If you receive a diagnosis for depression, or have depressive symptoms, you’re probably curious about antidepressant medication, and have a list of questions you need answered before you start treatment.
You’re not alone: there are millions of people in the U.S. with depression – and a large percentage of them engage in professional treatment and support with both psychotherapy and medication. In this article, we’ll address the ten most common questions people with depression ask about antidepressant medication when they first receive a diagnosis for depression.
Data from the National Health and Nutrition Examination Survey (NHNES) show that between 2015 and 2019, 13.2 percent of adults in the United States used prescription antidepressant medication in the month before taking the survey. This past-30-day metric is a proxy for current use. Based on that data, we estimate – using population information from the U.S. Census – that close to 44 million adults in the United States currently use antidepressant medications.
The NHNES also shows the following:
Antidepressant use was higher among women than men:
- 17.7% women
- 8.4% men
Use was highest in older women:
- 24.3% for females age 60+
Use varied by education level:
- 14.3% for college graduates
- 11.5% for high school graduates
- 11.4% for non-high school graduates
Finally, the survey identified differences in use by race/ethnicity:
- 16.6% among non-Hispanic white adults
- 7.8% among non-Hispanic black adults
- 6.5% among Hispanic adults
- 2.8% among non-Hispanic Asian adults
That information is eye-opening: tens of millions of people in the U.S. are on antidepressant medication, and there’s significant variation in use among demographic groups. Because use of these medications is so prevalent, I’m writing this article to answer several basic questions about antidepressants with information people need to know. This article can help people seeking treatment with antidepressant medication, people currently in treatment with antidepressant medication, and friends and family of people in treatment or seeking treatment for mental health diagnoses with antidepressant medication.
Antidepressant Medication: Top Ten Questions
When we prescribe antidepressant medication to our patients, these are the ten questions they ask most often. The answers below are based on a combination of our extensive clinical experience and a review of the latest peer-reviewed research.
1. What types of medications help people with depression?
The standard medications for people with depression fall into two categories:
- Selective serotonin reuptake inhibitors (SSRI). These medications work by preventing the reuptake of the neurotransmitter serotonin by brain cells. Serotonin is associated with positive mood, and increase levels of circulating serotonin can improve mood. The most common SSRIs include Zoloft, Prozac, Luvox, Paxil, Lexapro, and Celexa.
- Serotonin-norepinephrine reuptake inhibitors (SNRI). These medications block the reuptake of the neurotransmitters serotonin and norepinephrine by brain cells. Increased serotonin can improve mood, and increased norepinephrine can increase levels of energy and motivation. The most common SNRIs include Effexor, Pristiq, Fetzima, Cymbalta, and Savella.
In addition, two new medications – ketamine and Spravato – can help people with treatment resistant depression (TRD). Treatment-resistant depression is defined as depression that does not respond well to at least one unsuccessful attempt at a treatment plan using SSRIs or SNRIs.
- Ketamine/IV ketamine. Ketamine works by increasing the number of receptors in brain cells that bind to neurotransmitters involved with mood and neuroplasticity. Evidence shows these changes can lead to rapid relief of depressive symptoms.
- Spravato is a type of ketamine called esketamine, and works in the same way as ketamine. Whereas ketamine is most often administered orally or intravenously, Spravato is administered intranasally (through the nose) in a fine powder form – delivery is exactly like a nasal allergy spray.
2. What is the most powerful antidepressant?
There’s not one that’s significantly stronger or more powerful than any others. Response to these medications varies by the individual, the severity of their symptoms, and various genetic, medical, and lifestyle factors.
3. Which medication works best for people diagnosed with both anxiety and depression?
Evidence shows both common types of antidepressants can help people with comorbid anxiety and depression. However, as we mention above, patients with treatment-resistant depression (TRD) may experience symptom relief with new medications, e.g. ketamine and derivatives, when standard, first-line medications don’t provide adequate symptom relief.
4. How do psychiatrists choose which medication to prescribe?
Psychiatrists use a variety of factors to choose which medication to prescribe, beginning with the diagnosis. Once they determine an accurate diagnosis, they review:
- Patient goals
- Symptom severity
- Medical history
- Mental health history
- Mental health treatment history – therapy and/or medication
Once they know and understand all of the above, they present a range of options to the patient, with special attention to various side effects and other factors related to the medication. When the patient has the complete picture, psychiatrist and patient reach a joint decision about what medication to add to the treatment plan
5. Are there blood tests that can tell which antidepressant might work best?
Not really. However, there are currently no tests that can tell which antidepressant will offer the most significant symptom relief.
6. What is the most commonly prescribed antidepressant in the U.S.?
A report on prescription antidepressants in 2023 – based on insurance claim data – shows the top 5 most commonly prescribed medications:
- Zoloft
- Trazadone
- Prozac
- Cymbalta
- Lexapro
7. How long do standard antidepressants take to start working?
The time it takes depends on the individual. In some cases, SSRIs and SNRIs can begin relieving symptoms within 1-2 weeks. In other cases, it may take 1-2 months.
8. Do any medications for depression work more quickly?
Yes. for some patients, medication such as ketamine can offer symptom relief within hours.
9. Are some more difficult to stop taking than others? Are there side effects when you stop taking antidepressants?
In some cases, discontinuing antidepressants has a withdrawal effect, known as discontinuation syndrome. The presence and/or severity varies by individual, determined by:
- Patient medical history
- Current dosage
- Length of time at current dosage
The following mnemonic device can help people remember the symptoms of antidepressant discontinuation syndrome: FINISH.
- Flu-like symptoms
- Insomnia
- Nausea
- Imbalance, i.e. dizziness, vertigo, lightheadedness
- Sensory abnormalities, such as itching, tingling, and sensations that resemble a mild electric shock
- Hyperarousal, i.e. agitation/irritability
10. What can people who don’t want to take medication or go to therapy do to help depression?
We recommend professional treatment and support for people with depression. The best treatment plans include a combination of psychotherapy, medication, family and peer support, and lifestyle modifications. In the absence of therapy and medication, the following choices can help manage the symptoms of depression:
- Sleep hygiene: 7-8 hours of sleep per night
- Healthy diet: prioritize fresh fruits and vegetables, whole grains, and learn protein. Avoid alcohol, caffeine, and drugs. Reduce processed foods, added sugar, and red meat.
- Daily exercise/activity: check the CDC guidelines for activity and follow them the best you can. Any exercise or activity is better than none.
- Relaxation/stress management: Yoga, mindfulness, and meditation are effective, non-medical, no-therapeutic methods for reducing stress and improving overall mood and personal wellness.
- Social support: community peer support groups for depression resemble group therapy, but are less formal, and can help people with depression learn from the experiences of other people with depression
- Hobbies: it’s important to stay interested and engaged in and with the world. Finding a hobby is a good way to meet like-minded people, and preferable to spending time in isolation. Hobbies can improve mood, boost self-esteem, and give people with depression something concrete to look forward to.
Therapy, Medication, and Lifestyle Changes
We hope that the information about antidepressant medication – and any questions you have – is covered in the answers we provide above. Before we close this article, we’d like to point out something interesting.
When we researched the facts on rates of antidepressant prescriptions, we learned that the most prescribed medications in the U.S. are for hypertension and cardiovascular disease.
That’s interesting for several reasons:
- Hypertension and cardiovascular disease – like depression – are both chronic medical conditions
- All three conditions respond well to a combination of medication and lifestyle changes.
- Community support, peer support, and family support improve outcomes for all three conditions.
Finally, we’ll point out that successful treatment for all three start with a positive relationship between patient and provider, built on a foundation of trust, respect, and understanding. And with regards to depression, that relationship can make all the difference. Alongside medication and lifestyle changes, a productive, positive treatment alliance with a skilled and experienced therapist can improve outcomes and help people with depression manage their symptoms and lead a full and productive life.
Gianna Melendez
Jodie Dahl, CpHT