The depressing side of antidepressants

Story by Emiko Essmiller
Co-Design Editor & Staff Photographer

Illustration by Sunny (Sunhye) Choi
Staff Illustrator

Antidepressants are one of the most crucial medications for those within the mental health community, especially in a time period of ever-growing importance for such support and resources. Based on a survey conducted by the Center for Diseases Control, it was shown that about one in 10 Americans, over the age of 11, take some form of antidepressant medication. This number has increased steadily through the years and is predicted to continue to grow worldwide. The prescriptions aim to treat a variety of disorders, including but not limited to depressive disorders, generalized anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). They are most commonly found in the form of selective serotonin reuptake inhibitors (SSRIs), though others include tricyclic antidepressants (TCAs) and selective serotonin noradrenaline reuptake inhibitors (SNRIs). 

Patients on an antidepressant of any kind most often find themselves somewhere on this spectrum, working with a psychiatrist who prescribes them the medication. What is often not talked about, however, are the side effects of such drugs. 

All antidepressants are equipped with a black box warning — the U.S. Food and Drug Administration’s most stringent caution. Antidepressants have been linked to an increased suicide rate because of the way the class of drugs works: targeting the chemical imbalances found in the brain causing the disorder. All antidepressants work to rebalance these messengers — most often serotonin. 

The increased suicidal thoughts or anxiety is all linked to the chemical messengers in which they seek to balance. When the brain goes from a period of stress and imbalance to a state of equilibrium within the chemicals, it does not quite know how to respond. Just as people react in unexpected ways when a large change happens in their life, the nervous system reacts in the same way. As a result, some patients may feel heightened depression and anxiety symptoms when first transitioned onto the medication. 

“Antidepressant therapy typically involves a substantial delay before clinically obvious improvements occur. During initial…recovery, it is possible that suicidal impulses as well as the energy to act on them may increase,” the National Library of Medicine states on their website. “Patients should be forewarned of this likely delay in treatment effects, [and] should be given encouragement and monitored especially closely in the initial days and weeks of treatment. If full response to treatment is not observed, adjustments in medication dosage, or a change to a different antidepressant, may be necessary.” 

There is no functional method of predicting how someone may react to an antidepressant. The spectrum ranges from major hair loss to weight gain or depletion of appetite. The list goes on and is constantly growing every day. The side effects of increased suicidality and anxiety typically lasts about one to six weeks from the start of treatment. In other words, patients who are most vulnerable — most at risk for suicide — have to be thoroughly observed by their psychiatrist or other qualified medical professionals during this period of time.  

This is the reason for the FDA’s black box label. It refers to the serious or possibly detrimental side effects of antidepressants — not the idea that antidepressants cannot be taken, nor that patients should shoulder their mental illness alone. 

There is no alternative for antidepressants. All patients who use them have reached a point in their life where this was the most or only effective solution. Whether they were prescribed by will or not, these medications are what keep some of these patients alive — and certainly are not something to take lightly. They come with unavoidable, sometimes life-altering side effects, but it must be acknowledged that there will never be a cure-all for mental illness. 

If only it were possible to offer help by finding a way to exempt people from the harshest symptoms of antidepressants — or even to assist them in finding small instances of peace in their lives. In an ideal world, they would not have to be subjected to an even greater influx of hardships. The last thing that those struggling to get out of bed in the morning need is an increase in their depression or suicidal thoughts. Hoping for the impossible is both mindless and futile, but it should be desired nonetheless. There is a cost, and the only resources we have to lessen the impact is found in education and support.

The irony of antidepressants should not keep people away from them, nor should communities stop providing as many mental health resources as possible to people of all ages. It is crucial that we maintain focus on the issue at hand and offer support to those that need it. Nobody can see what individuals are struggling with behind closed doors and nobody knows when or who may end up dead because of it. This is not a case that should be disregarded. 

If you or a loved one is ever is at risk of suicide or crisis, please call the National Suicide Helpline: 988.

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