When I first made the decision to go on antidepressants, my emotional and mental states had been careening out of control for some time. Even in moments of relative contentment, intense anguish and debilitating anxiety lingered just beneath the surface, spilling into nearly every facet of my life.
Through seeing a psychiatrist, I would later learn I had depression, anxiety, and obsessive-compulsive disorder, which I suspected but hadn’t been formally diagnosed with when I consulted with my general physician and asked for antidepressants. I just wanted relief—possible side effects be damned—and wanted it immediately.
Going on antidepressants was indeed the right next step for me. They helped alleviate symptoms that made my day-to-day feel unbearable. Still, there was a lot I didn’t know before starting my medication that I wish someone had told me. If you’re considering going on antidepressants for the first time, here are some crucial things to keep in mind.
1. There’s more than one type of antidepressant.
Antidepressants are meant to balance brain chemicals called neurotransmitters, which include serotonin, dopamine, and norepinephrine. Neurotransmitters affect your moods and emotions, and different kinds of drugs target them in different ways.
“The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors, or SSRIs. They tend to have fewer side effects than other antidepressants,” Nadia Ward, Ph.D., deputy director for public affairs at The Consultation Center at Yale and associate professor of psychiatry at the Yale School of Medicine, tells SELF. SSRIs work by blocking the reabsorption (reuptake) of serotonin in the brain, according to the Mayo Clinic. That increases serotonin levels, generally resulting in positive changes like stabilized moods, improved sleep, less difficulty concentrating, and increased appetite, Ward says.
Other kinds of antidepressants include serotonin and norepinephrine reuptake inhibitors (SNRIs, which increase those two neurotransmitters in the brain), monoamine oxidase inhibitors (MAOIs, the first kind of antidepressant developed, which increases serotonin, dopamine, and norepinephrine in the brain), and atypical antidepressants (each of which works differently from the next).
One added benefit of some antidepressants is that their neurochemical effects may help with more than just depression. Some SNRIs, for example, can target anxiety in addition to depression.
2. Different antidepressants can come with different side effects.
SSRIs are often associated with side effects like drowsiness, nausea, dry mouth, insomnia, diarrhea, and headache, among others. They can also result in sexual problems, like a frustratingly low libido or orgasm that’s always out of reach. Other depression treatments come with their own potential downsides. For instance, SNRIs might cause excessive sweating. MAOIs might interact negatively with certain foods and some medications, leading to dangerously high blood pressure, which is why they’re not used as often as newer forms of antidepressants.
Keep in mind, though, that everyone’s body can react differently to different drugs, so this is an individual thing. (That’s why discussing your options thoroughly with your doctor is so key.) Also, these side effects may abate after a few weeks, Ward says. It really just depends.
If your antidepressant is causing side effects you just can’t (or don’t want to) deal with, tell your doctor. This is especially crucial if your meds bring about or exacerbate thoughts of self-harm, which is unfortunately possible since no antidepressant is perfect. “If you are experiencing side effects that are particularly troubling, such as suicidal ideation, contact your doctor immediately,” Ward says.
3. It might take some trial and error to find an antidepressant that works for you.
That’s not to say you definitely won’t hit the antidepressant jackpot on the first go. Some people have that kind of luck! But it’s also not uncommon for the first antidepressant or dosage you try to be at odds with your body in one way or another.
Maybe your treatment fails to provide relief in your ideal timeframe (these drugs typically take four to eight weeks to become fully effective) or falls short in some other way. In any case, rest assured: You’ve got options.
4. Listening to your body when starting new meds is critical.
My antidepressant journey kicked off with major dietary and digestive issues, a virtually nonexistent libido, and persistent headaches that made me wonder if I was dying or had an undiscovered brain tumor (anxiety is a blast).
Weirdly enough, there was a bright side. Taking antidepressants pushed me to be more cognizant of how I felt emotionally, physically, and mentally. This new level of attentiveness became vital in maintaining a healthy relationship with my medication and knowing when it was time to adjust my treatment plan.
Think of yourself as the only liaison between your doctors and your body. No one is as keyed into what you’re feeling and as equipped to communicate your experience. Listen to your gut when something feels off, and address relevant issues—yes, even the embarrassing, slightly shame-inducing, or uncomfortable stuff—with your doctor.
5. Antidepressant withdrawal is a thing, so you shouldn’t stop your meds cold turkey.
If you’re ready to come off your medication, gradually tapering your dosage under the guidance of your doctor is the way to go. Not only could cutting off medication cold turkey trigger withdrawal symptoms like nausea, dizziness, insomnia, and incredibly unpleasant electric-shock sensations, it could worsen the condition or symptoms you’re treating in the first place. If that happens and you decide you do actually want to be on medication, you may have to wait weeks for it to become effective again.
6. In a healthy treatment plan, taking medication might be only one part of the puzzle.
While medication can be incredibly beneficial to some, and in some cases, a literal life saver, it’s crucial to understand that it’s often just one part of effective treatment. “The best treatment plan is, in my opinion, one that is diverse and layered,” Tricia Kayiatos-Smith, M.S.W, a Los Angeles-based clinical social worker and psychotherapist, tells SELF.
Therapy, a support group, and staying in tune with how you feel are all valid additions to your toolbox, she says. So is self-care, which is an integral part of my journey with depression. Continuing to learn what self-care means for me and how I can incorporate it into my daily routine has been invaluable. Small acts like taking time to make myself a nice meal and embracing a more health-conscious diet, getting fresh air with a walk outside when I’ve been cooped up inside too long, regularly decompressing with a good film, and taking a hot relaxing shower have all served a role in helping me feel like my best self.
7. And if therapy is part of your treatment plan, know that finding a therapist you trust can also be maddeningly hard, but it’s so worth it.
I wish I could dole out advice saying, “Follow these simple steps and you, too, can find a therapist that’s a swell match!” In reality, finding someone who understands the layers of your personhood to your liking, is affordable or takes your insurance, is accessible location-wise, and who is accepting new patients can be a total pain. It usually takes some legwork.
“I often say that finding the right therapist is a bit like dating—you find what you can about them online, you meet in person, you feel each other out, and see if there is a connection,” Kayiatos-Smith says. “The right therapist should be welcoming, nonjudgmental, and lovingly challenge you.” Finding a therapist who is a comfortable fit can be a struggle for anyone, but that problem can increase manyfold if you’re a person navigating multiple marginalized identities. Having an intersectional identity, like being a woman of a certain religion, a person of color, trans, queer, or a survivor of trauma informs who you are, Kayiatos-Smith says. “A therapist who understands, or who at least is willing to learn, is essential to providing you with the healing space you deserve.” While some people don’t mind explaining their identities and experiences, it might trigger or exasperate others who want a therapist who also identifies in similar ways, she explains.
To start, consider asking your general physician or even another doctor you like, like your ob/gyn, for a reference. You might want to check in with friends you know are in therapy who you feel comfortable with. Beyond that, you can use tools like the National Alliance on Mental Illness’s HelpLine, which you can email at firstname.lastname@example.org or call at 1-800-950-6264. The HelpLine operates Monday through Friday, from 10 A.M. to 6 P.M., and one of their staffers or volunteers may be able to point you in the right direction. Online resources like GoodTherapy also allow you to search for local therapists using a variety of filters. If you have insurance, your provider might have an online database of therapists you can search through, too.
Once you are seeing a therapist, regularly check in with yourself: Does your therapist listen to your concerns or habitually dismiss them? When you sit down for your session, do you feel you’re in a safe, mutually respectful environment? How do you feel when you leave your appointments? It’s fine for a therapist to be a placeholder until you find someone better suited for your needs—like antidepressants, it might take some time to find the right fit—but your sessions should still feel productive.
8. You don’t need to feel ashamed about being on antidepressants.
When I first went on antidepressants, I’d find myself keeping my medication in the pharmacy bag and tucking it in a discreet pocket of my kitchen so as to hide it from plain view, despite no one else being around. I was confident in my decision to go on meds, but I’d still internalized the stigma. If you’re wrestling with similar feelings, know that for many people, taking antidepressants is a big step towards feeling better and improving their quality of life. An antidepressant may end up being the right fit for you, or it may not. Either way, there is no shame in making an effort to help yourself.