The Pros and Cons of Antidepressants

The idea of taking medication to treat psychiatric conditions such as depression has garnered quite a bit of controversy in comparison to other areas of medicine. Many people are vocal about whether antidepressants are good or bad on various media platforms and have strong opinions on either side of the debate, but very few are neutral.

Some feel that there are too many side effects or that they don’t work or that others will judge them if they are taking antidepressants. Others fear they will become addicted to them or that they will change their personality.

The choice to take antidepressants or not is indeed a pretty big one. So are antidepressants worth it? Doing your research and having one or more meaningful discussions with your doctor is the best place to start.

Below are some pros and cons of taking antidepressants based on years of clinical research and understanding what patients hope for and worry about when making this personal decision.

Are Antidepressants Worth It?

If you're thinking about taking antidepressants and wondering if they're right for you, you'll want to get an idea of some of the advantages and disadvantages of taking antidepressants. Ultimately, your best bet is to work with your doctor to determine the right treatments and medications for you.

Pros of Antidepressants

Below are some of the common benefits of taking antidepressants.

Motivation to Enact Lifestyle Changes

Many lifestyle changes could help manage depressive symptoms. Things such as exercise, hobbies, and a balanced diet are known to be beneficial in dealing with mental illness.

The catch is that a depressed person cannot always get motivated enough to initiate these lifestyle adjustments. Antidepressants can provide a running start to the implementation of a healthier way of living.

Antidepressants Are Safe

Antidepressants have been proven to be safe. The word safe may feel vague but, for antidepressants, this refers to:

• How safe the drug is in overdose
• The severity of side effects at the therapeutic (prescribed) dose
• Whether the antidepressant has any dangerous interactions with other drugs or substances

There are studies demonstrating that antidepressants can even be safe for certain vulnerable populations such as pregnant women, organ transplant recipients, those with active tumors, and those who've recently had a stroke.

Antidepressants Are Effective

Whenever a drug is tested for efficacy, it is tested against a placebo. A placebo has no active ingredients but might produce an effect because some patients respond to the suggestion of treatment. Any benefits of medication have to surpass that of the “placebo effect” to be declared effective. 

As this class of medication has been in use for over 40 years, there is a plethora of information about how they affect the body. Since the 1980’s, several large-scale studies have compared these medications against placebo and against each other as new ones come on the market. However, very little information is available regarding a hierarchy of efficacy among antidepressants.

The fact that antidepressants are effective is a significant pro. Depression is a terrible condition involving symptoms such as sleep disturbances, hopelessness, difficulty concentrating, lethargy, and suicidal thoughts.

A depressive episode can undermine close relationships, interrupt lives and increase the likelihood of risky behaviors and poor choices. It can severely limit psychosocial functioning and diminish your quality of life.

According to the World Health Organization (WHO), major depression is the third leading cause of disease burden worldwide. They project that the disease will rank first by 2030.

Cons of Antidepressants

When deciding if antidepressants are right for you, it's important to also get an understanding of the possible disadvantages of taking them.

Side Effects

Although antidepressants are safe, they are not free of side effects. A medication can be considered safe even if it has side effects if the side effects are not life threatening and/or go away when the medication is discontinued. This is largely true for antidepressants.

A few of the more common side effects of antidepressants include:

• Fatigue
• Stomach upset
• Decreased libido

Many people don’t have side effects at all or the side effects go away as the body adjusts to the medication. An ongoing open dialogue with your prescriber about your experience is a must, so make sure your concerns are heard from the start.

Some people who have side effects decide that the benefits they are getting from the medication are worth it. So, they are willing to put up with things such as dry mouth, for example, and make sure they have plenty of water on hand, in exchange for living without depression.

Delayed Onset

Antidepressants don’t work right away. Of course, it depends on the medication and the individual, but benefits can start as soon as a few days after taking your first dose.

Most will experience some benefits within two to four weeks. A trial of an antidepressant isn’t considered to technically be a failure unless you have felt no improvements after six weeks on a therapeutic dose.

Some medications will be introduced at a low dose to allow your body to adjust, and then that dose will be slowly titrated upwards. You and your doctor can discuss whether it is realistic to expect benefits before getting to that dosage.

Stigma

We try to avoid being swayed by stigma when making major life decisions. However, one should be honest with themselves regarding the potential for considerable stigma and self-stigma involved with being on antidepressants and how it may affect their behavior. 

Some individuals might feel so much ambivalence about taking medication that they skip doses or won’t disclose their use of antidepressants to other providers who may need a complete health history.

Some Antidepressants May Not Work For You

At times, a medication is either ineffective or doesn’t result in the full desired effect. In this case, you and your doctor can work on a plan which might be a new medication, or in some cases, an additional medication. 

Currently, there is no great way to predict in advance which medication might work for a given individual with just a standard interview. 

However, there appears to be a genetic component to antidepressant response. Some companies offer genetic testing which may be helpful in determining the best choice for you.

Your prescriber may also inquire about other relatives with a depression history and what medications worked for them to help guide her prescribing.

We Don't Really Know Why Antidepressants Work

While it is commonly believed by many people that depression is caused by brain chemistry, researchers and doctors now know this not to be the case. This theory has been on the decline for years, but a 2022 study demonstrated that there is no reason to believe that depression is caused by chemical imbalances in the brain.

Depression is complex and can have multiple causes. Because of this, no single treatment works for everyone.

Taking an antidepressant might improve your symptoms, but it won't necessarily change the underlying factors contributing to your depression. For this reason, combining medication with psychotherapy, lifestyle changes, stress management, and other tactics may provide the best relief.

A Word From Verywell

Making the commitment to take an antidepressant is a major decision. Although there are so many great resources on the internet for independently doing research, make sure to hear your options from a medical professional.

You can get a rundown from your doctor of treatment options that might be right for you without making a commitment, so don’t be afraid of getting informed.