Antidepressants help many individuals achieve meaningful depression symptom relief. They are often prescribed as single medication treatments but are versatile enough to be used in custom combinations when needed. Deep transcranial magnetic stimulation (Deep TMS™) is an FDA-cleared treatment that can also be combined with medication treatments and is particularly effective against treatment-resistant depression. While adverse side effects are possible with antidepressants, the positive aspects may outweigh the negative ones for some individuals.
Read on to learn about the most effective antidepressants for treating depression. Then review the role antidepressants play with depression relapse prevention. Finally, explore how other psychiatric disorders are treated with antidepressants.
Are antidepressants effective? The answer is complex. Many antidepressants have the potential to provide symptom relief, so an individual who does not respond to their first choice has a variety of effective choices. However, 63% of individuals who try their first antidepressant do not find relief. 33% do not respond after two medications and are considered treatment-resistant to antidepressants. For these patients, finding effective treatment may involve more time, adjustment to current medications, and considerations of non-medication treatments.
For those considering antidepressants, medication selection often comes down to individual responsiveness and tolerance of adverse side effects. These five antidepressants at the top of the list in one extensive research review.
Research indicates that long-term use of antidepressants offers some protection from depression relapse—an additional episode of depressive symptoms following a period of remission. One study showed that for individuals who had been taking antidepressants for at least two years, those who maintained treatment had a relapse risk of 39%, while those who stopped treatment had a 56% risk of relapsing. Many of those who discontinued medication also reported a lower quality of life, as well as an increase in depression and anxiety symptoms.
Abrupt discontinuation of antidepressants may also trigger depression rebound—a short-term susceptibility to more intensive symptoms during the first week or two following medication discontinuation. While depression rebound may appear to be similar to the above-mentioned relapse, depression rebound symptoms take longer to appear,and tend to resolve more slowly, even after the reintroduction of antidepressants. Individuals can minimize or prevent depression rebound effects by gradually tapering off their dose over four weeks—as always, under the careful supervision of a licensed mental health professional.
Long-term antidepressant use is the primary recommendation for preventing depression relapse. But this position has stirred controversy about the actual efficacy and benefits of long-term reliance on medication. Despite significant research support for maintaining antidepressant use in the early stages of treatment, the evidence is yet unclear or sufficiently abundant regarding its use during maintenance periods that last several years.
Though antidepressants were initially hailed for their efficacy when treating depressive symptoms, their impact goes beyond mood disorders. The role of neurotransmitter activity in both emotional and cognitive functioning has led to a better understanding of psychological symptoms and the commonalities of many mental disorders.
Several SSRIs are FDA-approved to treat obsessive-compulsive disorder (OCD), in addition to the tricyclic antidepressant clomipramine. When treating OCD, antidepressant doses are increased beyond the typical range for depression. Symptom relief may also take as long as twelve weeks to emerge and a few months before stabilizing. Deep transcranial magnetic stimulation (Deep TMS) has also been FDA-cleared to treat OCD, due to its proven safety and efficacy.
Trauma-focused and cognitive therapies are the primary drivers of PTSD treatment outcomes, while antidepressants are used as a secondary line of treatment to reduce symptom severity. Evidence backs the use of SSRIs sertraline, paroxetine, and fluoxetine, as well as the SNRI venlafaxine as most effective for this purpose. These medications are conditionally recommended by the American Psychological Association (APA) to treat PTSD as they are shown to potentially lead to good outcomes, but the evidence may not be as strong or potential harms and benefits may not balance as favorably.
Several SSRIs and SNRIs can effectively reduce anxiety symptoms. However, the benefits of these medications are small for those with milder symptoms, indicating that other treatments may provide more overall benefit. When compared to the axiolytic family of benzodiazepines, antidepressants appeared to have lower cognitive and motor skill impairment, but not superior efficacy. Research supports the use of cognitive behavioral therapy and exposure-based therapy for anxiety disorders, two therapies known to provide symptom relief without concerns about side effects.
While no antidepressant has been identified as the superior treatment for panic disorders, some SSRIs have been shown to provide specific panic disorder symptom reduction benefits. Specifically, studies have cited that using citalopram for panic symptoms can work well for shorter episodes of panic disorder. SSRIs paroxetine and sertraline are more effective for panic disorders of longer duration. Interestingly, older age was linked with higher clinical improvement in panic symptoms for individuals treated with sertraline.
The efficacy of paroxetine, an SSRI used to treat panic disorders, extends to agoraphobia and social phobia. Both SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRIs) are recommended as treatments for social phobia. MAOIs were the first antidepressant used to treat social phobia, but they are now considered a second-line choice because of adverse effects, such as drowsiness, nausea, and drug interactions leading to a rare disorder called serotonin toxicity.
The efficacy of antidepressants makes them invaluable treatments for depression and beyond. Researchers are still learning about the biochemical mechanisms of antidepressants while discovering innovative ways to use the most effective attributes of these medications. By reducing the burden of symptoms, antidepressants have been proven to offer hope for many patients battling depression and other mental health conditions
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