Explainer Link Copied 02.29.24

Do You Need Meds for Major Depressive Disorder?

Also, why are there SO MANY kinds? ByAmy Marturana Winderl

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Living with major depressive disorder (MDD) can be rough. Also referred to as clinical depression, MDD can make you feel consistently bummed out and uninterested or unexcited about things that normally bring you joy. That can also come with a side of guilt or worthlessness, low energy, fatigue, and a struggle to concentrate or sleep. Sometimes, MDD can lead to suicidal thoughts too.

That’s why, for lots of people, major depressive disorder medication can be a life-changing (and life-saving) tool to manage those symptoms. Of course, medication isn’t the only way to treat MDD. Therapy, like cognitive behavioral therapy (CBT), can help shift your thought patterns, behaviors, and ultimately your mood. But depending on how severe your depression is, therapy may not make enough of a difference on its own, says Sagar Parikh, MD, professor of psychiatry at the University of Michigan and associate director of the University of Michigan Depression Center.

Sometimes it’s too hard to even make it to a therapist’s office when you’re depressed, Dr. Parikh says. If that’s the case, or you’re just looking for faster relief, medication can be very helpful. “[Medication for major depressive disorder] makes it easier to do things, whether that’s attending psychotherapy or simply getting out of bed,” he explains.

Love that for us, but you should know that there are approximately one zillion different meds that can help with MDD, and various kinds work in different ways. Yep, that’s overwhelming, but your doctor can help you figure out where to begin. In the meantime, if you’re curious about what’s out there, we’re breaking down the basics of major depressive disorder medication. Shall we?

Does everyone with major depressive disorder need medication?

Nope! Mental health meds are just one tool in your larger treatment arsenal for depression. Dr. Parikh says that for her average patient with MDD, there’s about a 50/50 chance that they’ll do better with an antidepressant. While some docs might suggest a prescription right away, others could recommend starting with lifestyle changes like therapy, exercise, and more time outside. If those basics aren’t doing much, then medication could make sense. 

Usually, some combo of medication, therapy, and complementary treatments like yoga or acupuncture work well, says psychiatrist Elspeth Ritchie, MD, chair of psychiatry at MedStar Washington Hospital Center. But, just like any mental health condition, what’s good for one person doesn’t always work for another. 

If you’ve been down the therapy and medication route and still aren’t feeling better, talk with your care team about other options for people who are resistant to depression medication and need more help, per the National Institutes of Health.

What types of medications for major depressive disorder are out there? 

As we said, when it comes to MDD meds, you’ve got lots of options. It’s kind of impossible to know which type or specific brand will be your perfect match, so doctors typically start with an SSRI, one of the more common medications that are usually effective with relatively few side effects, Dr. Parikh says. After a few weeks, they’ll check in to see if you’re noticing any relief or rough side effects, at which point they can adjust the dosage or consider a different medication entirely.

According to the NIH and U.S. Food and Drug Administration (FDA), the main types of medication for MDD are:

• SSRIs: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used antidepressants and usually the first thing your doctor will try. Examples include fluoxetine, sertraline, citalopram, escitalopram, and paroxetine. 
• SNRIs: Serotonin-norepinephrine reuptake inhibitors (SNRIs) are often prescribed to people who have depression and pain disorders happening at the same time. Examples include duloxetine, venlafaxine, levomilnacipran, and desvenlafaxine.
• Tricyclic Antidepressants: These medications tend to have more side effects than SSRIs and SNRIs, so they’re typically only used if you don’t respond to the other drugs first, according to the Mayo Clinic. Examples include amitriptyline, desipramine, amoxapine, doxepin, and nortriptyline. 
• MAOIs: Monoamine oxidase inhibitors (MAOIs) are not prescribed very often because they require a special diet (as weird as that sounds) to avoid dangerous side effects. But they’re an option for people who haven’t had success with other depression meds. Some research also suggests that people with atypical depression may benefit from MAOIs. Examples include isocarboxazid, phenelzine, and tranylcypromine.
• Atypical Antidepressants: This category is sort of a catch-all for depression medications that don’t exactly fit into those other categories, but can be effective either alone or in addition to another medication. Examples include bupropion, mirtazapine, nefazodone, trazodone, and vortioxetine.
• Mood Stabilizers and Antipsychotics: Sometimes other mental health medications, like antipsychotics, can help improve mood and sort of bolster the effects of antidepressants, Dr. Parikh explains. Examples include aripiprazole, quetiapine, and risperidone.

How do medications for major depressive disorder work?

In general, most MDD medications work by increasing the amount of certain chemical messengers in the brain (neurotransmitters) that regulate our brain function and moods. Serotonin, norepinephrine, and dopamine are the biggies usually implicated in depression.

Still, it’s not clear exactly how this improves MDD symptoms. “We know a lot, but we don't know everything about how they work,” Dr. Ritchie says. For example, SSRIs increase how much of the feel-good chemical (serotonin) stays hanging out in your brain, but why that changes your mood is still a bit of a mystery, Dr. Ritchie explains. 

Still, researchers know that these and other medications affect brain chemicals in a way that helps relieve MDD symptoms. That’s the most important part, right?

What can you expect if you start taking medication for major depressive disorder?

MDD medications can take a little time to start working. “I usually give someone two to three weeks so they won't get discouraged,” Dr. Ritchie says. Once they kick in, MDD medications can help relieve most symptoms of depression, including things like fatigue and not being able to concentrate, Dr. Parikh says. Those little things can be a massive help when it’s a struggle to just get out of bed and brush your teeth in the morning. You might even feel energized and motivated enough to start making more changes that can help you feel better.

Of course, most medications have side effects too, and MDD meds are no exception. In general, SSRIs and SNRIs have the most mild ones, while tricyclic antidepressants and MAOIs have more persistent or potentially severe ones. That’s why the latter aren’t prescribed as often. 

Common side effects of MDD medications often include feeling sick to your stomach, sleepiness, a cotton-mouth kind of feeling, sexual issues, sweating, and other random and annoying struggles, per the FDA. 

Do you need to stay on depression meds forever?

Not necessarily. Even if medication is the right choice for you now, it’s cool if that changes too. If you feel well and have had no major depressive episodes for about a year, it may be a good time to start working your way off them, says Dr. Parikh.

Whatever you do, please don’t stop taking them cold turkey, Dr. Parikh warns. “Antidepressants are not addictive,” he says, “but you can get withdrawal effects if you stop them abruptly.” Think: flu-like symptoms, like fatigue, achiness, and headaches. There’s actually a name for it—antidepressant discontinuation syndrome—and, according to research in the Canadian Medical Association Journal, about 20 percent of people on antidepressants experience it. Insomnia, nausea, balance problems, hyperarousal (irritability, agitation, anxiety, the works), and sensory disturbances (like something called a brain zap which, yes, feels like an electric shock in your noggin) can also happen.

So, yeah, you definitely don’t want to just wake up one day and stop taking your MDD meds. Instead, your doctor can help you taper off the dosage over time (usually a couple of months) until you reach nada. “The most important thing about tapering is that you should have also done something else to improve your life,” Dr. Parikh says. Things like starting psychotherapy can teach you important coping strategies and habits that get you through mood changes sans medication.

But if you’re happy and living your best life on your meds and don’t want to rock the boat, you probably don’t need to. Dr. Ritchie says that, in general, it’s good to reassess after about a year and make sure you’re happy with your treatment. If you’re doing well and aren’t having side effects, you can keep doing you. "In general, the long-term effects of the newer classes of antidepressants are low and mild and not dangerous,” explains Dr. Ritchie. “However, you should always talk to your doctor about what those side effects might be or [how they’re impacting you].” If anything feels off, you can always adjust the medication or the dosage, she adds. 

The bottom line: Medication isn’t the right fit for everyone with MDD, but for many people, it can make a huge difference in depression symptoms—especially when paired with therapy. If you’re not sure what to do about your depression symptoms, check in with a mental health or primary care provider to see what your options are.