Signs of Depression]

Do Antidepressants Work?

  • Roughly 70% of people get a good response to practically any antidepressant they try. The 30% who don’t can try another class.
  • Half of those who get a response get full remission. The other 50% of patients often feel better, but don’t feel as though they’re fully back to their old selves. They may benefit from an augmenting agent.

What’s An Augmenting Agent?

Augmenting agents refer to medicines taken in conjunction with antidepressants that help people who are experiencing some benefit, but not full remission, from the antidepressant. Augmenting agents can boost a partial response to a full response. The most common ones include aripiprazole (Abilify), an ADHD stimulant medication (amphetamine or methylphenidate), thyroid hormone, lithium, or a second antidepressant from a different class.

How Long Do Antidepressants Take to Work?

One of the most important things to remember when starting antidepressants is that they do not work immediately, as ADHD stimulant medication does. If you don’t notice an immediate improvement in symptoms, that does not mean the medicine isn’t effective. Here is what patients can expect, in terms of symptom relief and side effects:

For the first 10-14 days:

In the first two weeks, side effects will likely outnumber benefits. Initial side effects (which are likely to resolve later) include sleep disturbances, headache, dry mouth, dizziness, nausea, and loose bowel movements. Noticeable depression symptom relief is unlikely.

After about 2 weeks:

Two main symptoms of depression — irritability and crying spells — typically subside. These improvements can go unnoticed unless you’re actively looking for the change, so pay special attention to this. Any side effects also typically dissipate during this time.

After about 10 weeks:

This is the point at which you should be seeing everything that medication at that dose is going to do. If you do not have full remission by 10 weeks, you should discuss an augmenting agent with your clinician.

How Long Do You Stay on an Antidepressant?

The length of time you should stay on medication for depression depends on a wide range of factors and should be decided in discussion with your doctor.

That said, multiple studies have shown the following for individuals who experienced full remission:

  • When they stopped taking medication after 12 months, 5% of people relapsed to the depressive syndrome they experienced previous to medication.
  • When they stopped before nine months, 75% relapsed.

Consequently, you are highly likely to relapse if you stop taking medication any time before one year on the medication(s)  So, it is best to keep taking the antidepressant medication for a whole year even if you are feeling back to your old self.

All of the mood disorders are what we call “kindling illnesses” — that is, the more episodes you have, the more you will have in the future and the more severe they will get with each repetition. Statistically, if you immediately treat each depressive episode for a full year, you should expect 3 episodes in your whole life. If, on the other hand, you do not treat each episode completely or stop as soon as  you as you feel better, you can expect 17 more depressive episodes through your life with each one becoming progressively more impairing, more painful, longer, and closer together.

How Do You Stop Taking Antidepressants?

As with any medication that works in the brain, it’s not a good idea to stop taking antidepressants suddenly. Some antidepressants can cause withdrawal-like symptoms and can worsen depression when stopped suddenly. If you’re thinking about ceasing your antidepressant medications, speak with your doctor about it and then taper off slowly according to their guidance.

Depression Medication: Next Steps

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