Antidepressants: the basics

Antidepressants are medicines that can ease depression. They help many people, especially with moderate or more severe symptoms, and often work best together with therapy. They aren't the right choice for everyone, and deciding is something you do with a prescriber.

This page explains the basics. It isn't advice about any specific medicine or dose. Talk to a health care provider before starting, stopping or changing any medicine.

Who can prescribe

Primary care doctor

Many people start here. Primary care doctors prescribe most antidepressants in the US.

Psychiatrist

A medical doctor who specializes in mental health. Helpful if things are complicated, or if first treatments haven't helped.

Psychiatric nurse practitioner (PMHNP)

A nurse practitioner trained in mental health who can evaluate and prescribe.

Some primary care practices offer collaborative care: your doctor prescribes, a care manager checks in with you, and a psychiatrist advises on your plan.

Common types

SSRIs

Selective serotonin reuptake inhibitors. The most commonly prescribed type, because they tend to have fewer side effects than older medicines.

SNRIs

Serotonin and norepinephrine reuptake inhibitors. Similar to SSRIs, acting on a second brain chemical too.

Bupropion

Works differently from SSRIs and SNRIs, and has a different set of side effects.

Mirtazapine

Another type. It can help with sleep and appetite, and can cause drowsiness and weight gain.

Older types, like tricyclics and MAOIs, cause more side effects but can be the best option for some people. No one type works best for everyone. You may need to try more than one to find what suits you.

What to expect

• Antidepressants take time, usually 4–8 weeks, to work fully. Sleep, appetite, energy and focus often improve before mood does.
• Side effects are common at first and often ease within a few weeks. Tell your prescriber about any that bother you. There are usually ways to help, like changing the time you take it or trying a different medicine.
• Don't stop suddenly, even if you feel better. Stopping quickly can cause unpleasant effects and can bring symptoms back. Your prescriber can help you lower the dose slowly when the time is right.
• Tell your prescriber about every other medicine and supplement you take, and about alcohol or drug use.

Important safety information

Children, teenagers and young adults under 25 may have more suicidal thoughts or behavior when they take antidepressants, especially in the first few weeks or when the dose changes. These medicines carry an FDA warning about this. People of all ages should be watched closely during this time.

If you or someone you care for has new or worse thoughts of suicide, call or text 988, and tell the prescriber right away. In immediate danger, call 911.

Before starting an antidepressant, it's important to check for bipolar disorder. If you've had times of feeling unusually high or energetic, or needing much less sleep, for several days in a row, tell your prescriber. Bipolar depression is treated differently, and antidepressants on their own can sometimes trigger those high periods.

If it isn't helping

If you've taken a medicine for 6–8 weeks and aren't feeling better enough, talk with your prescriber. Options include changing the dose, switching medicine, adding a second medicine, or adding therapy. If two or more medicines haven't helped enough, see when treatment hasn't worked.

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