What to expect when starting antidepressants for the first time

If you’ve been prescribed antidepressants, you’re not alone. Antidepressants are some of the most commonly prescribed medications in America, and their popularity has only grown since the start of the COVID-19 pandemic. A recent analysis found that 11% of commercially insured Americans received at least one prescription for antidepressants in 2020 — and nearly a third of those patients had no history of antidepressants six months prior.

“Mental health has become a huge topic nowadays,” said Ali Stith, a registered pharmacist with Express Scripts^® Pharmacy. “People have felt more isolated than ever and there’s been so much fear related to illness, not just for adults but kids too.”

As with many maintenance medications, taking antidepressants comes with a bit of a learning curve. Stith shared some helpful information about what you can expect when starting antidepressants for the first time.

What are antidepressants?

Antidepressants are medications prescribed to treat depression as well as other mood disorders like anxiety, obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder (PTSD). They work by increasing the levels of feel-good chemicals serotonin and noradrenaline in the brain.

“Medication has become a preferred way to manage anxiety and depression,” said Stith. “Along with therapy and healthy lifestyle habits like exercise, sleep, and nutrition, medication can have a huge impact.”

Types of antidepressants

There are many different classes of antidepressants that all work in slightly different ways.

• Selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed antidepressant medication because they have fewer side effects than other classes of antidepressants. They are commonly used to treat moderate to severe depression.
• Some patients respond better to serotonin and norepinephrine reuptake inhibitors (SNRIs). Similar to SSRIs, these medications have few side effects. SNRIs are commonly used to treat depression and other mood disorders, as well as attention deficit hyperactivity disorder (ADHD) and some pain disorders.
• Tricyclic antidepressants (TCAs) are an older type of antidepressant often recommended to treat OCD and bipolar disorder. TCAs come with more side effects than SSRIs and SNRIs and have a higher risk of overdose even at a relatively low dosage.
• Monoamine oxidase inhibitors (MAOIs) and serotonin antagonist and reuptake inhibitors (SARIs) aren’t commonly prescribed anymore because they have more side effects, but may still be an option when other medications aren’t a good fit.

It’s important to work with your doctor and pharmacist to figure out what medication is right for you.

Understanding the side effects

Your doctor will likely start you off on a low dose of medication to help reduce the risk of side effects. Different classes of medications have different side effects, but newer medications like SSRIs and SNRIs have the fewest. It’s important to note that side effects are usually the strongest the first few weeks you start a medication.

Here are the most common side effects some patients may experience:

• Nausea
• Dizziness
• Insomnia
• Restlessness
• Sweating
• Upset stomach
• Headaches
• Weight gain
• Sexual problems
• Loss of appetite
• Agitation

Anxiety can also be a common side effect when starting these medications.

“Antidepressants can boost your mood and energy,” explained Stith. “Your mind and your body may not know what to do with that energy right away.”

However, this is temporary and should improve over time.

Call your doctor or pharmacist right away if you experience new or worsening symptoms, have thoughts of suicide, are experiencing panic attacks or mania, acting aggressively, or acting on dangerous impulses. If it’s an emergency, always call 911.

Results take time

Stith emphasized that antidepressants aren’t like other medications where you see results right away.

“There’s a transition period,” said Stith. “You’re not going to take medication and then immediately feel better.”

Some people see improvement in a few weeks while others may take a few months. It can also take time for your doctor or specialist to find the medication and dose that works best for you.

“There’s no magic pill,” Stith said. “Sometimes you have to increase the dose or try another medication.”

She said the key to finding a successful medication is starting and staying on your medication for the length prescribed. Stopping abruptly because you feel better or because your medication doesn’t seem to be helping can cause withdrawal symptoms. Your doctor can help slowly wean you off the medication before stopping or starting a new one.

Antidepressants and medication interactions

Before starting antidepressants, tell your doctor or pharmacist about any medications you’re taking, including over-the-counter medications, vitamins, and supplements. Some anticoagulants and pain medications like Advil^® and Tylenol^® may increase your risk of bleeding.

Stith also recommends avoiding alcohol. It can make depression worse and increase side effects of your medication like drowsiness, coordination issues, and dizziness. Learn more about common medication interactions.

Helping you on the road to better mental health

At Express Scripts^® Pharmacy, our pharmacists are available 24/7 to go over all the details of your new medication and answer any questions you have.

“It’s becoming a lot more acceptable to talk about mental health,” said Stith. “The stigma is being reduced.”

Our pharmacists also know how important it is to stay up to date on your medication. That’s why we notify you when you’re due for a refill or renewal and will even reach out to your doctor on your behalf.

Learn more about how Express Scripts^® Pharmacy is making pharmacy simpler and better.