Kathimerini Greece Newsroom
Even if you’ve never taken antidepressants, you’re likely familiar with the criticism and controversy surrounding them. It’s not uncommon to hear statements like: “These drugs are pure placebo,” “You’ll definitely gain weight,” or “Once you start them, you’ll get addicted.” But how true are these claims?
Some of these opinions contain “an element of truth,” says Dr. Gerard Sanacora, a professor of psychiatry at Yale Medical School. It’s important to clarify these issues, as people’s expectations about their treatment—whether positive or negative—“can have a profound effect on its course and effectiveness,” he adds. Sanacora and other experts address some of the most common questions and widespread misconceptions about antidepressants.
Will antidepressants change your personality?
When an antidepressant starts working, you may feel somewhat different, says Naomi Torres-Macchi, a clinical psychologist based in New York. “Imagine a huge, dark cloud weighing you down—as it starts to dissipate, the world seems different,” she explains. This change may enable you to experience more joy in life, she adds.
However, up to 50% of people on antidepressants may experience some degree of emotional bluntness or numbness. When antidepressants are effective, patients should feel a range of emotions, even if the daily sadness they once experienced has subsided, says Dr. Lane Young-Walker, chair of the Department of Psychiatry at the University of Missouri School of Medicine. If you’re experiencing emotional numbness, it’s important to discuss it with your doctor. Adjusting the dosage may help.
Will your weight increase significantly while taking antidepressants?
On average, weight gain associated with antidepressants is modest—typically between 1 and 3.5 kg over two years, according to a recent study. However, individual experiences can vary significantly. Initially, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) often cause temporary appetite suppression, which may lead to weight loss. Over time, though, studies show that patients often experience weight gain when these medications are used for several months or longer.
Bupropion, which is not part of the SSRI or SNRI classes, appears to have the lowest likelihood of causing weight gain, according to recent research. In some cases, weight gain may indicate that the medication is working, as one symptom of depression is a loss of appetite. Some individuals may not gain weight at all, while others may gain more than expected, notes Dr. Jonathan E. Alpert, chair of the Department of Psychiatry at Montefiore Einstein. If you notice weight changes, talk to your doctor to discuss potential management strategies.
Do antidepressants have an immediate effect?
Antidepressants typically take about four to six weeks to start working, experts say. However, the first medication you try might not be effective. “Many of my patients who’ve had the most success with antidepressants have tried two or three different medications,” says Torres-Macchi. A large study on antidepressant use found that 50% of participants improved with the first or second medication they tried, and nearly 70% were symptom-free by the fourth medication.
Can antidepressants cause suicidal tendencies?
In 2004, the Food and Drug Administration (FDA) required pharmaceutical companies to include a black box warning on antidepressants, indicating a possible association with suicidal thoughts and behaviors in adolescents. This warning was later extended to individuals aged 18 to 24. The decision was based on clinical trials that showed an increased risk of suicidal ideation, though no actual suicides were recorded.
Some experts argue the warning should be reconsidered, as other studies suggest SSRIs are associated with lower suicide rates and a reduced risk of suicidal behavior in young people.
Do antidepressants cause addiction?
Mental health experts do not consider antidepressants addictive. They do not create a strong craving or drive individuals to risk their jobs, relationships, or safety to obtain them, explains Alpert. However, long-term use may lead to withdrawal symptoms when discontinuing, including anxiety, sleep disturbances, mood swings, gastrointestinal issues, and “brain zaps” (a sensation resembling an electric shock to the head). To minimize withdrawal symptoms, consult your doctor before stopping antidepressant use.
Will antidepressants affect your sex life?
Sexual side effects are not guaranteed but are possible, particularly with SSRIs and SNRIs. More than 50% of individuals on these medications report issues such as reduced libido, delayed orgasm, or genital numbness, making sexual dysfunction one of the most common side effects associated with antidepressant use.
Are antidepressants just placebos?
While antidepressants don’t always outperform placebos in clinical trials, this doesn’t mean they’re equivalent. “Overall, studies show that antidepressants improve symptoms of depression, though the benefits are considered modest,” says Sanacora. Antidepressants tend to be more effective for severe depression than for mild cases.
