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What are antidepressants?

Antidepressants are prescription medicines to treat depression. Depression is more than feeling a little sad or "blue" for a few days. It's a very common, serious medical illness that affects your mood and general mental health It can make you feel tired, hopeless, worried, or fearful. It can change your thinking, sleeping, and eating. Depression may make some people think about ending their lives.

But antidepressants can help many people who have depression. Researchers think antidepressants may help improve the way your brain uses certain chemicals that control mood or stress.

Are antidepressants used for other conditions?

A health care provider may prescribe antidepressants for anxiety, chronic pain, or insomnia. Sometimes providers also prescribe antidepressants for other conditions.

What are the different types of antidepressants?

There are many types of antidepressants. Each one works differently. Providers usually prescribe newer antidepressants first because they don't cause as many side effects as older types. They also seem to help more kinds of depression and anxiety problems.

Most of the newer antidepressants belong to one of these three groups:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Atypical antidepressants, which are newer antidepressants that don't fit into the other groups

If these antidepressants don't help, your provider might suggest one of the older antidepressants. The older types include tricyclic antidepressants (TCAs), tetracyclics, and monoamine oxidase inhibitors (MAOIs). Even though these antidepressants may cause more serious side effects, the benefits may outweigh the risks for some people.

Which type of antidepressant is right for me?

Our bodies and brains all work differently. That means one antidepressant won't work for everyone. You may need to try two or more medicines before you find one that works for you.

Your provider will work with you to choose the best option to try first. You'll consider questions such as:

• Which symptoms bother you most? Some antidepressants may do a better job helping specific symptoms, such as trouble sleeping.
• What other medicines and supplements do you take? Some antidepressants can cause problems if you take them with certain medicines and herbs.
• Did a certain antidepressant work well for a close relative? An antidepressant that helped a parent, brother, or sister could be a good choice for you, too.
• Do you have other health conditions? Certain antidepressants can make some other conditions better or worse. Any other conditions that you have will be part of choosing your depression treatment.
• Are you pregnant, planning for pregnancy, or breastfeeding? If so, your provider will help you find a way to treat your depression that's safe for you and your baby.

How long do antidepressants take to work?

Antidepressants usually take 4 to 8 weeks to work, so you'll need to be patient. You may notice that some problems, such as sleeping and eating, get better before your mood improves. That's a good sign. You may just need to give the medicine a little more time to do its job.

Sometimes an antidepressant helps at first, but symptoms return while you're still taking it. But there's usually another one you can try. To get more relief from depression, your provider may suggest combining two antidepressants, using another kind of medicine with an antidepressant, or adding talk therapy or other approaches to improve your mental health.

How long will I need to take an antidepressant?

When an antidepressant starts to work, you and your provider can decide how long you need to stay on it. The typical length of treatment is 6 to 12 months, but some people may stay on antidepressants for much longer.

What are the side effects of antidepressants?

Not everyone has side effects from antidepressants. But if you do have them, they're usually mild and may get better over time as your body gets used to the new medicine.

The most common side effects from antidepressants include:

• Nausea and vomiting
• Weight gain
• Diarrhea
• Sleepiness
• Sexual problems, such as a lack of desire or ability to have sex

When thinking about side effects, it's important to remember that there are also risks from not treating depression. Your provider can help you think through the pros and cons of all your options.

If you have any side effects from antidepressants, your provider may suggest ways to manage them while you wait to see if the antidepressant will work. If the side effects bother you too much, you may need to change antidepressants. But you should never change your dose or stop taking an antidepressant on your own.

If you have serious problems or notice any changes that worry you, such as new or worsening symptoms, unusual changes in your mood, or you start acting differently, call your provider right away.

In some cases, children, teenagers, and young adults under 25 may be more likely to think about hurting or killing themselves when starting antidepressants or when the dose is changed. Get medical help right away if this happens.

What can I do to take antidepressants safely?

Antidepressants are generally safe when you use them correctly:

• Tell your provider about everything you take. That includes medicines, herbs, supplements, and over-the-counter medicines you take, such as pain relievers and decongestants. Be honest about recreational drugs and alcohol, too.
• Try to get all your medicines from the same pharmacy. That way the pharmacist can warn you and your provider if you take medicines that may cause problems when used together.
• Follow all instructions about how to take your medicine.
• Talk with your provider if side effects bother you.
• Never stop taking antidepressants without your provider's help. Stopping too fast may make depression come back. You could even make your condition worse. To stop antidepressants safely, you need to give your body time to get used to being without the medicine. Your provider can tell you the safest way to go off an antidepressant.

NIH: National Institute of Mental Health

What is panic disorder?

Panic disorder is a type of anxiety disorder. It causes repeated panic attacks, which are sudden periods of intense fear, discomfort, or a sense of losing control. These attacks happen even though there is no real danger. They often cause physical symptoms. For example, you may have a rapid or pounding heartbeat and feel like you are having a heart attack.

If you have panic attacks, it doesn't mean you will develop a panic disorder. Many people only have one or two panic attacks in their lifetime and get better without treatment.

But some of the people who have panic attacks do develop panic disorder. They have repeated panic attacks. The attacks can happen as often as several times a day or as rarely as a few times a year. People with panic disorder often worry about having another attack. It may cause them to avoid places and situations where they had panic attacks in the past.

Panic disorder is not life-threatening, but it can be upsetting and affect your quality of life. And if it is not treated, it can sometimes lead to other health conditions, including depression and substance use disorders.

What causes panic disorder?

The cause of panic disorder is unknown. Researchers think that certain factors may play a role:

• Genetics - panic disorder sometimes runs in families. But no one knows for sure why some family members have it while others don't.
• Brain biology and chemistry.
• Your environment.
• Major stress.

Who is more likely to develop panic disorder?

Panic disorder is more common in women than men. It often starts in the late teens or early adulthood. Sometimes it starts when a person is under a lot of stress. People who have had trauma, especially in childhood, are more likely to develop panic disorder.

What are the symptoms of panic disorder?

People with panic disorder may have:

• Sudden and repeated panic attacks of overwhelming anxiety and fear
• A feeling of being out of control or a fear of death during a panic attack
• An intense worry about another panic attack
• A fear or avoidance of places and situations where they had panic attacks in the past
• Physical symptoms during a panic attack, such as:
  • Pounding or racing heart
  • Sweating or chills
  • Trembling or shaking
  • Trouble breathing
  • The feeling that they are choking
  • Weakness or dizziness
  • Chest pain
  • Stomach pain or nausea

Panic attacks can happen anytime, without warning. They can last anywhere from a few minutes to over an hour.

How is panic disorder diagnosed?

To find out if you have panic disorder, your health care provider:

• Will ask about your medical history and symptoms
• May check if an unrelated physical problem is causing your symptoms, for example with:
  • A physical exam
  • Blood tests to check for thyroid problems and other possible conditions
  • Heart health tests
• May do a panic disorder test
• May refer you to a mental health provider for the panic disorder test or other types of psychological evaluations

What are the treatments for panic disorder?

Treatment for panic disorder usually includes one or more of the following:

• Talk therapy, also called psychotherapy or counseling, which can help you understand your feelings.
  • It may include cognitive-behavioral therapy (CBT), a type of talk therapy that helps you change your negative thoughts and how you react to things that cause you to feel anxiety.
• Medicines, including:
  • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Anti-anxiety medicines

Your provider may also suggest that you follow a healthy lifestyle, which may help with panic disorder. It may include:

• Avoiding alcohol
• Reducing caffeine
• Eating regular meals
• Getting enough sleep
• Getting regular exercise

Joining a support group may also be helpful. Support groups can make you feel like you are not alone, and you may learn some new tips on how to cope.

NIH: National Institute of Mental Health